CSPR - Certified Specialist Payment Rep (HFMA) Exam with Complete Solutions
Question: Which of the following statements regarding
employer-based health insurance in the United States is true?
Correct answer: The real advent of employer-based insurance
came through Blue Cross, which was started by hospital associations during the Depression.
Question: The Health Maintenance Organization (HMO) Act
of 1973 gave qualified HMOs the right to "mandate" an
employer under certain conditions, meaning employers:
Correct answer: Would have to offer HMO plans along side
traditional fee-for-service medical plans.
Question: Which of the following is an anticipated change in
the relationships between consumers and providers?
Correct answer: Providers will face many new service
demands and consumers will have virtually unfettered access to those services.
Question: Which statement is false concerning ABNs?
Correct answer: ABN began establishing new requirements
for managed care plans participating in the Medicare program.
Question: Which Statement is TRUE concerning ABNs?
Correct 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.
Question: Which option is a practice used to control costs of
managed care?
Correct answer: -Making advance payment to providers for
all services needed to care for a member -Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment for each service.
Question: Which option is a risk involved in per diem
payments?
Correct answer: -The risk to the insurance company or health
plan -The risk to the hospital -The risk when embracing per diem payments in complex case
Question: Which three components are used to determine the
total RVU value for a service?
Correct answer: -Malpractice expense
-Lowest market price for services used -Medicare discounts
Question: According to MedPAC, which option is a benefit or
undesirable consequence of bundling payments?
Correct answer: -It allows Medicare to pay a set fee per
hospitalization episode.-It would provide the potential to improve efficiency and quality -It would lead to underutilization of services
Question: As the healthcare industry moves to control growth
in medical spending, what initiative can NOT help hospitals maintain their margins?
Correct answer: -Pay-for-performance programs
-Health savings accounts -Price transparency
Question: Which option is a service provided by a well-
managed third-party administrator (TPA)?
Correct answer: -Administrative
-Utilization review (UR) -Claims processing