HFMA CSPR | TOP SCORES MADE SIMPLE | TRUSTED
TEST SOLUTIONS!
QUALITY CONTENT YOU CAN RELY ON!
The No Surprise Act was a product of:
A) The Health Insurance Portability Act
B) The Consolidation Appropriations Act
C) The Treaty of Algeron
D) The Affordable Care ActAnswer:D) The Affordable Care Act
Which of the following is an advantage of direct contracting?
A) Providers do not have to adjudicate claims for payment
B) Employers can save the cost of working with an insurance company
C) It allows the patients to have a choice of providers and physicians
D) Providers can work directly with employers to reduce the cost of providing
insuranceAnswer:D) Providers can work directly with employers to reduce the cost of
providing insurance
Accountable Care Organizations (ACOs) have all of the following characteristics EXCEPT:
A) Patient centric care model
B) Financial incentive for quantity of care
C) Integrated care coordination
D) Electronic Medical Record SystemAnswer:B) Financial incentive for quantity of care
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient may be
transferred from one hospital to another when in a(n) condition:
A) Life threatening
B) Non-emergency
C) Stable
D) ChronicAnswer:A) Life threatening
STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
1
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,C) Services provided by hospitals
D) Services provided by physiciansAnswer:B) Medicare Advantage health plan
performance
To evaluate an organization's compliance with the CMS COP standards and other
accreditation requirements, is the purpose of:
A) A comprehensive accreditation process
B) Recovery Audits
C) The American Osteopathic Association
D) A clean claimAnswer:A) A comprehensive accreditation process
What is tiering?
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per episode
of care
B) Healthcare coverage products featuring narrow networks, high cost sharing and very low
premiums
C) An effort by insurers to increase premiums and to address calls from employers and the
public for improved quality
D) The ranking or classifying of one or more of the provider delivery system components to
influence choiceAnswer:D) The ranking or classifying of one or more of the provider
delivery system components to influence choice
Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
B) Family medical history
C) Type of service
D) Procedure codeAnswer:B) Family medical history
Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation
ACT (COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48
months for qualifying events
2
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, B) COBRA coverage begins on the date that healthcare coverage would otherwise have
been lost because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying
events to be eligible for benefits
D) Group health coverage for COBRA participants is usually more expensive than health
coverage for active employeeAnswer:A) COBRA beneficiaries generally are eligible for
group coverage during a maximum of 48 months for qualifying events
Which of the following is a managed care trend that can reduce utilization and costs
because patients pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
D) Growth in participation in Medicare managed care plansAnswer:B) Growth in high-
deductible health plans with a Health Savings (HSA) option
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed paymentAnswer:C) Notifies member of non-covered
service
The appropriate addition of some risk in the exchange of health care to a patient for some
form of remuneration, is also known as:
A) Diagnosis-related groups (DRG's)
B) Per diems
C) Fee-for-Service reimbursement
D) Aligning incentivesAnswer:B) Per diems
The federal government pays a share of the medical assistance expenditures under each
state's Medicaid program. How is that share, known as the federal medical assistance
percentage (FMAP), determined?
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
TEST SOLUTIONS!
QUALITY CONTENT YOU CAN RELY ON!
The No Surprise Act was a product of:
A) The Health Insurance Portability Act
B) The Consolidation Appropriations Act
C) The Treaty of Algeron
D) The Affordable Care ActAnswer:D) The Affordable Care Act
Which of the following is an advantage of direct contracting?
A) Providers do not have to adjudicate claims for payment
B) Employers can save the cost of working with an insurance company
C) It allows the patients to have a choice of providers and physicians
D) Providers can work directly with employers to reduce the cost of providing
insuranceAnswer:D) Providers can work directly with employers to reduce the cost of
providing insurance
Accountable Care Organizations (ACOs) have all of the following characteristics EXCEPT:
A) Patient centric care model
B) Financial incentive for quantity of care
C) Integrated care coordination
D) Electronic Medical Record SystemAnswer:B) Financial incentive for quantity of care
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient may be
transferred from one hospital to another when in a(n) condition:
A) Life threatening
B) Non-emergency
C) Stable
D) ChronicAnswer:A) Life threatening
STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
,C) Services provided by hospitals
D) Services provided by physiciansAnswer:B) Medicare Advantage health plan
performance
To evaluate an organization's compliance with the CMS COP standards and other
accreditation requirements, is the purpose of:
A) A comprehensive accreditation process
B) Recovery Audits
C) The American Osteopathic Association
D) A clean claimAnswer:A) A comprehensive accreditation process
What is tiering?
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per episode
of care
B) Healthcare coverage products featuring narrow networks, high cost sharing and very low
premiums
C) An effort by insurers to increase premiums and to address calls from employers and the
public for improved quality
D) The ranking or classifying of one or more of the provider delivery system components to
influence choiceAnswer:D) The ranking or classifying of one or more of the provider
delivery system components to influence choice
Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
B) Family medical history
C) Type of service
D) Procedure codeAnswer:B) Family medical history
Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation
ACT (COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48
months for qualifying events
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
, B) COBRA coverage begins on the date that healthcare coverage would otherwise have
been lost because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying
events to be eligible for benefits
D) Group health coverage for COBRA participants is usually more expensive than health
coverage for active employeeAnswer:A) COBRA beneficiaries generally are eligible for
group coverage during a maximum of 48 months for qualifying events
Which of the following is a managed care trend that can reduce utilization and costs
because patients pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
D) Growth in participation in Medicare managed care plansAnswer:B) Growth in high-
deductible health plans with a Health Savings (HSA) option
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed paymentAnswer:C) Notifies member of non-covered
service
The appropriate addition of some risk in the exchange of health care to a patient for some
form of remuneration, is also known as:
A) Diagnosis-related groups (DRG's)
B) Per diems
C) Fee-for-Service reimbursement
D) Aligning incentivesAnswer:B) Per diems
The federal government pays a share of the medical assistance expenditures under each
state's Medicaid program. How is that share, known as the federal medical assistance
percentage (FMAP), determined?
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
