CSPR - Certified Specialist Payment Rep
(HFMA) EXAM || MOST RECENT EXAM 2026-
2027 ACTUAL COMPLETE REAL EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+
| GUARANTEED SUCCESS!! NEWEST EXAM |
JUST RELEASED!!
Identify the various types of private health plan coverage. -
ANSWER --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
Identify the various types of government‐sponsored health
coverage. - ANSWER --Medicare - Government; Beneficiaries
enrolled in such plans, but, participation in these plans is
voluntary.
-Medicaid
-Medicaid Managed Care - Medicaid beneficiaries are required
to select and enroll in a managed care plan.
,-Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Identify some key drivers of increasing healthcare costs -
ANSWER -Demographics
-Chronic Conditions
-Provider payment systems - Provider payment systems that
are designed to reward volume rather than quality, outcomes,
and prevention -Consumer
Perceptions
-Health Plan pressure
-Physician Relationships
-Supply Chain
Medicare - ANSWER --Part A - provides inpatient/hospital,
hospice, and skilled
nursing
coverage
-Part B - provides outpatient/medical
coverage
-Part C - an alternative way to receive your Medicare
benefits (known as
Medicare
Advantage)
-Part D - prescription drug
coverage
Which of the following statements regarding employer-based
health insurance in the United States is true? - ANSWER -The
real advent of employer-based insurance came through Blue
,Cross, which was started by hospital associations during the
Depression.
The Health Maintenance Organization (HMO) Act of 1973 gave
qualified HMOs the right to "mandate" an employer under
certain conditions, meaning employers: - ANSWER -Would
have to offer HMO plans along side traditional fee-for-service
medical plans.
Which of the following is an anticipated change in the
relationships between consumers and providers? - ANSWER -
Providers will face many new service demands and consumers
will have virtually unfettered access to those services
What transition began as a result of the March 2010 healthcare
reform legislation? - ANSWER -A transition toward new models
of health care delivery with corresponding changes system
financing and provider reimbursement.
Which statement is false concerning ABNs? - ANSWER -ABN
began establishing new requirements for managed care plans
participating in the Medicare program.
Which Statement is TRUE concerning ABNs? - ANSWER --
ABNs are not required for services that are never covered by
Medicare.
-An ABN form notifies the patient before he or she receives
the service that it may not be covered by Medicare and that
he or she will need to pay out of pocket.
, -Although ABNs can have significant financial implications
for the physician,
they
also
serve an important fraud and abuse
compliance function.
What is the overall function of Medicaid? - ANSWER -The
pay for medical
assistance for certain individuals and low-
income families
Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is
defined as: -
ANSWER -Total Medical Expenses divided by
Total Premiums
Provider service organizations (PSOs) function like health
maintenance organizations (HMOs) in all of the following ways,
EXCEPT: - ANSWER -Ties to the healthcare delivery industry
rather than the insurance industry
Provider service organizations (PSOs) function like health
maintenance organizations (HMOs) in all of the following ways:
- ANSWER --Risk pooling -Capitalization
-Network management
Which of the following is a service provided by a well-
managed third-party
(HFMA) EXAM || MOST RECENT EXAM 2026-
2027 ACTUAL COMPLETE REAL EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+
| GUARANTEED SUCCESS!! NEWEST EXAM |
JUST RELEASED!!
Identify the various types of private health plan coverage. -
ANSWER --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
Identify the various types of government‐sponsored health
coverage. - ANSWER --Medicare - Government; Beneficiaries
enrolled in such plans, but, participation in these plans is
voluntary.
-Medicaid
-Medicaid Managed Care - Medicaid beneficiaries are required
to select and enroll in a managed care plan.
,-Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Identify some key drivers of increasing healthcare costs -
ANSWER -Demographics
-Chronic Conditions
-Provider payment systems - Provider payment systems that
are designed to reward volume rather than quality, outcomes,
and prevention -Consumer
Perceptions
-Health Plan pressure
-Physician Relationships
-Supply Chain
Medicare - ANSWER --Part A - provides inpatient/hospital,
hospice, and skilled
nursing
coverage
-Part B - provides outpatient/medical
coverage
-Part C - an alternative way to receive your Medicare
benefits (known as
Medicare
Advantage)
-Part D - prescription drug
coverage
Which of the following statements regarding employer-based
health insurance in the United States is true? - ANSWER -The
real advent of employer-based insurance came through Blue
,Cross, which was started by hospital associations during the
Depression.
The Health Maintenance Organization (HMO) Act of 1973 gave
qualified HMOs the right to "mandate" an employer under
certain conditions, meaning employers: - ANSWER -Would
have to offer HMO plans along side traditional fee-for-service
medical plans.
Which of the following is an anticipated change in the
relationships between consumers and providers? - ANSWER -
Providers will face many new service demands and consumers
will have virtually unfettered access to those services
What transition began as a result of the March 2010 healthcare
reform legislation? - ANSWER -A transition toward new models
of health care delivery with corresponding changes system
financing and provider reimbursement.
Which statement is false concerning ABNs? - ANSWER -ABN
began establishing new requirements for managed care plans
participating in the Medicare program.
Which Statement is TRUE concerning ABNs? - ANSWER --
ABNs are not required for services that are never covered by
Medicare.
-An ABN form notifies the patient before he or she receives
the service that it may not be covered by Medicare and that
he or she will need to pay out of pocket.
, -Although ABNs can have significant financial implications
for the physician,
they
also
serve an important fraud and abuse
compliance function.
What is the overall function of Medicaid? - ANSWER -The
pay for medical
assistance for certain individuals and low-
income families
Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is
defined as: -
ANSWER -Total Medical Expenses divided by
Total Premiums
Provider service organizations (PSOs) function like health
maintenance organizations (HMOs) in all of the following ways,
EXCEPT: - ANSWER -Ties to the healthcare delivery industry
rather than the insurance industry
Provider service organizations (PSOs) function like health
maintenance organizations (HMOs) in all of the following ways:
- ANSWER --Risk pooling -Capitalization
-Network management
Which of the following is a service provided by a well-
managed third-party
