CSPR - Certified Specialist Payment Rep (HFMA) Exam Practice Questions and Answers
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Course
2024/2025
Institution
2024/2025
CSPR - Certified Specialist Payment Rep
(HFMA) Exam Practice Questions and
Answers
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 ...
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.
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 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.
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