1h|hPh ah gh e
CSPR - h
CERTIFIED SPECIALIST PAYMENT REP (HFMA) 2024 ACTUAL
h h h h h h h
EXAM COMPLETE 200 QUESTIONS WITH DETAILED VERIFIE
h h h h h h h
D ANSWERS (100% CORRECT ANSWERS) ALREADY GRADED
h h h h h h h
A+
What is the overall function of Medicaid? -
h h h h h h h
CORRECT ANSWER >>>>The pay for medical assistance
h h h h h h h h
for certain individuals and low-income families
h h h h h
Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is
h h h h h h h h h h
defined as: - h h
CORRECT ANSWER >>>>Total Medical Expenses divide
h h h h h h
d by Total Premiums
h h h
Provider service organizations (PSOs) function like healt
h h h h h h
h maintenance organizations (HMOs) in all of the followi
h h h h h h h h
ng ways, EXCEPT: -
h h h
CORRECT ANSWER >>>>Ties to the healthcare delivery i
h h h h h h h h
ndustry rather than the insurance industry
h h h h h
,2h|hPh ah gh e
Provider service organizations (PSOs) function like healt
h h h h h h
h maintenance organizations (HMOs) in all of the follow
h h h h h h h h
ing ways: - CORRECT ANSWER >>>>-Risk pooling
h h h h h h
-Capitalization
-Network management h
Which of the following is a service provided by a well-
h h h h h h h h h h
managed third-party administrator (TPA)? -
h h h h h
CORRECT ANSWER >>>>-Administrative
h h h
-Utilization review (UR) h h
-Claims processing h
What is tiering? - h h h
CORRECT ANSWER >>>>The ranking or classifying of on
h h h h h h h h
e or more of the provider delivery system components
h h h h h h h h
Which option is a practice used to control costs of mana
h h h h h h h h h h
ged care? - CORRECT ANSWER >>>>-
h h h h h
Making advance payment to providers for all services ne
h h h h h h h h
eded to care for a member
h h h h h
-
Combining services provided and bundling the associate
h h h h h h
d charges
h
-
Agreement between the payer and provider on reasona h h h h h h h
ble payment for each service.
h h h h
,3h|hPh ah gh e
Which option is a risk involved in per diem payments?
h h h h h h h h h
- CORRECT ANSWER >>>>-
h h h
The risk to the insurance company or health plan
h h h h h h h h
-The risk to the hospital
h h h h
-
The risk when embracing per diem payments in complex
h h h h h h h h
case
h
Diagnosis-related group (DRG) is: - CORRECT ANSWER h h h h h h
>>>>A payment category h h
How is the term carve-
h h h h
out used when discussing managed care? -
h h h h h h
CORRECT ANSWER >>>>To refer to specific benefits or s
h h h h h h h h h
ervices
What is the term Coordination of Benefits (COB)? -
h h h h h h h h
CORRECT ANSWER >>>>A term used to describe how pa
h h h h h h h h h
yment is coordinated for patients who have coverage th
h h h h h h h h
rough two insurance policies
h h h
Which three components are used to determine the tot
h h h h h h h h
al RVU value for a service? - CORRECT ANSWER
h h h h h h h h
>>>>-Malpractice expense h
-Lowest market price for services used
h h h h h
-Medicare discounts h
, 4h|hPh ah gh e
A fixed payment amount based upon the number of me
h h h h h h h h h
mbers assigned to a provider, and does not vary based u
h h h h h h h h h h
pon the number of services rendered, is known as: -
h h h h h h h h h
CORRECT ANSWER >>>>Capitation
h h h
Aligning incentives has come to mean h .- h h h h h h
CORRECT ANSWER >>>>The appropriate addition of s
h h h h h h h
ome risk in the exchange of health care to a patient for
h h h h h h h h h h h h
some form of remuneration.
h h h
According to MedPAC, which option is a benefit or unde h h h h h h h h h
sirable consequence of bundling h h h
payments? - CORRECT ANSWER >>>>- h h h h
It allows Medicare to pay a set fee per hospitalization epi
h h h h h h h h h h
sode.
