CSPR - Certified Specialist Payment Rep (HFMA) Study Guide
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Course
2024/2025
Institution
2024/2025
CSPR - Certified Specialist Payment Rep
(HFMA) Study Guide
Steps used to control costs of managed care include: - Answer-Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
DRG is used to classify - Answer-Inpatient admissions for the purpose of reimbursing
hospitals fo...
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 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.
What is the overall function of Medicaid? - Answer✔✔-The pay for medical assistance for
certain individuals and low-income families
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