HFMA CSPR Actual Exam Newest / HFMA CSPR Exam Preparation
HFMA CSPR ACTUAL EXAM NEWEST / HFMA CSPR EXAM PREPARATION/HFMA
CSPR PRACTICE EXAM WITH COMPLETE QUESTIONS AND CORRECT ANSWERS|
BRAND NEW VERSION!
Which of the following is not an example of an objective criteria set that may be
applied in utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA - Correct Answer-C) Milliman
Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation - Correct Answer-A) Bundled payment
Integrated healthcare delivery systems are most capable of successfully managing
which type of payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
1|Page
, HFMA CSPR Actual Exam Newest / HFMA CSPR Exam Preparation
D) Global capitation - Correct Answer-D) Global capitation
A clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
D) A properly completed billing form, ICD-10 or CMS 1500 - Correct Answer-B) A
properly completed billing form, UB-04 or CMS 1500
To ensure that patients have the education, tools, and support they need to make
decisions and participate in their own care is the goal of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's) - Correct Answer-B) A patient-centered
medical home (PCMH)
Accountable Care Organizations are designed with the following criteria:
A) To make providers independent of each other
B) To provide no financial incentives for provider cooperation
C) To save money by avoiding unnecessary tests
2|Page
, HFMA CSPR Actual Exam Newest / HFMA CSPR Exam Preparation
D) To increase the use of emergency room services - Correct Answer-C) To save
money by avoiding unnecessary tests
Prospective performance and Retrospective performances are considered:
A) Private health plans
B) Contract performance models
C) Rating tiers
D) Consumer Directed Health Plans (CDHP) - Correct Answer-B) Contract
performance models
Reporting initiative including: Required Nation Performance Measurement,
Voluntary National Performance Measurement, and Employer Coalition
Performance Measure, are all:
A) Group advocacy goals intended to reduced consumer spending
B) Consumer advocacy and healthcare value efforts
C) Healthcare report cards available to the public
D) Reports that contain public information regarding all healthcare issues - Correct
Answer-C) Healthcare report cards available to the public
Identify which option is NOT a payment type that comprises a large percentage of
Medicare expenditures.
A) Inpatient prospective Payment Systems
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, HFMA CSPR Actual Exam Newest / HFMA CSPR Exam Preparation
B) Outpatient Prospective Payment System
C) Medicare payments to physicians
D) MS-DRG payment - Correct Answer-C) Medicare payments to physicians
Which option is NOT a practice used to control the costs of managed care?
A) Delivering services that are reasonable, and payers agree on medical necessity
and reimburse for services
B) Combining services, bundling associated charges, determining an appropriate
charge the that set of services
C) Making advance payment to providers for all services needed to care for a
member
D) The payer and provider agreeing on a reasonable payment for each service -
Correct Answer-C) Making advance payment to providers for all services needed
to care for a member
Under Title XIX of the Social Security Act, Medicaid:
A) Mandates medical services for certain individuals and low-income families
B) Advocates medical assistance for certain individuals and low-come families
C) Pays for medical assistance for certain individuals and low-income families
4|Page
HFMA CSPR ACTUAL EXAM NEWEST / HFMA CSPR EXAM PREPARATION/HFMA
CSPR PRACTICE EXAM WITH COMPLETE QUESTIONS AND CORRECT ANSWERS|
BRAND NEW VERSION!
Which of the following is not an example of an objective criteria set that may be
applied in utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA - Correct Answer-C) Milliman
Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation - Correct Answer-A) Bundled payment
Integrated healthcare delivery systems are most capable of successfully managing
which type of payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
1|Page
, HFMA CSPR Actual Exam Newest / HFMA CSPR Exam Preparation
D) Global capitation - Correct Answer-D) Global capitation
A clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
D) A properly completed billing form, ICD-10 or CMS 1500 - Correct Answer-B) A
properly completed billing form, UB-04 or CMS 1500
To ensure that patients have the education, tools, and support they need to make
decisions and participate in their own care is the goal of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's) - Correct Answer-B) A patient-centered
medical home (PCMH)
Accountable Care Organizations are designed with the following criteria:
A) To make providers independent of each other
B) To provide no financial incentives for provider cooperation
C) To save money by avoiding unnecessary tests
2|Page
, HFMA CSPR Actual Exam Newest / HFMA CSPR Exam Preparation
D) To increase the use of emergency room services - Correct Answer-C) To save
money by avoiding unnecessary tests
Prospective performance and Retrospective performances are considered:
A) Private health plans
B) Contract performance models
C) Rating tiers
D) Consumer Directed Health Plans (CDHP) - Correct Answer-B) Contract
performance models
Reporting initiative including: Required Nation Performance Measurement,
Voluntary National Performance Measurement, and Employer Coalition
Performance Measure, are all:
A) Group advocacy goals intended to reduced consumer spending
B) Consumer advocacy and healthcare value efforts
C) Healthcare report cards available to the public
D) Reports that contain public information regarding all healthcare issues - Correct
Answer-C) Healthcare report cards available to the public
Identify which option is NOT a payment type that comprises a large percentage of
Medicare expenditures.
A) Inpatient prospective Payment Systems
3|Page
, HFMA CSPR Actual Exam Newest / HFMA CSPR Exam Preparation
B) Outpatient Prospective Payment System
C) Medicare payments to physicians
D) MS-DRG payment - Correct Answer-C) Medicare payments to physicians
Which option is NOT a practice used to control the costs of managed care?
A) Delivering services that are reasonable, and payers agree on medical necessity
and reimburse for services
B) Combining services, bundling associated charges, determining an appropriate
charge the that set of services
C) Making advance payment to providers for all services needed to care for a
member
D) The payer and provider agreeing on a reasonable payment for each service -
Correct Answer-C) Making advance payment to providers for all services needed
to care for a member
Under Title XIX of the Social Security Act, Medicaid:
A) Mandates medical services for certain individuals and low-income families
B) Advocates medical assistance for certain individuals and low-come families
C) Pays for medical assistance for certain individuals and low-income families
4|Page
