CSPR-CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM | QUESTIONS & ANSWERS (VERIFIED)| LATEST UPDATE| GRADED A+

CSPR - N




CERTIFIED SPECIALIST PAYMENT REP (H
N N N N N




FMA) EXAM | QUESTIONS & ANSWERS (VE
N N N N N N




RIFIED) | LATEST UPDATE | GRADED A+
N N N N N N




StepsNusedNtoNcontrolNcostsNofNmanagedNcareNinclude:

CorrectNAnswer:N N BundledNcodes

Capitation

PayerNandNProviderNtoNagreeNonNreasonableNpayment



DRGNisNusedNtoNclassify

CorrectNAnswer:N N InpatientNadmissionsNforNtheNpurposeNofNreimbursingNhospitalsNfor

eachNcaseNinNaNgivenNcategoryNw/aNnegotiatedNfixedNfee,NregardlessNofNtheNactualNcosts

incurred



IdentifyNtheNvariousNtypesNofNprivateNhealthNplanNcoverage

CorrectNAnswer:N N HMO

Conventional

PPONandNPOS




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,HDHP/SONplansN-Nhigh-deductibleNhealthNplansNwithNaNsavingsNoption;NPrivateN-NInclude

higherNpatientNout-of-pocketNexpendituresNforNtreatmentsNthatNcanNserveNtoNreduce

utilization/costs.



ManagedNcareNorganizationsN(MCO)NexistNprimarilyNinNfourNforms:

CorrectNAnswer:N N HealthNMaintenanceNOrganizationsN(HMO)

PreferredNProviderNOrganizationsN(PPO)

PointNofNServiceN(POS)NOrganizations

ExclusiveNProviderNOrganizationsN(EPO)



IdentifyNtheNvariousNtypesNofNgovernment‐sponsoredNhealthNcoverage:

CorrectNAnswer:N N MedicareN-NGovernment;NBeneficiariesNenrolledNinNsuchNplans,Nbut,

participationNinNthese

plansNisNvoluntary.

Medicaid

MedicaidNManagedNCareN-NMedicaidNbeneficiariesNareNrequiredNtoNselectNandNenrollNinNa

managedNcareNplan.

MedicareNManagedNCareN(a.k.a.NMedicareNAdvantageNPlans)



IdentifyNsomeNkeyNdriversNofNincreasingNhealthcareNcosts

CorrectNAnswer:N N Demographics

ChronicNConditions




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,ProviderNpaymentNsystemsN-NProviderNpaymentNsystemsNthatNareNdesignedNtoNreward

volumeNratherNthanNquality,Noutcomes,NandNprevention

ConsumerNPerceptions

HealthNPlanNpressure

PhysicianNRelationships

SupplyNChain



HealthNMaintenanceNOrganizationsN(HMO)

CorrectNAnswer:N N Referrals

PCP

PatientsNmustNuseNanNin-networkNproviderNforNtheirNservicesNtoNbeNcovered.

ReimbursementN-NmajorityNofNservicesNofferedNareNreimbursedNthroughNcapitation

paymentsN(PMPM)



MedicareNisNcomposedNofNfourNparts:

CorrectNAnswer:N N PartNAN-NprovidesNinpatient/hospital,Nhospice,NandNskilledNnursing

coverage

PartNBN-NprovidesNoutpatient/medicalNcoverage

PartNCN-NanNalternativeNwayNtoNreceiveNyourNMedicareNbenefitsN(knownNasNMedicare

Advantage)

PartNDN-NprescriptionNdrugNcoverage



HMONActNofN1973




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, CorrectNAnswer:N N TheNHMONActNofN1973NgaveNfederallyNqualifiedNHMOsNtheNrightNto

mandateNthatNemployersNofferNtheirNproductNtoNtheirNemployeesNunderNcertainNconditions.

MandatingNanNemployerNmeantNthatNemployersNwhoNhadN25NorNmoreNemployeesNand

wereNfor‐profitNcompaniesNwereNrequiredNtoNmakeNaNdualNchoiceNavailableNtoNtheir

employees.



WhichNofNtheNfollowingNstatementsNregardingNemployer-basedNhealthNinsuranceNinNthe

UnitedNStatesNisNtrue?

CorrectNAnswer:N N TheNrealNadventNofNemployer-basedNinsuranceNcameNthroughNBlue

Cross,NwhichNwasNstartedNbyNhospitalNassociationsNduringNtheNDepression.



TheNHealthNMaintenanceNOrganizationN(HMO)NActNofN1973NgaveNqualifiedNHMOsNtheNright

toN"mandate"NanNemployerNunderNcertainNconditions,NmeaningNemployers:

CorrectNAnswer:N N WouldNhaveNtoNofferNHMONplansNalongNsideNtraditionalNfee-for-service

medicalNplans.



WhichNofNtheNfollowingNisNanNanticipatedNchangeNinNtheNrelationshipsNbetweenNconsumers

andNproviders?

CorrectNAnswer:N N ProvidersNwillNfaceNmanyNnewNserviceNdemandsNandNconsumersNwill

haveNvirtuallyNunfetteredNaccessNtoNthoseNservices



WhatNtransitionNbeganNasNaNresultNofNtheNMarchN2010NhealthcareNreformNlegislation?




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