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CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA)
2026ACTUAL EXAM LATEST COMPLETE QUESTIONS A
ND CORRECT ANSWERS (100% CORRECT ANSWERS)
ALREADY GRADED A+
Which of the following is a service provided by a wellmanaged third-
party administrator (TPA)? - CORRECT
ANSWER >>>>-Administrative
-Utilization review (UR)
-Claims processing
What is tiering? - CORRECT ANSWER >>>>The ranking
or classifying of one or more of the provider delivery
system components
Which option is a practice used to control costs of managed care? -
CORRECT ANSWER >>>>-Making advance payment to providers for all
services needed to care for a member
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-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment
for each service.
Which option is a risk involved in per diem payments? - CORRECT
ANSWER >>>>-The risk to the insurance company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
Diagnosis-related group (DRG) is: - CORRECT ANSWER
>>>>A payment category
How is the term carve-out used when discussing
managed care? - CORRECT ANSWER >>>>To refer to
specific benefits or services
What is the term Coordination of Benefits (COB)? - CORRECT ANSWER
>>>>A term used to describe how payment is coordinated for patients
who have
coverage through two insurance policies
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Which three components are used to determine the total RVU value for
a service? - CORRECT ANSWER
>>>>-Malpractice expense
-Lowest market price for services used
-Medicare discounts
A fixed payment amount based upon the number of members assigned
to a provider, and does not vary based upon the number of services
rendered, is
known as: - CORRECT ANSWER >>>>Capitation
What is the overall function of Medicaid? - CORRECT ANSWER >>>>The
pay for medical assistance for certain individuals and low-income
families
Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is defined as: -
CORRECT ANSWER >>>>Total Medical
Expenses divided by Total Premiums
Provider service organizations (PSOs) function like health maintenance
organizations (HMOs) in all of the following ways, EXCEPT: - CORRECT
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ANSWER >>>>Ties to the healthcare delivery industry rather than the
insurance industry
Provider service organizations (PSOs) function like health maintenance
organizations (HMOs) in all of the following ways: - CORRECT ANSWER
>>>>-Risk pooling
-Capitalization
-Network management
Aligning incentives has come to mean _________. - CORRECT ANSWER
>>>>The appropriate addition of some risk in the exchange of health
care to a patient for some form of remuneration.
According to MedPAC, which option is a benefit or undesirable
consequence of bundling payments? - CORRECT ANSWER >>>>-It
allows
Medicare to pay a set fee per hospitalization episode. -It would provide
the potential to improve efficiency and quality
-It would lead to underutilization of services
CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA)
2026ACTUAL EXAM LATEST COMPLETE QUESTIONS A
ND CORRECT ANSWERS (100% CORRECT ANSWERS)
ALREADY GRADED A+
Which of the following is a service provided by a wellmanaged third-
party administrator (TPA)? - CORRECT
ANSWER >>>>-Administrative
-Utilization review (UR)
-Claims processing
What is tiering? - CORRECT ANSWER >>>>The ranking
or classifying of one or more of the provider delivery
system components
Which option is a practice used to control costs of managed care? -
CORRECT ANSWER >>>>-Making advance payment to providers for all
services needed to care for a member
,2 | Page
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment
for each service.
Which option is a risk involved in per diem payments? - CORRECT
ANSWER >>>>-The risk to the insurance company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
Diagnosis-related group (DRG) is: - CORRECT ANSWER
>>>>A payment category
How is the term carve-out used when discussing
managed care? - CORRECT ANSWER >>>>To refer to
specific benefits or services
What is the term Coordination of Benefits (COB)? - CORRECT ANSWER
>>>>A term used to describe how payment is coordinated for patients
who have
coverage through two insurance policies
,3 | Page
Which three components are used to determine the total RVU value for
a service? - CORRECT ANSWER
>>>>-Malpractice expense
-Lowest market price for services used
-Medicare discounts
A fixed payment amount based upon the number of members assigned
to a provider, and does not vary based upon the number of services
rendered, is
known as: - CORRECT ANSWER >>>>Capitation
What is the overall function of Medicaid? - CORRECT ANSWER >>>>The
pay for medical assistance for certain individuals and low-income
families
Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is defined as: -
CORRECT ANSWER >>>>Total Medical
Expenses divided by Total Premiums
Provider service organizations (PSOs) function like health maintenance
organizations (HMOs) in all of the following ways, EXCEPT: - CORRECT
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ANSWER >>>>Ties to the healthcare delivery industry rather than the
insurance industry
Provider service organizations (PSOs) function like health maintenance
organizations (HMOs) in all of the following ways: - CORRECT ANSWER
>>>>-Risk pooling
-Capitalization
-Network management
Aligning incentives has come to mean _________. - CORRECT ANSWER
>>>>The appropriate addition of some risk in the exchange of health
care to a patient for some form of remuneration.
According to MedPAC, which option is a benefit or undesirable
consequence of bundling payments? - CORRECT ANSWER >>>>-It
allows
Medicare to pay a set fee per hospitalization episode. -It would provide
the potential to improve efficiency and quality
-It would lead to underutilization of services
