CSPR CERTIFIED SPECIALIST PAYMENT REP
EXAM SCRIPT 2026 COMPLETE ANSWERS
VERIFIED
◉ As the healthcare industry moves to control growth in medical
spending, what initiative can help hospitals maintain their margins.
Answer: Contract standardization
◉ As the healthcare industry moves to control growth in medical
spending, what initiative can NOT help hospitals maintain their
margins. Answer: -Pay-for-performance programs
-Health savings accounts
-Price transparency
◉ Identify which initiatives are focused on in an effort to help
increase an organization's revenue/profit /margins.. Answer: -
Health plan consolidation
-Payment policing and standardization of contract requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
◉ What are rating tiers?. Answer: Different rates charged on the
basis of the number and relationships
,◉ What is the role of reinsurance?. Answer: Reinsurance seeks to
limit a policyholder's liability for catastrophic claims
◉ Which option is a major trend in case management?. Answer: -
Shift from broad-based toward more focused efforts
-Reduction of administrative costs
-Greater physician involvement
◉ What type of provider authorization is applied in emergency
cases, where prior authorization is impossible?. Answer: Concurrent
◉ What is utilization management (UM)?. Answer: A tool to control
the costs of providing healthcare services to enrollees
◉ Which of the following statements is true about disease
management (DM)?. Answer: DM programs encourage patients to
assume some control over their disease state
◉ What is the function of catastrophic case management (CM)?.
Answer: It is used to manage diseases in patients with very high
costs of care.
,◉ What is demand management?. Answer: A coordinated effort by
the MCO, employers, and providers to control the utilization of
medical services and resources
◉ All of the following are effective contract evaluation criteria,
EXCEPT:. Answer: Detailed contract performance assessments
◉ All of the following are effective contract evaluation criteria:.
Answer: -General payer or provider criteria
-Reimbursement levels and parameters
-Provider costs and responsibilities
◉ The following are tools for optimizing contract performance,
EXCEPT:. Answer: Contract language
◉ The following are tools for optimizing contract performance:.
Answer: -Financial and volume analysis models.
-Managed care contract dashboard.
-Detailed contract performance assessments.
◉ Which option is considered a key difference between inpatient
and outpatient contracting?. Answer: -Reimbursement methodology
differences
-Operational policies and procedures
, -Market differences affecting outpatient and inpatient volumes
◉ All of the following should be analyzed prior to and/or during
contract negotiations, EXCEPT:. Answer: Historical member
premiums
◉ All of the following should be analyzed prior to and/or during
contract negotiations:. Answer: -Member volumes by product type
-Historical reimbursement levels by product type
-Historical claims payment and/or submission problems
◉ What is a clean claim?. Answer: A properly completed billing form
◉ Which data is included in a termination provision in standard
contracting?. Answer: -What is cause?
-What is termination Without Cause?
-Notice of termination
◉ What is direct contracting?. Answer: A single-employer or multi-
employer healthcare alliances that contract directly with providers
for healthcare services
EXAM SCRIPT 2026 COMPLETE ANSWERS
VERIFIED
◉ As the healthcare industry moves to control growth in medical
spending, what initiative can help hospitals maintain their margins.
Answer: Contract standardization
◉ As the healthcare industry moves to control growth in medical
spending, what initiative can NOT help hospitals maintain their
margins. Answer: -Pay-for-performance programs
-Health savings accounts
-Price transparency
◉ Identify which initiatives are focused on in an effort to help
increase an organization's revenue/profit /margins.. Answer: -
Health plan consolidation
-Payment policing and standardization of contract requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
◉ What are rating tiers?. Answer: Different rates charged on the
basis of the number and relationships
,◉ What is the role of reinsurance?. Answer: Reinsurance seeks to
limit a policyholder's liability for catastrophic claims
◉ Which option is a major trend in case management?. Answer: -
Shift from broad-based toward more focused efforts
-Reduction of administrative costs
-Greater physician involvement
◉ What type of provider authorization is applied in emergency
cases, where prior authorization is impossible?. Answer: Concurrent
◉ What is utilization management (UM)?. Answer: A tool to control
the costs of providing healthcare services to enrollees
◉ Which of the following statements is true about disease
management (DM)?. Answer: DM programs encourage patients to
assume some control over their disease state
◉ What is the function of catastrophic case management (CM)?.
Answer: It is used to manage diseases in patients with very high
costs of care.
,◉ What is demand management?. Answer: A coordinated effort by
the MCO, employers, and providers to control the utilization of
medical services and resources
◉ All of the following are effective contract evaluation criteria,
EXCEPT:. Answer: Detailed contract performance assessments
◉ All of the following are effective contract evaluation criteria:.
Answer: -General payer or provider criteria
-Reimbursement levels and parameters
-Provider costs and responsibilities
◉ The following are tools for optimizing contract performance,
EXCEPT:. Answer: Contract language
◉ The following are tools for optimizing contract performance:.
Answer: -Financial and volume analysis models.
-Managed care contract dashboard.
-Detailed contract performance assessments.
◉ Which option is considered a key difference between inpatient
and outpatient contracting?. Answer: -Reimbursement methodology
differences
-Operational policies and procedures
, -Market differences affecting outpatient and inpatient volumes
◉ All of the following should be analyzed prior to and/or during
contract negotiations, EXCEPT:. Answer: Historical member
premiums
◉ All of the following should be analyzed prior to and/or during
contract negotiations:. Answer: -Member volumes by product type
-Historical reimbursement levels by product type
-Historical claims payment and/or submission problems
◉ What is a clean claim?. Answer: A properly completed billing form
◉ Which data is included in a termination provision in standard
contracting?. Answer: -What is cause?
-What is termination Without Cause?
-Notice of termination
◉ What is direct contracting?. Answer: A single-employer or multi-
employer healthcare alliances that contract directly with providers
for healthcare services
