CSPR - CERTIFIED SPECIALIST
PAYMENT REP (HFMA) 2024 LATEST
UPDATED 350 QUESTIONS WITH
DETAILED VERIFIED AND 100%
CORRECT ANSWERS ACTUAL BRAND-
NEW EXAM
ALREADY GRADED A+
All of the following are true regarding a non-direct PPO,
EXCEPT:
A) Many providers sign such agreements, without
understanding that there is little volume promised in
exchange for any preferred rates
B) Many providers sign such agreements, without
understanding that there is no specific steerage to
contracted providers
C) The arrangements does not discount provider fees with
no incentives for patients to access the provider's services
D) Such PPO's or networks are national networks -
....ANSWER...C) The arrangements does not discount
1
,provider fees with no incentives for patients to access the
provider's services
Which fixed-rate payment method uses a single price for
an inpatient stay, outpatient procedure, or outpatient
diagnosis if charges exceed a threshold dollar amount?
A) Per diem payments
B) Carve-outs
C) Inpatient Stop-Loss
D) Case rate payments - ....ANSWER...D) Case rate
payments
RBRVS is:
A) The relative weight for calculating MS-DRG payments
B) The relative weight for calculating OPPS payments
C) Medicare physician payment relative weights
D) Acronym for Real Based Reference Verification
System - ....ANSWER...C) Medicare physician
payment relative weights
When explaining managed care, the most appropriate time
refers to:
2
,A) The least costly
B) The right amount of care provided (and will be billed
and paid for)
3
, C) Medical intervention at the earliest possible time to
prevent a bad situation from becoming unnecessarily
worse
D) The least intensive setting required to provide the care
appropriately - ....ANSWER...D) The least intensive
setting required to provide the care appropriately
Detailed contract performance assessments; negotiating-
strategy planning briefs; and financial and volume analysis
models are all:
A) Tools used to optimize contract performance
B) Key components of a typical contract audit
C) Performance evaluation tools
D) Contract evaluation criteria - ....ANSWER...A) Tools
used to optimize contract performance
The medical cost ratio is equal to the:
A) Total medical expenses divided by total premiums
B) Total Medicare payments divided by the total premiums
C) Total resource allocation costs divided by total
premiums
4
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller EliteExamsPlug. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $16.49. You're not tied to anything after your purchase.
