HFMA CSPR Certification Exam Review HFMA
Certified Specialist Payment & Reimbursement
(CSPR) Exam Questions and Answers | 100% Pass
Guaranteed | 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 - 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 - 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 - 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 - 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 - 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
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
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
Certified Specialist Payment & Reimbursement
(CSPR) Exam Questions and Answers | 100% Pass
Guaranteed | 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 - 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 - 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 - 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 - 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 - 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
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
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
