CSPR - CERTIFIED SPECIALIST PAYMENT REP
(HFMA) EXAM WITH ACTUAL QUESTIONS AND
100% VERIFIED ANSWERS | LATEST 2025/ 2026
UPDATE | GRADED A+ | 100% SUCCESS
Medicare - correct 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: - correct 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: - correct
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) - correct answer --covers most
medically necessary hospital, skilled nursing facility, home
health, and hospice care services.
-It is free if you have worked and paid Social Security taxes for at least
40 calendar quarters (10 years); those who have worked and paid taxes
for less than 40 calendar quarters (10 years) are required to pay a fee
Mcare Part B (Medical Insurance) - correct answer -covers most
medically necessary doctors' services, preventive care, durable medical
equipment, hospital outpatient services, laboratory tests, x-rays, mental
health care, and some home health and ambulance services. An
additional monthly premium is paid for this coverage.
,Mcare Part C (Advantage) - correct answer --allows private health
insurance companies to provide Medicare
benefits.
-These Medicare private health plans are known as Medicare Advantage
Plans. These plans
must offer at least the same benefits as Original Medicare (those
covered under Parts A and B) but can do so with different rules, costs,
and coverage restrictions.
-Medicare Part C may also offer additional health coverage benefits; you
typically obtain Part D as part of a Medicare Advantage benefits
package. --You may pay a monthly premium for this coverage, in
addition to your Part B
premium.
Mcare Part D (Prescription) - correct answer --outpatient prescription
drug insurance, was established by the Medicare Prescription Drug,
Improvement, and Modernization Act (MMA) on January 1, 2006.
-Part D is provided only through private insurance companies that have
contracts with the government—it is never provided directly by the
government (like original Medicare is).
, Dual Eligibility - correct 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.
How is Mcare financed? - correct 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
(HFMA) EXAM WITH ACTUAL QUESTIONS AND
100% VERIFIED ANSWERS | LATEST 2025/ 2026
UPDATE | GRADED A+ | 100% SUCCESS
Medicare - correct 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: - correct 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: - correct
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) - correct answer --covers most
medically necessary hospital, skilled nursing facility, home
health, and hospice care services.
-It is free if you have worked and paid Social Security taxes for at least
40 calendar quarters (10 years); those who have worked and paid taxes
for less than 40 calendar quarters (10 years) are required to pay a fee
Mcare Part B (Medical Insurance) - correct answer -covers most
medically necessary doctors' services, preventive care, durable medical
equipment, hospital outpatient services, laboratory tests, x-rays, mental
health care, and some home health and ambulance services. An
additional monthly premium is paid for this coverage.
,Mcare Part C (Advantage) - correct answer --allows private health
insurance companies to provide Medicare
benefits.
-These Medicare private health plans are known as Medicare Advantage
Plans. These plans
must offer at least the same benefits as Original Medicare (those
covered under Parts A and B) but can do so with different rules, costs,
and coverage restrictions.
-Medicare Part C may also offer additional health coverage benefits; you
typically obtain Part D as part of a Medicare Advantage benefits
package. --You may pay a monthly premium for this coverage, in
addition to your Part B
premium.
Mcare Part D (Prescription) - correct answer --outpatient prescription
drug insurance, was established by the Medicare Prescription Drug,
Improvement, and Modernization Act (MMA) on January 1, 2006.
-Part D is provided only through private insurance companies that have
contracts with the government—it is never provided directly by the
government (like original Medicare is).
, Dual Eligibility - correct 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.
How is Mcare financed? - correct 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
