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Certified Specialist Payment Rep (CSPR) HFMA 2024 Review

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What is tiering? - Ans: The ranking or classifying of one or more of the provider delivery system components Which option is a practice used to control costs of managed care? - Ans: -Making advance payment to providers for all services needed to care for a member -Combining services provided and bundling the associated charges -Agreement between the payer and provider on reasonable payment for each service. Which option is a risk involved in per diem payments? - Ans: -The risk to the insurance company or health plan -The risk to the hospital -The risk when embracing per diem payments in complex case Diagnosis-related group (DRG) is: - Ans: A payment category How is the term carve-out used when discussing managed care? - Ans: To refer to specific benefits or services What is the term Coordination of Benefits (COB)?

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