CSPRB B CERTIFIEDB SPECIALISTB PAYMENTB RE PB (HFMA)B EXAMB | B QUESTIONSB &B ANSW ERSB (VERIFIED)B | B LATESTB UPDATEB | B GR

CSPR - B




CERTIFIED SPECIALIST PAYMENT RE
B B B B




P (HFMA) EXAM | QUESTIONS & ANSW
B B B B B B




ERS (VERIFIED) | LATEST UPDATE | GR
B B B B B B




ADED A+ B




StepsBusedBtoBcontrolBcostsBofBmanagedBcareBinclude:

CorrectBAnswer:B B BundledBcodes

Capitation

PayerBandBProviderBtoBagreeBonBreasonableBpayment



DRGBisBusedBtoBclassify

CorrectBAnswer:B B InpatientBadmissionsBforBtheBpurposeBofBreimbursingBhospitalsBfor

eachBcaseBinBaBgivenBcategoryBw/aBnegotiatedBfixedBfee,BregardlessBofBtheBactualBcosts

incurred



IdentifyBtheBvariousBtypesBofBprivateBhealthBplanBcoverage

CorrectBAnswer:B B HMO

Conventional

PPOBandBPOS

,1

,HDHP/SOBplansB-Bhigh-deductibleBhealthBplansBwithBaBsavingsBoption;BPrivateB-BInclude

higherBpatientBout-of-pocketBexpendituresBforBtreatmentsBthatBcanBserveBtoBreduce

utilization/costs.



ManagedBcareBorganizationsB(MCO)BexistBprimarilyBinBfourBforms:

CorrectBAnswer:B B HealthBMaintenanceBOrganizationsB(HMO)

PreferredBProviderBOrganizationsB(PPO)

PointBofBServiceB(POS)BOrganizations

ExclusiveBProviderBOrganizationsB(EPO)



IdentifyBtheBvariousBtypesBofBgovernment‐sponsoredBhealthBcoverage:

CorrectBAnswer:B B MedicareB-BGovernment;BBeneficiariesBenrolledBinBsuchBplans,Bbut,

participationBinBthese

plansBisBvoluntary.

Medicaid

MedicaidBManagedBCareB-BMedicaidBbeneficiariesBareBrequiredBtoBselectBandBenrollBinBa

managedBcareBplan.

MedicareBManagedBCareB(a.k.a.BMedicareBAdvantageBPlans)



IdentifyBsomeBkeyBdriversBofBincreasingBhealthcareBcosts

CorrectBAnswer:B B Demographics

ChronicBConditions




2

, ProviderBpaymentBsystemsB-BProviderBpaymentBsystemsBthatBareBdesignedBtoBreward

volumeBratherBthanBquality,Boutcomes,BandBprevention

ConsumerBPerceptions

HealthBPlanBpressure

PhysicianBRelationships

SupplyBChain



HealthBMaintenanceBOrganizationsB(HMO)

CorrectBAnswer:B B Referrals

PCP

PatientsBmustBuseBanBin-networkBproviderBforBtheirBservicesBtoBbeBcovered.

ReimbursementB-BmajorityBofBservicesBofferedBareBreimbursedBthroughBcapitation

paymentsB(PMPM)



MedicareBisBcomposedBofBfourBparts:

CorrectBAnswer:B B PartBAB-BprovidesBinpatient/hospital,Bhospice,BandBskilledBnursing

coverage

PartBBB-BprovidesBoutpatient/medicalBcoverage

PartBCB-BanBalternativeBwayBtoBreceiveByourBMedicareBbenefitsB(knownBasBMedicare

Advantage)

PartBDB-BprescriptionBdrugBcoverage



HMOBActBofB1973




3