CSPR Certified Specialist Payment Rep
HFMA
Steps used to control costs of managed care include: - answersBundled codes
Capitation
Payer and Provider to agree on reasonable payment
All of the above
DRG is used to classify - answersInpatient 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 - answersHMO
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: - answersHealth
Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
All of the above
HFMA
Steps used to control costs of managed care include: - answersBundled codes
Capitation
Payer and Provider to agree on reasonable payment
All of the above
DRG is used to classify - answersInpatient 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 - answersHMO
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: - answersHealth
Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
All of the above
