CSPR - CERTIFIED SPECIALIST
PAYMENT REP (HFMA) 2025 LATEST
UPDATED ACTUAL EXAM COMPLETE
QUESTIONS WITH DETAILED
VERIFIED
ANSWERS (100% CORRECT
ANSWERS) /ALREADY
GRADED A+ SURE PASS!!
1. Medicare is composed of four parts: - 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
2. HMO Act of 1973 - ANSWER The HMO Act of 1973 gave federally
qualified HMOs the right to mandate that employers offer their
product to their employees under certain conditions. Mandating an
employer meant that employers who had 25 or more employees and
were for profit companies were required to make a dual choice
available to their employees.
3. 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.
4. 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.
5. 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
6. 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.
7. 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.
8. What is the overall function of Medicaid? - ANSWER The pay for
medical assistance for certain individuals and low-income families
9. Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is defined
as: - ANSWER Total Medical Expenses divided by Total Premiums
PAYMENT REP (HFMA) 2025 LATEST
UPDATED ACTUAL EXAM COMPLETE
QUESTIONS WITH DETAILED
VERIFIED
ANSWERS (100% CORRECT
ANSWERS) /ALREADY
GRADED A+ SURE PASS!!
1. Medicare is composed of four parts: - 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
2. HMO Act of 1973 - ANSWER The HMO Act of 1973 gave federally
qualified HMOs the right to mandate that employers offer their
product to their employees under certain conditions. Mandating an
employer meant that employers who had 25 or more employees and
were for profit companies were required to make a dual choice
available to their employees.
3. 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.
4. 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.
5. 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
6. 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.
7. 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.
8. What is the overall function of Medicaid? - ANSWER The pay for
medical assistance for certain individuals and low-income families
9. Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is defined
as: - ANSWER Total Medical Expenses divided by Total Premiums
