HFMA CSPR EXAM WITH QUESTIONS AND CORRECT DETAILED
ANSWERS/EXPERT VERIFIED FOR GUARANTEED PASS!/LATEST
UPDATE
RBRVS is:
A) The relative weight for calculating MS-DRG payments
B) The relative weight for calculating OPPS payments
C) Mediare physician payment relative weights
D) Acronym for Real Based Reference Verification System - CORRECT ANSWERS-C) Mediare
physician payment relative weights
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient may be transferred
from one hospital to another when in a(n) condition:
A) Life threatening
B) Non-emergency
C) Stable
D) Chronic - CORRECT ANSWERS-A) Life threatening
STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
C) Services provided by hospitals
D) Services provided by physicians - CORRECT ANSWERS-B) Medicare Advantage health plan
performance
To evaluate an organization's compliance with the CMS COP standards and other accreditation
requirements, is the purpose of:
,A) A comprehensive accreditation process
B) Recovery Audits
C) The American Osteopathic Association
D) A clean claim - CORRECT ANSWERS-A) A comprehensive accreditation process
What is tiering?
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per episode of care
B) Healthcare coverage products featuring narrow networks, high cost sharing and very low premiums
C) An effort by insurers to increase premiums and to address calls from employers and the public for
improved quality
D) The ranking or classifying of one or more of the provider delivery system components to influence
choice - CORRECT ANSWERS-D) The ranking or classifying of one or more of the provider
delivery system components to influence choice
Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
B) Family medical history
C) Type of service
D) Procedure code - CORRECT ANSWERS-B) Family medical history
Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation ACT (COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48 months for
qualifying events
, B) COBRA coverage begins on the date that healthcare coverage would otherwise have been lost
because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events to be
eligible for benefits
D) Group health coverage for COBRA participants is usually more expensive than health coverage for
active employee - CORRECT ANSWERS-A) COBRA beneficiaries generally are eligible for group
coverage during a maximum of 48 months for qualifying events
Which of the following is a managed care trend that can reduce utilization and costs because patients
pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
D) Growth in participation in Medicare managed care plans - CORRECT ANSWERS-B) Growth
in high-deductible health plans with a Health Savings (HSA) option
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed payment - CORRECT ANSWERS-C) Notifies member of non-
covered service
The appropriate addition of some risk in the exchange of health care to a patient for some form of
remuneration, is also known as:
ANSWERS/EXPERT VERIFIED FOR GUARANTEED PASS!/LATEST
UPDATE
RBRVS is:
A) The relative weight for calculating MS-DRG payments
B) The relative weight for calculating OPPS payments
C) Mediare physician payment relative weights
D) Acronym for Real Based Reference Verification System - CORRECT ANSWERS-C) Mediare
physician payment relative weights
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient may be transferred
from one hospital to another when in a(n) condition:
A) Life threatening
B) Non-emergency
C) Stable
D) Chronic - CORRECT ANSWERS-A) Life threatening
STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
C) Services provided by hospitals
D) Services provided by physicians - CORRECT ANSWERS-B) Medicare Advantage health plan
performance
To evaluate an organization's compliance with the CMS COP standards and other accreditation
requirements, is the purpose of:
,A) A comprehensive accreditation process
B) Recovery Audits
C) The American Osteopathic Association
D) A clean claim - CORRECT ANSWERS-A) A comprehensive accreditation process
What is tiering?
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per episode of care
B) Healthcare coverage products featuring narrow networks, high cost sharing and very low premiums
C) An effort by insurers to increase premiums and to address calls from employers and the public for
improved quality
D) The ranking or classifying of one or more of the provider delivery system components to influence
choice - CORRECT ANSWERS-D) The ranking or classifying of one or more of the provider
delivery system components to influence choice
Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
B) Family medical history
C) Type of service
D) Procedure code - CORRECT ANSWERS-B) Family medical history
Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation ACT (COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48 months for
qualifying events
, B) COBRA coverage begins on the date that healthcare coverage would otherwise have been lost
because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events to be
eligible for benefits
D) Group health coverage for COBRA participants is usually more expensive than health coverage for
active employee - CORRECT ANSWERS-A) COBRA beneficiaries generally are eligible for group
coverage during a maximum of 48 months for qualifying events
Which of the following is a managed care trend that can reduce utilization and costs because patients
pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
D) Growth in participation in Medicare managed care plans - CORRECT ANSWERS-B) Growth
in high-deductible health plans with a Health Savings (HSA) option
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed payment - CORRECT ANSWERS-C) Notifies member of non-
covered service
The appropriate addition of some risk in the exchange of health care to a patient for some form of
remuneration, is also known as:
