CSPR - Certified Specialist Payment
Rep (HFMA) Exam Questions &
Answers3
Steps used to control costs of managed care include: - ANSWERS-Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
All of the above
DRG is used to classify - ANSWERS-Inpatient admissions for the purpose of reimbursing
hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual
costs incurred
Identify the various types of private health plan coverage - ANSWERS-HMO
Conventional
PPO and POS
HDHP/SO plans - high-deductible health plans with a savings option; Private - Include higher
patient out-of-pocket expenditures for treatments that can serve to reduce utilization/costs.
All of the above
Managed care organizations (MCO) exist primarily in four forms: - ANSWERS-Health
Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
All of the above
Rep (HFMA) Exam Questions &
Answers3
Steps used to control costs of managed care include: - ANSWERS-Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
All of the above
DRG is used to classify - ANSWERS-Inpatient admissions for the purpose of reimbursing
hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual
costs incurred
Identify the various types of private health plan coverage - ANSWERS-HMO
Conventional
PPO and POS
HDHP/SO plans - high-deductible health plans with a savings option; Private - Include higher
patient out-of-pocket expenditures for treatments that can serve to reduce utilization/costs.
All of the above
Managed care organizations (MCO) exist primarily in four forms: - ANSWERS-Health
Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
All of the above
