CSPR CERTIFIED SPECIALIST PAYMENT REP
HFMA EXAM WITH QUESTIONS AND
VERIFIED ANSWERS|| ALREADY GRADED A+||
GUARANTEED PASS|| LATEST UPDATE 2025
What is direct contracting? - ANSWER-A single-employer or multi-employer
healthcare alliances that contract directly with providers for healthcare services
What is a non-directed PPO? - ANSWER-A payer that has contracted either
directly or indirectly with the provider to access preferred rates
What is the function of electronic data interchange (EDI)? - ANSWER-To
allow both healthcare providers and payers to exchange common information
required
What was the aim of advocacy groups initiated in the late 1990s? - ANSWER-
To inform the discussion about the quality of care and the value of benefit plans
Which of the following statements is true regarding The Leapfrog Group? -
ANSWER-The Leapfrog Group was started in the late 1990s to engage
consumers and clinicians in the discussion to improve care quality.
Which option is included in the set of new value propositions and tools that
emerged in the early 2000s? - ANSWER--Product development focused on
employee contribution strategies, network access, and funding options.
-Medical management philosophies based on retrospective evaluation of care,
rather than prospective review and management.
-A proliferation of self-service technologies to reduce administrative costs.
,How is Mcare financed? - ANSWER--Part A - Accumulation of funds in the
Part A trust fund (for Medicare Part A benefits) occurs through a 1.45% payroll
tax on both employer and employee under the Social Security Act
-Part B - Accumulation of funds in the Part B trust fund occurs through the SMI
Trust Fund made by Congressional authorizations and through premiums paid
by enrollees.
-Part C - Not separately financed
-Part D - Financing for Part D comes from general revenues (71%), beneficiary
premiums (16%), and state contributions (12%). The monthly premium paid by
enrollees is set to cover 25.5% of the cost of standard drug coverage. Medicare
subsidizes the remaining 74.5%, based on bids submitted by plans for their
expected benefit payments. Higher-income Part D enrollees pay a larger share
of standard Part D costs, ranging from 35% to 85%, depending on income.
Dual Eligibility - ANSWER--Dual Eligibility is not a separate benefit, but to be
considered dually eligible, persons must enroll in Medicare Part A and/or
Medicare Part B. As an alternative to original Medicare (Part A and Part B),
persons may opt for Medicare Part C (Medicare Advantage).
-In addition, persons must be enrolled in either full Medicaid or one of
Medicaid's Medicare Savings Programs (MSPs).
-Medicare is always the first payer (primary) and Medicaid (secondary) covers
the remaining cost, given that the services are Medicaid covered.
-Medicaid does cover some expenses that Medicare does not, such as personal
care assistance in the home and community and long-term skilled nursing home
care (Medicare limits nursing home care to 100 days).
-Medicaid, via the Medicare Savings Program, also helps to cover the costs of
Medicare premiums, deductibles, and co-payments.
Identify some key drivers of increasing healthcare costs - ANSWER--
Demographics
-Chronic Conditions
, -Provider payment systems - Provider payment systems that are designed to
reward volume rather than quality, outcomes, and prevention -Consumer
Perceptions
-Health Plan pressure
-Physician Relationships
-Supply Chain
Medicare - ANSWER--Part A - provides inpatient/hospital, hospice, and skilled
nursing coverage
-Part B - provides outpatient/medical coverage
-Part C - an alternative way to receive your Medicare benefits (known as
Medicare
Advantage)
-Part D - prescription drug coverage
CMS is responsible for: - ANSWER--clear policy on eligibility for CMS
programs, coverage and reimbursement of healthcare services, standards for
providers, and program administration.
-Administration of comprehensive agreements with contractors and states; the
performance standards that must be met in their administration, and the
programmatic results that are to be achieved.
