CSPR CERTIFIED SPECIALIST PAYMENT REP
PRACTICE SET 2026 FULL SOLUTION
◉ Managed care arrangements generally result in providers:
Answer: A. Receiving, on average, a higher level of reimbursement.
**B. Assuming greater financial risk for the level of services
provided.
C. Relaxing their management for the level of services provided.
D. Being fairly and adequately reimbursed for the level of services
provided.
◉ Which option is NOT a general category of provider excess loss
insurance? Answer: A. Per-Person
B. Aggregate
C. Carve-Out
**D. Quality Indicators
◉ Which option is NOT a function of the Centers for Medicare and
Medicaid Services (CMS)? Answer: A. Establishment and
promulgation of clear policy on eligibility for CMS programs,
coverage and reimbursement of healthcare services, standards for
providers and program administration
B. Administration of comprehensive agreements with contractors
and states that stipulate the conditions under which CMS programs
,are carried out, the performance standards that must be met in their
administration, and the programmatic results that are to be achieved
C. Monitoring the performance of contractors and states in
administering CMS programs consistent with program and
performance standards, as well as the direct monitoring of
healthcare providers to make sure that programmatic goals are
achieved
**D. Regulation of federal and state legislation related to life and
safety issues, business compliance, and licensure requirements.
Regulatory Environment and Corporate Compliance
◉ Accrued salaries and payroll Taxes Answer: **Yes
No
◉ What is the second objective of risk management? Answer: A. To
minimize the cost of financing the risk
B. To allow direct access the reinsurance market
NOT - C. To establish regulatory requirements that must be met to
operate an insurance company
D. To minimize the establishment of a segregated cash account, or
trust, from which claims are paid
◉ What is the purpose of an investment policy? Answer: A. To
establish a framework to make investment decisions and evaluate
results
,B. To form a cushion to protect creditors if the operating
environment were to deteriorate
NOT - C. To maximize returns while ensuring that there is cash on
hand for day-to-day operations
D. To define how the organization intends to match the maturity of
the investments with the projected need for the proceeds
◉ What is the purpose of the IRS Form 990? Answer: **A. To provide
information to the IRS and the public regarding the tax-exempt
organization's programs
B. To require recognition of post-employment costs on an accrual
basis
C. To report a more detailed break-down of an individual's
compensation
D. To require numerous disclosures regarding the compensation
arrangements for officers, directors, trustees, and key employees
◉ Which option is false concerning return on investment? Answer:
A. The formula to calculate the return is income plus realized gains
minus realized losses.
**B. The formula to calculate the return is losses plus realized gains
minus realized income.
C. The expected return from an investment is correlated to the risk
profile.
, D. While it is difficult to quantify risk, it is easy to calculate the
return of an investment
◉ Health or social clubs dues or fees Answer: **Yes
No
◉ Under HIPAA and federal regulations, what is the difference
between "fraud" and "abuse"? Answer: A. There is no difference.
B. Abuse requires a knowing and intentional act, while fraud only
requires engaging in a practice that directly leads to unnecessary
costs to the Medicare and other federal programs.
NOT -C. Fraud requires a knowing and intentional act, while abuse
only requires engaging in a practice that directly leads to
unnecessary costs to the Medicare and other federal programs.
D. Fraud requires a knowing and intentional act, while abuse only
requires engaging in a practice that directly or indirectly leads to
unnecessary costs to the Medicare and other federal programs.
◉ Outpatient transitional corridor payment Answer: Yes
**No
◉ Public assistance. Answer: **Yes
No
PRACTICE SET 2026 FULL SOLUTION
◉ Managed care arrangements generally result in providers:
Answer: A. Receiving, on average, a higher level of reimbursement.
**B. Assuming greater financial risk for the level of services
provided.
C. Relaxing their management for the level of services provided.
D. Being fairly and adequately reimbursed for the level of services
provided.
◉ Which option is NOT a general category of provider excess loss
insurance? Answer: A. Per-Person
B. Aggregate
C. Carve-Out
**D. Quality Indicators
◉ Which option is NOT a function of the Centers for Medicare and
Medicaid Services (CMS)? Answer: A. Establishment and
promulgation of clear policy on eligibility for CMS programs,
coverage and reimbursement of healthcare services, standards for
providers and program administration
B. Administration of comprehensive agreements with contractors
and states that stipulate the conditions under which CMS programs
,are carried out, the performance standards that must be met in their
administration, and the programmatic results that are to be achieved
C. Monitoring the performance of contractors and states in
administering CMS programs consistent with program and
performance standards, as well as the direct monitoring of
healthcare providers to make sure that programmatic goals are
achieved
**D. Regulation of federal and state legislation related to life and
safety issues, business compliance, and licensure requirements.
Regulatory Environment and Corporate Compliance
◉ Accrued salaries and payroll Taxes Answer: **Yes
No
◉ What is the second objective of risk management? Answer: A. To
minimize the cost of financing the risk
B. To allow direct access the reinsurance market
NOT - C. To establish regulatory requirements that must be met to
operate an insurance company
D. To minimize the establishment of a segregated cash account, or
trust, from which claims are paid
◉ What is the purpose of an investment policy? Answer: A. To
establish a framework to make investment decisions and evaluate
results
,B. To form a cushion to protect creditors if the operating
environment were to deteriorate
NOT - C. To maximize returns while ensuring that there is cash on
hand for day-to-day operations
D. To define how the organization intends to match the maturity of
the investments with the projected need for the proceeds
◉ What is the purpose of the IRS Form 990? Answer: **A. To provide
information to the IRS and the public regarding the tax-exempt
organization's programs
B. To require recognition of post-employment costs on an accrual
basis
C. To report a more detailed break-down of an individual's
compensation
D. To require numerous disclosures regarding the compensation
arrangements for officers, directors, trustees, and key employees
◉ Which option is false concerning return on investment? Answer:
A. The formula to calculate the return is income plus realized gains
minus realized losses.
**B. The formula to calculate the return is losses plus realized gains
minus realized income.
C. The expected return from an investment is correlated to the risk
profile.
, D. While it is difficult to quantify risk, it is easy to calculate the
return of an investment
◉ Health or social clubs dues or fees Answer: **Yes
No
◉ Under HIPAA and federal regulations, what is the difference
between "fraud" and "abuse"? Answer: A. There is no difference.
B. Abuse requires a knowing and intentional act, while fraud only
requires engaging in a practice that directly leads to unnecessary
costs to the Medicare and other federal programs.
NOT -C. Fraud requires a knowing and intentional act, while abuse
only requires engaging in a practice that directly leads to
unnecessary costs to the Medicare and other federal programs.
D. Fraud requires a knowing and intentional act, while abuse only
requires engaging in a practice that directly or indirectly leads to
unnecessary costs to the Medicare and other federal programs.
◉ Outpatient transitional corridor payment Answer: Yes
**No
◉ Public assistance. Answer: **Yes
No
