,10/7/24, 7:36 AM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) 2024 ACTUAL EXAM COMPLETE 350 QUESTIONS WITH DETAI…
Which of the following is D) Providers can work directly with employers to
an advantage of direct reduce the cost of providing insurance
contracting?
A) Providers do not have
to adjudicate claims for
payment
B) Employers can save
the cost of working with
an insurance company
C) It allows the patients
to have a choice of
providers and physicians
D) Providers can work
directly with employers
to reduce the cost of
providing insurance
Accountable Care B) Financial incentive for quantity of care
Organizations (ACOs)
have all of the following
characteristics EXCEPT:
A) Patient centric care
model
B) Financial incentive for
quantity of care
C) Integrated care
coordination
D) Electronic Medical
Record System
,10/7/24, 7:36 AM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) 2024 ACTUAL EXAM COMPLETE 350 QUESTIONS WITH DETAI…
The Emergency A) Life threatening
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
STAR ratings are used to B) Medicare Advantage health plan performance
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
To evaluate an A) A comprehensive accreditation process
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
, 10/7/24, 7:36 AM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) 2024 ACTUAL EXAM COMPLETE 350 QUESTIONS WITH DETAI…
What is tiering? D) The ranking or classifying of one or more of the
provider delivery system components to influence
A) Typically fixed dollar choice
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
Which piece of B) Family medical history
information is NOT
necessary for claims
processing?
A) Provider or referring
provider identification
B) Family medical history
C) Type of service
D) Procedure code
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