1|Page
CSPR EXAM 2025, HFMA CERTIFICATION, CERTIFIED
SPECIALIST PAYMENT REP, HEALTHCARE FINANCE EXAM,
REIMBURSEMENT METHODOLOGIES, REVENUE CYCLE
MANAGEMENT, VERIFIED CSPR ANSWERS
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 - 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 - 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
,2|Page
C) Medicare
D) HSA - 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 - 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 - 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 - ANSWER-D) Payer specific claim data
,3|Page
Which of the following is not examined in a concurrent utilization management review?
A) Case management
B) Discharge Planning
C) Physician group
D) Length of stay - ANSWER-C) Physician group
Which option is NOT a utilization management technique?
A) Retrospective UM Techniques
B) Prospective UM Techniques
C) Reimbursement UM Techniques
D) Concurrent UM Techniques - ANSWER-C) Reimbursement UM Techniques
Medicare Part D:
A) Is part of the Medicare policy that provides outpatient prescription drug coverage
B) Is a type of coverage that typically covers outpatient-type services and physician services
C) Is a type of coverage intended to cover inpatient hospital care or skilled nursing facility care
D) Is part of the Medicare policy that allows private health insurance companies to provide
Medicare benefits - ANSWER-A) Is part of the Medicare policy that provides outpatient
prescription drug coverage
With regards to managed care, a hospital's board of directors is responsible for:
, 4|Page
A) Understanding the hospital's contracting strategy
B) Reviewing all managed care contracting arrangements
C) Ensuring appropriate IT is in a place to process claims
D) Safeguarding that the hospital pricing isn't available to consumers - ANSWER-B) Reviewing all
managed care contracting arrangements
Deductibles, copayments, coinsurance, and out of pocket maximums are all financial
mechanisms of a benefit plan designed to:
A) Alleviate provider "revenue stress"
B) Subsidize costs
C) Share costs
D) Contain costs - ANSWER-C) Share costs
High-Deductible health plans are:
A) Private healthcare coverage which includes higher patient out-of-pocket expenditures for
treatments
B) Government healthcare coverage where beneficiaries are required to select and enroll in a
managed care plan
C) Government health care where beneficiaries enroll in such plans but participation in these
plans is voluntary
CSPR EXAM 2025, HFMA CERTIFICATION, CERTIFIED
SPECIALIST PAYMENT REP, HEALTHCARE FINANCE EXAM,
REIMBURSEMENT METHODOLOGIES, REVENUE CYCLE
MANAGEMENT, VERIFIED CSPR ANSWERS
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 - 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 - 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
,2|Page
C) Medicare
D) HSA - 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 - 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 - 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 - ANSWER-D) Payer specific claim data
,3|Page
Which of the following is not examined in a concurrent utilization management review?
A) Case management
B) Discharge Planning
C) Physician group
D) Length of stay - ANSWER-C) Physician group
Which option is NOT a utilization management technique?
A) Retrospective UM Techniques
B) Prospective UM Techniques
C) Reimbursement UM Techniques
D) Concurrent UM Techniques - ANSWER-C) Reimbursement UM Techniques
Medicare Part D:
A) Is part of the Medicare policy that provides outpatient prescription drug coverage
B) Is a type of coverage that typically covers outpatient-type services and physician services
C) Is a type of coverage intended to cover inpatient hospital care or skilled nursing facility care
D) Is part of the Medicare policy that allows private health insurance companies to provide
Medicare benefits - ANSWER-A) Is part of the Medicare policy that provides outpatient
prescription drug coverage
With regards to managed care, a hospital's board of directors is responsible for:
, 4|Page
A) Understanding the hospital's contracting strategy
B) Reviewing all managed care contracting arrangements
C) Ensuring appropriate IT is in a place to process claims
D) Safeguarding that the hospital pricing isn't available to consumers - ANSWER-B) Reviewing all
managed care contracting arrangements
Deductibles, copayments, coinsurance, and out of pocket maximums are all financial
mechanisms of a benefit plan designed to:
A) Alleviate provider "revenue stress"
B) Subsidize costs
C) Share costs
D) Contain costs - ANSWER-C) Share costs
High-Deductible health plans are:
A) Private healthcare coverage which includes higher patient out-of-pocket expenditures for
treatments
B) Government healthcare coverage where beneficiaries are required to select and enroll in a
managed care plan
C) Government health care where beneficiaries enroll in such plans but participation in these
plans is voluntary
