HFMA CSPR Exam Questions with
Complete Solutions27
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 Act - ANSWERS-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 insurance -
ANSWERS-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 System - ANSWERS-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) Chronic - ANSWERS-A) Life threatening
STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
C) Services provided by hospitals
D) Services provided by physicians - ANSWERS-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 claim - ANSWERS-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 choice - ANSWERS-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 code - ANSWERS-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
B) COBRA coverage begins on the date that healthcare coverage would otherwise have been
lost because of a qualifying event
Complete Solutions27
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 Act - ANSWERS-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 insurance -
ANSWERS-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 System - ANSWERS-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) Chronic - ANSWERS-A) Life threatening
STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
C) Services provided by hospitals
D) Services provided by physicians - ANSWERS-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 claim - ANSWERS-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 choice - ANSWERS-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 code - ANSWERS-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
B) COBRA coverage begins on the date that healthcare coverage would otherwise have been
lost because of a qualifying event
