CSPR - CERTIFIED SPECIALIST
PAYMENT REP HFMA CTUAL EXAM
NEWEST 2025 COMPLETE 200
QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
A Medicare Advanced Beneficiary Notice (ABN) provides
the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed payment Correct
Answer C) Notifies member of non-covered service
The appropriate addition of some risk in the exchange of
health care to a patient for some form of remuneration, is
also known as:
A) Diagnosis-related groups (DRG's)
B) Per diems
C) Fee-for-Service reimbursement
D) Aligning incentives Correct Answer B) Per diems
,The federal government pays a share of the medical
assistance expenditures under each state's Medicaid
program. How is that share, known as the federal medical
assistance percentage (FMAP), determined?
A) None of the above
B) By using a formula that compares the states average
per capita income level with the national income average
C) By ranking states according to the percentage of
residents at the poverty level
D) By averaging the percentage paid in the five previous
years Correct Answer B) By using a formula that
compares the states average per capita income level with
the national income average
The different rates charged on the basis of the number
and relationships of the people covered under one
employee's plan is known as:
A) Ratings
B) Rating tiers
C) Structures
D) Tier structures Correct Answer B) Rating tiers
A Patient Centered Medical Home has all the following
characteristics except:
,A) Comprehensive and continuous care
B) Health information technology
C) Limited access to care
D) Team-based care delivery Correct Answer C) Limited
access to care
All are areas that a NCQA review covers, EXCEPT:
A) Medical records review & Member rights and
responsibilities
B) Credentialing review & Preventive and adaptive health
services
C) QA review & UM review
D) Physician rights and responsibilities & Certification
review Correct Answer D) Physician rights and
responsibilities & Certification review
They are available to everyone, not just employees of a
small business or the self-employed. This is a benefit of:
A) NCQA
B) CDHP
C) Medicare
D) HSA Correct Answer C) Medicare
Coordination of Benefits is essential to:
, A) Identifying the correct primary/secondary insure for
proper payment
B) Determining charity care
C) Identifying the patient copay at the time of service
D) Ensuring appropriate care is provided Correct Answer
A) Identifying the correct primary/secondary insure for
proper payment
Patient and/or enrollee identification, age, gender, date of
service, and diagnosis codes are all regarded as:
A) Information not necessary for claims processing
B) Required information for health plans reporting
C) Information used to establish expected reimbursement
D) Information required for claims processing Correct
Answer D) Information required for claims processing
When modeling the proposed payer's contractual
reimbursement, you should include:
A) All claim data
B) All Medicare claim data
C) All commercial claim data
D) Payer specific claim data Correct Answer D) Payer
specific claim data
PAYMENT REP HFMA CTUAL EXAM
NEWEST 2025 COMPLETE 200
QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
A Medicare Advanced Beneficiary Notice (ABN) provides
the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed payment Correct
Answer C) Notifies member of non-covered service
The appropriate addition of some risk in the exchange of
health care to a patient for some form of remuneration, is
also known as:
A) Diagnosis-related groups (DRG's)
B) Per diems
C) Fee-for-Service reimbursement
D) Aligning incentives Correct Answer B) Per diems
,The federal government pays a share of the medical
assistance expenditures under each state's Medicaid
program. How is that share, known as the federal medical
assistance percentage (FMAP), determined?
A) None of the above
B) By using a formula that compares the states average
per capita income level with the national income average
C) By ranking states according to the percentage of
residents at the poverty level
D) By averaging the percentage paid in the five previous
years Correct Answer B) By using a formula that
compares the states average per capita income level with
the national income average
The different rates charged on the basis of the number
and relationships of the people covered under one
employee's plan is known as:
A) Ratings
B) Rating tiers
C) Structures
D) Tier structures Correct Answer B) Rating tiers
A Patient Centered Medical Home has all the following
characteristics except:
,A) Comprehensive and continuous care
B) Health information technology
C) Limited access to care
D) Team-based care delivery Correct Answer C) Limited
access to care
All are areas that a NCQA review covers, EXCEPT:
A) Medical records review & Member rights and
responsibilities
B) Credentialing review & Preventive and adaptive health
services
C) QA review & UM review
D) Physician rights and responsibilities & Certification
review Correct Answer D) Physician rights and
responsibilities & Certification review
They are available to everyone, not just employees of a
small business or the self-employed. This is a benefit of:
A) NCQA
B) CDHP
C) Medicare
D) HSA Correct Answer C) Medicare
Coordination of Benefits is essential to:
, A) Identifying the correct primary/secondary insure for
proper payment
B) Determining charity care
C) Identifying the patient copay at the time of service
D) Ensuring appropriate care is provided Correct Answer
A) Identifying the correct primary/secondary insure for
proper payment
Patient and/or enrollee identification, age, gender, date of
service, and diagnosis codes are all regarded as:
A) Information not necessary for claims processing
B) Required information for health plans reporting
C) Information used to establish expected reimbursement
D) Information required for claims processing Correct
Answer D) Information required for claims processing
When modeling the proposed payer's contractual
reimbursement, you should include:
A) All claim data
B) All Medicare claim data
C) All commercial claim data
D) Payer specific claim data Correct Answer D) Payer
specific claim data
