CSPR - Certified Specialist Payment Rep
(HFMA) ACTUAL Exam 2026 MOST
Recent Tested,Actual Exam Questions
(2026) WITH Recent Newest Verified
And Well Analyzed Exam Questions
(Actual Exam 2026-2027) Correct
Detailed & Verified ANSWERS (100%
Accurate Solutions) ||ALREADY
GRADED A+||Exam Guarantee Pass!!
Steps used to control costs of managed care include: - ANSWERS-Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
Provider service organizations (PSOs) function like health maintenance organizations
(HMOs) in all of the following ways: - ANSWERS--Risk pooling
-Capitalization
-Network management
Which of the following is a service provided by a well-managed third-party administrator
(TPA)? - ANSWERS--Administrative
-Utilization review (UR)
-Claims processing
,What is tiering? - ANSWERS-The ranking or classifying of one or more of the provider
delivery system components
Which option is a practice used to control costs of managed care? - ANSWERS--
Making advance payment to providers for all services needed to care for a member
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment for each service.
Which option is a risk involved in per diem payments? - ANSWERS--The risk to the
insurance company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
Diagnosis-related group (DRG) is: - ANSWERS-A payment category
How is the term carve-out used when discussing managed care? - ANSWERS-To refer
to specific benefits or services
What is the term Coordination of Benefits (COB)? - ANSWERS-A term used to describe
how payment is coordinated for patients who have coverage through two insurance
policies
Which three components are used to determine the total RVU value for a service? -
ANSWERS--Malpractice expense
-Lowest market price for services used
-Medicare discounts
A fixed payment amount based upon the number of members assigned to a provider,
and does not vary based upon the number of services rendered, is known as: -
ANSWERS-Capitation
, Aligning incentives has come to mean _________. - ANSWERS-The appropriate
addition of some risk in the exchange of health care to a patient for some form of
remuneration.
According to MedPAC, which option is a benefit or undesirable consequence of
bundling
payments? - ANSWERS--It allows Medicare to pay a set fee per hospitalization
episode.
-It would provide the potential to improve efficiency and quality
-It would lead to underutilization of services
As the healthcare industry moves to control growth in medical spending, what initiative
can help hospitals maintain their margins? - ANSWERS-Contract standardization
As the healthcare industry moves to control growth in medical spending, what initiative
can NOT help hospitals maintain their margins? - ANSWERS--Pay-for-performance
programs
-Health savings accounts
-Price transparency
Identify which initiatives are focused on in an effort to help increase an organization's
revenue/profit /margins. - ANSWERS--Health plan consolidation
-Payment policing and standardization of contract requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
What are rating tiers? - ANSWERS-Different rates charged on the basis of the number
and relationships
What is the role of reinsurance? - ANSWERS-Reinsurance seeks to limit a
policyholder's liability for catastrophic claims
(HFMA) ACTUAL Exam 2026 MOST
Recent Tested,Actual Exam Questions
(2026) WITH Recent Newest Verified
And Well Analyzed Exam Questions
(Actual Exam 2026-2027) Correct
Detailed & Verified ANSWERS (100%
Accurate Solutions) ||ALREADY
GRADED A+||Exam Guarantee Pass!!
Steps used to control costs of managed care include: - ANSWERS-Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
Provider service organizations (PSOs) function like health maintenance organizations
(HMOs) in all of the following ways: - ANSWERS--Risk pooling
-Capitalization
-Network management
Which of the following is a service provided by a well-managed third-party administrator
(TPA)? - ANSWERS--Administrative
-Utilization review (UR)
-Claims processing
,What is tiering? - ANSWERS-The ranking or classifying of one or more of the provider
delivery system components
Which option is a practice used to control costs of managed care? - ANSWERS--
Making advance payment to providers for all services needed to care for a member
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment for each service.
Which option is a risk involved in per diem payments? - ANSWERS--The risk to the
insurance company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
Diagnosis-related group (DRG) is: - ANSWERS-A payment category
How is the term carve-out used when discussing managed care? - ANSWERS-To refer
to specific benefits or services
What is the term Coordination of Benefits (COB)? - ANSWERS-A term used to describe
how payment is coordinated for patients who have coverage through two insurance
policies
Which three components are used to determine the total RVU value for a service? -
ANSWERS--Malpractice expense
-Lowest market price for services used
-Medicare discounts
A fixed payment amount based upon the number of members assigned to a provider,
and does not vary based upon the number of services rendered, is known as: -
ANSWERS-Capitation
, Aligning incentives has come to mean _________. - ANSWERS-The appropriate
addition of some risk in the exchange of health care to a patient for some form of
remuneration.
According to MedPAC, which option is a benefit or undesirable consequence of
bundling
payments? - ANSWERS--It allows Medicare to pay a set fee per hospitalization
episode.
-It would provide the potential to improve efficiency and quality
-It would lead to underutilization of services
As the healthcare industry moves to control growth in medical spending, what initiative
can help hospitals maintain their margins? - ANSWERS-Contract standardization
As the healthcare industry moves to control growth in medical spending, what initiative
can NOT help hospitals maintain their margins? - ANSWERS--Pay-for-performance
programs
-Health savings accounts
-Price transparency
Identify which initiatives are focused on in an effort to help increase an organization's
revenue/profit /margins. - ANSWERS--Health plan consolidation
-Payment policing and standardization of contract requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
What are rating tiers? - ANSWERS-Different rates charged on the basis of the number
and relationships
What is the role of reinsurance? - ANSWERS-Reinsurance seeks to limit a
policyholder's liability for catastrophic claims