-Monitoring the performance of contractors and states
Medicare provides health insurance benefits to the following: - ANSWER--All
persons age 65 and older
-Individuals with permanent renal (kidney) failure, eligible for dialysis
treatment
-Individuals with certain disabilities
Mcare Part A (Hospital Insurance) - ANSWER--covers most medically
necessary hospital, skilled nursing facility, home
HFMA EXAM WITH QUESTIONS AND
VERIFIED ANSWERS|| ALREADY GRADED A+||
GUARANTEED PASS|| LATEST UPDATE 2025
What is direct contracting? - ANSWER-A single-employer or multi-employer
healthcare alliances that contract directly with providers for healthcare services
What is a non-directed PPO? - ANSWER-A payer that has contracted either
directly or indirectly with the provider to access preferred rates
What is the function of electronic data interchange (EDI)? - ANSWER-To
allow both healthcare providers and payers to exchange common information
required
What was the aim of advocacy groups initiated in the late 1990s? - ANSWER-
To inform the discussion about the quality of care and the value of benefit plans
Which of the following statements is true regarding The Leapfrog Group? -
ANSWER-The Leapfrog Group was started in the late 1990s to engage
consumers and clinicians in the discussion to improve care quality.
Which option is included in the set of new value propositions and tools that
emerged in the early 2000s? - ANSWER--Product development focused on
employee contribution strategies, network access, and funding options.
-Medical management philosophies based on retrospective evaluation of care,
rather than prospective review and management.
-A proliferation of self-service technologies to reduce administrative costs.
,How is Mcare financed? - ANSWER--Part A - Accumulation of funds in the
Part A trust fund (for Medicare Part A benefits) occurs through a 1.45% payroll
tax on both employer and employee under the Social Security Act
-Part B - Accumulation of funds in the Part B trust fund occurs through the SMI
Trust Fund made by Congressional authorizations and through premiums paid
by enrollees.
-Part C - Not separately financed
-Part D - Financing for Part D comes from general revenues (71%), beneficiary
premiums (16%), and state contributions (12%). The monthly premium paid by
enrollees is set to cover 25.5% of the cost of standard drug coverage. Medicare
subsidizes the remaining 74.5%, based on bids submitted by plans for their
expected benefit payments. Higher-income Part D enrollees pay a larger share
of standard Part D costs, ranging from 35% to 85%, depending on income.
Dual Eligibility - ANSWER--Dual Eligibility is not a separate benefit, but to be
considered dually eligible, persons must enroll in Medicare Part A and/or
Medicare Part B. As an alternative to original Medicare (Part A and Part B),
persons may opt for Medicare Part C (Medicare Advantage).
-In addition, persons must be enrolled in either full Medicaid or one of
Medicaid's Medicare Savings Programs (MSPs).
-Medicare is always the first payer (primary) and Medicaid (secondary) covers
the remaining cost, given that the services are Medicaid covered.
-Medicaid does cover some expenses that Medicare does not, such as personal
care assistance in the home and community and long-term skilled nursing home
care (Medicare limits nursing home care to 100 days).
-Medicaid, via the Medicare Savings Program, also helps to cover the costs of
Medicare premiums, deductibles, and co-payments.
Identify some key drivers of increasing healthcare costs - ANSWER--
Demographics
-Chronic Conditions
, -Provider payment systems - Provider payment systems that are designed to
reward volume rather than quality, outcomes, and prevention -Consumer
Perceptions
-Health Plan pressure
-Physician Relationships
-Supply Chain
Medicare - ANSWER--Part A - provides inpatient/hospital, hospice, and skilled
nursing coverage
-Part B - provides outpatient/medical coverage
-Part C - an alternative way to receive your Medicare benefits (known as
Medicare
Advantage)
-Part D - prescription drug coverage
CMS is responsible for: - ANSWER--clear policy on eligibility for CMS
programs, coverage and reimbursement of healthcare services, standards for
providers, and program administration.
-Administration of comprehensive agreements with contractors and states; the
performance standards that must be met in their administration, and the
programmatic results that are to be achieved.
-Monitoring the performance of contractors and states
Medicare provides health insurance benefits to the following: - ANSWER--All
persons age 65 and older
-Individuals with permanent renal (kidney) failure, eligible for dialysis
treatment
-Individuals with certain disabilities
Mcare Part A (Hospital Insurance) - ANSWER--covers most medically
necessary hospital, skilled nursing facility, home
