CSPR - Certified Specialist Payment Rep (HFMA) Exam Questions And Answers 2025/2026

CSPR - Certified Specialist Payment Rep (HFMA) Exam Questions And Answers 2025/2026 Steps used to control costs of managed care include: - Correct Answer Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - Correct Answer Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - Correct Answer HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings option; Private - Include higher patient out-of-pocket expenditures for treatments that can serve to reduce utilization/costs. Managed care organizations (MCO) exist primarily in four forms: - Correct Answer Health Maintenance Organizations (HMO) Preferred Provider Organizations (PPO) Point of Service (POS) Organizations