CSPR - CERTIFIED SPECIALIST PAYMENT REP
(HFMA) 2024 ACTUAL EXAM COMPLETE 300+
QUESTIONS WITH DETAILED VERIFIED
ANSWERS (WITH RATIONALES) /ALREADY
GRADED A+
Medicare is composed of four parts: - Answer-Part A
- provides inpatient/hospital, hospice, and skilled
nursing coverage
Part B - ...
Medicare is composed of four parts: - 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
HMO Act of 1973 - Answer-The HMO Act of 1973
gave federally qualified HMOs the right to mandate
that employers offer their product to their employees
under certain conditions. Mandating an employer
meant that employers who had 25 or more
employees and were for‐profit companies were
required to make a dual choice available to their
employees.
, 2
Which of the following statements regarding
employer-based health insurance in the United
States is true? - Answer-The real advent of
employer-based insurance came through Blue
Cross, which was started by hospital associations
during the Depression.
The Health Maintenance Organization (HMO) Act of
1973 gave qualified HMOs the right to "mandate" an
employer under certain conditions, meaning
employers: - Answer-Would have to offer HMO plans
along side traditional fee-for-service medical plans.
Which of the following is an anticipated change in
the relationships between consumers and
providers? - Answer-Providers will face many new
service demands and consumers will have virtually
unfettered access to those services
What transition began as a result of the March 2010
healthcare reform legislation? - Answer-A transition
toward new models of health care delivery with
, 3
corresponding changes system financing and
provider reimbursement.
Which statement is false concerning ABNs? -
Answer-ABN began establishing new requirements
for managed care plans participating in the Medicare
program.
Which Statement is TRUE concerning ABNs? -
Answer--ABNs are not required for services that are
never covered by Medicare.
-An ABN form notifies the patient before he or she
receives the service that it may not be
covered by Medicare and that he or she will need to
pay out of pocket.
-Although ABNs can have significant financial
implications for the physician, they also
serve an important fraud and abuse compliance
function.
, 4
What is the overall function of Medicaid? - Answer-
The pay for medical assistance for certain
individuals and low-income families
Medical Cost Ratio (MCR) or Medical Loss Ratio
(MLR) is defined as: - Answer-Total Medical
Expenses divided by Total Premiums
Provider service organizations (PSOs) function like
health maintenance organizations (HMOs) in all of
the following ways, EXCEPT: - Answer-Ties to the
healthcare delivery industry rather than the
insurance industry
Provider service organizations (PSOs) function like
health maintenance organizations (HMOs) in all of
the following ways: - Answer--Risk pooling
-Capitalization
-Network management
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