-
It would provide the potential to improve efficiency and
h h h h h h h h h
quality
-It would lead to underutilization of services
h h h h h h
As the healthcare industry moves to control growth in m
h h h h h h h h h
edical spending, what initiative can help hospitals maint
h h h h h h h
ain their margins? - CORRECT ANSWER
h h h h h
>>>>Contract standardization h
CSPR - h
CERTIFIED SPECIALIST PAYMENT REP (HFMA) 2024 ACTUAL
h h h h h h h
EXAM COMPLETE 200 QUESTIONS WITH DETAILED VERIFIE
h h h h h h h
D ANSWERS (100% CORRECT ANSWERS) ALREADY GRADED
h h h h h h h
A+
What is the overall function of Medicaid? -
h h h h h h h
CORRECT ANSWER >>>>The pay for medical assistance
h h h h h h h h
for certain individuals and low-income families
h h h h h
Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is
h h h h h h h h h h
defined as: - h h
CORRECT ANSWER >>>>Total Medical Expenses divide
h h h h h h
d by Total Premiums
h h h
Provider service organizations (PSOs) function like healt
h h h h h h
h maintenance organizations (HMOs) in all of the followi
h h h h h h h h
ng ways, EXCEPT: -
h h h
CORRECT ANSWER >>>>Ties to the healthcare delivery i
h h h h h h h h
ndustry rather than the insurance industry
h h h h h
,2h|hPh ah gh e
Provider service organizations (PSOs) function like healt
h h h h h h
h maintenance organizations (HMOs) in all of the follow
h h h h h h h h
ing ways: - CORRECT ANSWER >>>>-Risk pooling
h h h h h h
-Capitalization
-Network management h
Which of the following is a service provided by a well-
h h h h h h h h h h
managed third-party administrator (TPA)? -
h h h h h
CORRECT ANSWER >>>>-Administrative
h h h
-Utilization review (UR) h h
-Claims processing h
What is tiering? - h h h
CORRECT ANSWER >>>>The ranking or classifying of on
h h h h h h h h
e or more of the provider delivery system components
h h h h h h h h
Which option is a practice used to control costs of mana
h h h h h h h h h h
ged care? - CORRECT ANSWER >>>>-
h h h h h
Making advance payment to providers for all services ne
h h h h h h h h
eded to care for a member
h h h h h
-
Combining services provided and bundling the associate
h h h h h h
d charges
h
-
Agreement between the payer and provider on reasona h h h h h h h
ble payment for each service.
h h h h
,3h|hPh ah gh e
Which option is a risk involved in per diem payments?
h h h h h h h h h
- CORRECT ANSWER >>>>-
h h h
The risk to the insurance company or health plan
h h h h h h h h
-The risk to the hospital
h h h h
-
The risk when embracing per diem payments in complex
h h h h h h h h
case
h
Diagnosis-related group (DRG) is: - CORRECT ANSWER h h h h h h
>>>>A payment category h h
How is the term carve-
h h h h
out used when discussing managed care? -
h h h h h h
CORRECT ANSWER >>>>To refer to specific benefits or s
h h h h h h h h h
ervices
What is the term Coordination of Benefits (COB)? -
h h h h h h h h
CORRECT ANSWER >>>>A term used to describe how pa
h h h h h h h h h
yment is coordinated for patients who have coverage th
h h h h h h h h
rough two insurance policies
h h h
Which three components are used to determine the tot
h h h h h h h h
al RVU value for a service? - CORRECT ANSWER
h h h h h h h h
>>>>-Malpractice expense h
-Lowest market price for services used
h h h h h
-Medicare discounts h
, 4h|hPh ah gh e
A fixed payment amount based upon the number of me
h h h h h h h h h
mbers assigned to a provider, and does not vary based u
h h h h h h h h h h
pon the number of services rendered, is known as: -
h h h h h h h h h
CORRECT ANSWER >>>>Capitation
h h h
Aligning incentives has come to mean h .- h h h h h h
CORRECT ANSWER >>>>The appropriate addition of s
h h h h h h h
ome risk in the exchange of health care to a patient for
h h h h h h h h h h h h
some form of remuneration.
h h h
According to MedPAC, which option is a benefit or unde h h h h h h h h h
sirable consequence of bundling h h h
payments? - CORRECT ANSWER >>>>- h h h h
It allows Medicare to pay a set fee per hospitalization epi
h h h h h h h h h h
sode.
-
It would provide the potential to improve efficiency and
h h h h h h h h h
quality
-It would lead to underutilization of services
h h h h h h
As the healthcare industry moves to control growth in m
h h h h h h h h h
edical spending, what initiative can help hospitals maint
h h h h h h h
ain their margins? - CORRECT ANSWER
h h h h h
>>>>Contract standardization h
