CSPR (HFMA) EXAM QUESTIONS WITH 100% CORRECTLY
SOLVED ANSWERS
1) Which of the following is not an example of an objective criteria set that may be
applied in utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA -- Correct Answer ✔✔ C) Milliman
2) Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation -- Correct Answer ✔✔ A) Bundled payment
3) Integrated healthcare delivery systems are most capable of successfully managing
which type of payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
D) Global capitation -- Correct Answer ✔✔ D) Global capitation
4) A clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
, D) A properly completed billing form, ICD-10 or CMS 1500 -- Correct
Answer ✔✔ B) A properly completed billing form, UB-04 or CMS 1500
5) To ensure that patients have the education, tools, and support they need to make
decisions and participate in their own care is the goal of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's) -- Correct Answer ✔✔ B) A patient-
centered medical home (PCMH)
6) Accountable Care Organizations are designed with the following criteria:
A) To make providers independent of each other
B) To provide no financial incentives for provider cooperation
C) To save money by avoiding unnecessary tests
D) To increase the use of emergency room services -- Correct Answer ✔✔
C) To save money by avoiding unnecessary tests
7) Prospective performance and Retrospective performances are considered:
A) Private health plans
B) Contract performance models
C) Rating tiers
D) Consumer Directed Health Plans (CDHP) -- Correct Answer ✔✔ B)
Contract performance models
8) Reporting initiative including: Required Nation Performance Measurement, Voluntary
National Performance Measurement, and Employer Coalition Performance Measure,
are all:
A) Group advocacy goals intended to reduced consumer spending
B) Consumer advocacy and healthcare value efforts
C) Healthcare report cards available to the public
, D) Reports that contain public information regarding all healthcare issues --
Correct Answer ✔✔ C) Healthcare report cards available to the public
9) Identify which option is NOT a payment type that comprises a large percentage of
Medicare expenditures.
A) Inpatient prospective Payment Systems
B) Outpatient Prospective Payment System
C) Medicare payments to physicians
D) MS-DRG payment -- Correct Answer ✔✔ C) Medicare payments to
physicians
10) Which option is NOT a practice used to control the costs of managed care?
A) Delivering services that are reasonable, and payers agree on medical
necessity and reimburse for services
B) Combining services, bundling associated charges, determining an
appropriate charge the that set of services
C) Making advance payment to providers for all services needed to care for a
member
D) The payer and provider agreeing on a reasonable payment for each service
-- Correct Answer ✔✔ C) Making advance payment to providers for all
services needed to care for a member
11) Under Title XIX of the Social Security Act, Medicaid:
A) Mandates medical services for certain individuals and low-income families
B) Advocates medical assistance for certain individuals and low-come families
C) Pays for medical assistance for certain individuals and low-income families
D) Provides medical referrals for certain individuals and low-income families --
Correct Answer ✔✔ C) Pays for medical assistance for certain individuals
and low-income families
SOLVED ANSWERS
1) Which of the following is not an example of an objective criteria set that may be
applied in utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA -- Correct Answer ✔✔ C) Milliman
2) Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation -- Correct Answer ✔✔ A) Bundled payment
3) Integrated healthcare delivery systems are most capable of successfully managing
which type of payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
D) Global capitation -- Correct Answer ✔✔ D) Global capitation
4) A clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
, D) A properly completed billing form, ICD-10 or CMS 1500 -- Correct
Answer ✔✔ B) A properly completed billing form, UB-04 or CMS 1500
5) To ensure that patients have the education, tools, and support they need to make
decisions and participate in their own care is the goal of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's) -- Correct Answer ✔✔ B) A patient-
centered medical home (PCMH)
6) Accountable Care Organizations are designed with the following criteria:
A) To make providers independent of each other
B) To provide no financial incentives for provider cooperation
C) To save money by avoiding unnecessary tests
D) To increase the use of emergency room services -- Correct Answer ✔✔
C) To save money by avoiding unnecessary tests
7) Prospective performance and Retrospective performances are considered:
A) Private health plans
B) Contract performance models
C) Rating tiers
D) Consumer Directed Health Plans (CDHP) -- Correct Answer ✔✔ B)
Contract performance models
8) Reporting initiative including: Required Nation Performance Measurement, Voluntary
National Performance Measurement, and Employer Coalition Performance Measure,
are all:
A) Group advocacy goals intended to reduced consumer spending
B) Consumer advocacy and healthcare value efforts
C) Healthcare report cards available to the public
, D) Reports that contain public information regarding all healthcare issues --
Correct Answer ✔✔ C) Healthcare report cards available to the public
9) Identify which option is NOT a payment type that comprises a large percentage of
Medicare expenditures.
A) Inpatient prospective Payment Systems
B) Outpatient Prospective Payment System
C) Medicare payments to physicians
D) MS-DRG payment -- Correct Answer ✔✔ C) Medicare payments to
physicians
10) Which option is NOT a practice used to control the costs of managed care?
A) Delivering services that are reasonable, and payers agree on medical
necessity and reimburse for services
B) Combining services, bundling associated charges, determining an
appropriate charge the that set of services
C) Making advance payment to providers for all services needed to care for a
member
D) The payer and provider agreeing on a reasonable payment for each service
-- Correct Answer ✔✔ C) Making advance payment to providers for all
services needed to care for a member
11) Under Title XIX of the Social Security Act, Medicaid:
A) Mandates medical services for certain individuals and low-income families
B) Advocates medical assistance for certain individuals and low-come families
C) Pays for medical assistance for certain individuals and low-income families
D) Provides medical referrals for certain individuals and low-income families --
Correct Answer ✔✔ C) Pays for medical assistance for certain individuals
and low-income families
