1|Page
HFMA CSPR Exam 2025 | LATEST Test Bank with 100% Verified
Questions & Correct Detailed Answers || Revenue Cycle •
Reimbursement • Patient Access || Graded A+ & Expert-Verified
Hospitals, health systems, and large physician groups are likely to have robust governance
models models with supporting organizational infrastructure to oversee and carry out managed
care operations. Small Physician groups could have all of the following, EXCEPT:
A) Relationships with large provider organizations to share managed care operations
B) Outsource managed care operations
C) Similar operations only for chargemaster price estimation
D) Reliance on a core set of individuals to direct and administer managed care operations
C) Similar operations only for chargemaster price estimation
The law that encompasses all health benefit issues of a self-funded health insurance plan,
including administrator competence, is called the:
A) HMO Act
B) Employee Self-Funded Plan Act (ESPA)
C) Employee Retirement Income Security Act (ERISA)
D) Affordable Care Act (ACA)
C) Employee Retirement Income Security Act (ERISA)
One way that the term carve-out is used when discussing managed care is:
A) Referring to benefits that are administered separately from the rest of Medicaid
B) Referring to specific benefits or services that are administered together with the rest of
managed care plan
C) Referring to a broad range of benefits or services that are administered separately from the
rest of the managed care plan
D) Referring to specific benefits or services that are administered separately from the rest of the
managed care plan
,2|Page
D) Referring to specific benefits or services that are administered separately from the rest of the
managed care plan
The Patient Centered Medical Home model is expected to reduce costs by:
A) All of the above
B) Reducing emrgency room visits
C) Reducing inpatient admissions
D) Increasing preventive care
A) All of the above
The purpose of the Medicare Value-Based Purchasing (VBP) program is:
A) To provide better services and a broader range of options for Medicare beneficiaries in health
plans
B) To financially reward or penalize physicians based on their performance related to cost,
quality, and patient experience measures
C) To provide "targeted, accessible, continuous, and coordinated care to Medicare
beneficiaries..."
D) To provide differential payments to physicians based on the quality of care provided to
Medicare beneficiaries
D) To provide differential payments to physicians based on the quality of care provided to
Medicare beneficiaries
The following are quality-related outcomes that can be measured except:
A) Transplant quality indicators
B) Risk-adjusted mortality rates
C) Level of physician compnesation
D) Readmission rates
C) Level of physician compnesation
Which fixed-rate payment method uses a single price for an inpatient stay, outpatient procedure,
or outpatient diagnosis?
, 3|Page
A) Indexed case rate
B) Global case rate
C) Indexed per diem
D) Front-loaded per diem
B) Global case rate
Medicaid is:
A) Government health coverage where beneficiaries are required to select and enroll in a
managed care plan
B) Private healthcare coverage which includes higher patient out-of-pocket expenditures for
treatments
C) Private healthcare coverage that includes additional products such as PPO and POS, with
typically higher cost sharing
D) Government health care where beneficiaries enroll in such plans but participation in these
plans is voluntary
D) Government health care where beneficiaries enroll in such plans but participation in these
plans is voluntary
Which option is NOT true regarding prospective UM techniques?
A) It requires an opinion from a practitioner other than the specialist making the
recommendation to confirm that a proposed treatment is appropriate
B) The primary care physician (PCP) coordinates, manages, and authorizes al services for the
patient
C) It is an analysis of practice patterns intended to target individual case reviews and identify
potential problems
D) It requires a resolution that the proposed medical service is appropriate for the patient
C) It is an analysis of practice patterns intended to target individual case reviews and identify
potential problems
Although it now offers accreditation for a spectrum of healthcare services, URAC originally
offered a specialty accreditation program for _________:
HFMA CSPR Exam 2025 | LATEST Test Bank with 100% Verified
Questions & Correct Detailed Answers || Revenue Cycle •
Reimbursement • Patient Access || Graded A+ & Expert-Verified
Hospitals, health systems, and large physician groups are likely to have robust governance
models models with supporting organizational infrastructure to oversee and carry out managed
care operations. Small Physician groups could have all of the following, EXCEPT:
A) Relationships with large provider organizations to share managed care operations
B) Outsource managed care operations
C) Similar operations only for chargemaster price estimation
D) Reliance on a core set of individuals to direct and administer managed care operations
C) Similar operations only for chargemaster price estimation
The law that encompasses all health benefit issues of a self-funded health insurance plan,
including administrator competence, is called the:
A) HMO Act
B) Employee Self-Funded Plan Act (ESPA)
C) Employee Retirement Income Security Act (ERISA)
D) Affordable Care Act (ACA)
C) Employee Retirement Income Security Act (ERISA)
One way that the term carve-out is used when discussing managed care is:
A) Referring to benefits that are administered separately from the rest of Medicaid
B) Referring to specific benefits or services that are administered together with the rest of
managed care plan
C) Referring to a broad range of benefits or services that are administered separately from the
rest of the managed care plan
D) Referring to specific benefits or services that are administered separately from the rest of the
managed care plan
,2|Page
D) Referring to specific benefits or services that are administered separately from the rest of the
managed care plan
The Patient Centered Medical Home model is expected to reduce costs by:
A) All of the above
B) Reducing emrgency room visits
C) Reducing inpatient admissions
D) Increasing preventive care
A) All of the above
The purpose of the Medicare Value-Based Purchasing (VBP) program is:
A) To provide better services and a broader range of options for Medicare beneficiaries in health
plans
B) To financially reward or penalize physicians based on their performance related to cost,
quality, and patient experience measures
C) To provide "targeted, accessible, continuous, and coordinated care to Medicare
beneficiaries..."
D) To provide differential payments to physicians based on the quality of care provided to
Medicare beneficiaries
D) To provide differential payments to physicians based on the quality of care provided to
Medicare beneficiaries
The following are quality-related outcomes that can be measured except:
A) Transplant quality indicators
B) Risk-adjusted mortality rates
C) Level of physician compnesation
D) Readmission rates
C) Level of physician compnesation
Which fixed-rate payment method uses a single price for an inpatient stay, outpatient procedure,
or outpatient diagnosis?
, 3|Page
A) Indexed case rate
B) Global case rate
C) Indexed per diem
D) Front-loaded per diem
B) Global case rate
Medicaid is:
A) Government health coverage where beneficiaries are required to select and enroll in a
managed care plan
B) Private healthcare coverage which includes higher patient out-of-pocket expenditures for
treatments
C) Private healthcare coverage that includes additional products such as PPO and POS, with
typically higher cost sharing
D) Government health care where beneficiaries enroll in such plans but participation in these
plans is voluntary
D) Government health care where beneficiaries enroll in such plans but participation in these
plans is voluntary
Which option is NOT true regarding prospective UM techniques?
A) It requires an opinion from a practitioner other than the specialist making the
recommendation to confirm that a proposed treatment is appropriate
B) The primary care physician (PCP) coordinates, manages, and authorizes al services for the
patient
C) It is an analysis of practice patterns intended to target individual case reviews and identify
potential problems
D) It requires a resolution that the proposed medical service is appropriate for the patient
C) It is an analysis of practice patterns intended to target individual case reviews and identify
potential problems
Although it now offers accreditation for a spectrum of healthcare services, URAC originally
offered a specialty accreditation program for _________:
