Hfma Cspr Actual Exam Newest Update
With Detailed Questions And Correct
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Making advance payment to providers for all services needed to care for a member, in
an effort to control costs is known as:
A) Financial Management
B) Risk Adjustment
C) Capitation
D) Premium - CORRECT ANSWER C) Capitation
Under capitation, which option is NOT an increased risk for the provider:
A) Cost of delivering care
B) Product marketing that could result in adverse selection (or a disproportionate
amount of people who will need care)
C) Cost of retaining quality physicians
D) Accuracy of the actuarial projections used to determine the anticipated use, severity,
and acuity of services to be provided - CORRECT ANSWER D) Accuracy of the
actuarial projections used to determine the anticipated use, severity, and acuity of
services to be provided
Disproportionate/ concentrated expenditures on a relatively small percentage of the
population with chronic condition is a factor:
A) That can clearly be identified as a contributing driver of health cost increases
,B) That contributes to the fundamental change in the relationships between healthcare
organizations and the government
C) That can clearly be identified as a reason for healthcare coverage denials
D) That contributes to the fundamental change in the relationships between consumers
and providers - CORRECT ANSWER A) That can clearly be identified as a contributing
driver of health cost increases
To ensure that MCOs contracting with Medicare and Medicaid protect and improve the
health and satisfaction of enrolled beneficiaries, is the purpose of:
A) The Balance Budget Act of 1997 (BBA)
B) Quality Assurance (QA)
C) Quality Improvement System for Managed Care (QISMC)
D) Medicare Advantage (MA) - CORRECT ANSWER C) Quality Improvement System
for Managed Care (QISMC)
The following are types of Accountable Care Organizations offered by Medicare except:
A) Pioneer ACO Model
B) Medicare Shared Savings Program
C) Advance Payment Model
D) Healthcare Maintenance Organization Model - CORRECT ANSWER D) Healthcare
Maintenance Organization Model
Which option is NOT true concerning URAC:
A) URAC's standards keep pace with the rapid changes in the healthcare system
, B) Established in 1990, it is formerly known as the Utilization Review Accreditation
Commission
C) URAC's standards provide a mark of distinction for healthcare organizations to
demonstrate their commitment to quality and accountability
D) Provides a comprehensive assessment covering physician practice management -
CORRECT ANSWER D) Provides a comprehensive assessment covering physician
practice management
Which option is NOT true concerning the Health Maintenance Organization Act of 1973:
A) It represented a significant change in the way the federal government regulated
health policies
B) It was directed at changing the system of healthcare delivery
C) It is the legislation that governs health benefit plans of self-insured, self-funded
employers in the United States
D) It established financial guidelines for operating an HMO - CORRECT ANSWER C) It
is the legislation that governs health benefit plans of self-insured, self-funded employers
in the United States
Both employees and employers can contribute pretax dollars to a qualified account This
is a benefit of:
A) CDHP
B) NCQA
C) Medicare
D) HSA - CORRECT ANSWER D) HSA
With Detailed Questions And Correct
Answers A+ Graded And Verified By
Experts
Making advance payment to providers for all services needed to care for a member, in
an effort to control costs is known as:
A) Financial Management
B) Risk Adjustment
C) Capitation
D) Premium - CORRECT ANSWER C) Capitation
Under capitation, which option is NOT an increased risk for the provider:
A) Cost of delivering care
B) Product marketing that could result in adverse selection (or a disproportionate
amount of people who will need care)
C) Cost of retaining quality physicians
D) Accuracy of the actuarial projections used to determine the anticipated use, severity,
and acuity of services to be provided - CORRECT ANSWER D) Accuracy of the
actuarial projections used to determine the anticipated use, severity, and acuity of
services to be provided
Disproportionate/ concentrated expenditures on a relatively small percentage of the
population with chronic condition is a factor:
A) That can clearly be identified as a contributing driver of health cost increases
,B) That contributes to the fundamental change in the relationships between healthcare
organizations and the government
C) That can clearly be identified as a reason for healthcare coverage denials
D) That contributes to the fundamental change in the relationships between consumers
and providers - CORRECT ANSWER A) That can clearly be identified as a contributing
driver of health cost increases
To ensure that MCOs contracting with Medicare and Medicaid protect and improve the
health and satisfaction of enrolled beneficiaries, is the purpose of:
A) The Balance Budget Act of 1997 (BBA)
B) Quality Assurance (QA)
C) Quality Improvement System for Managed Care (QISMC)
D) Medicare Advantage (MA) - CORRECT ANSWER C) Quality Improvement System
for Managed Care (QISMC)
The following are types of Accountable Care Organizations offered by Medicare except:
A) Pioneer ACO Model
B) Medicare Shared Savings Program
C) Advance Payment Model
D) Healthcare Maintenance Organization Model - CORRECT ANSWER D) Healthcare
Maintenance Organization Model
Which option is NOT true concerning URAC:
A) URAC's standards keep pace with the rapid changes in the healthcare system
, B) Established in 1990, it is formerly known as the Utilization Review Accreditation
Commission
C) URAC's standards provide a mark of distinction for healthcare organizations to
demonstrate their commitment to quality and accountability
D) Provides a comprehensive assessment covering physician practice management -
CORRECT ANSWER D) Provides a comprehensive assessment covering physician
practice management
Which option is NOT true concerning the Health Maintenance Organization Act of 1973:
A) It represented a significant change in the way the federal government regulated
health policies
B) It was directed at changing the system of healthcare delivery
C) It is the legislation that governs health benefit plans of self-insured, self-funded
employers in the United States
D) It established financial guidelines for operating an HMO - CORRECT ANSWER C) It
is the legislation that governs health benefit plans of self-insured, self-funded employers
in the United States
Both employees and employers can contribute pretax dollars to a qualified account This
is a benefit of:
A) CDHP
B) NCQA
C) Medicare
D) HSA - CORRECT ANSWER D) HSA
