HFMAl CSPRl Examl Guidel (Latestl 2025/l 2026l Update)l Questionsl &l Answers|l Gradel A|l 100%l Correctl (Verifiedl Solutions)
Q:l Balancedl Budgetl Actl ofl 1997l Objectives
Answer:
Decreasel Medicarel reimbursementl levels,l Mandatel anl endl tol thel mostl areasl ofl cost- basedl reimbursementl andl Medicarel Partl Cl plans
Q:l Inpatientl Prospectivel Paymentl Systeml (IPPS)
Answer:
systeml inl whichl Medicarel reimbursesl hospitalsl forl inpatientl hospitall servicesl accordingl tol al predeterminedl ratel forl eachl discharge.
Q:l Outpatientl Prospectivel Paymentl Systeml (OPPS)
Answer:
Thel Medicarel prospectivel paymentl systeml usedl forl hospital-basedl outpatientl servicesl andl proceduresl thatl isl predicatedl onl thel assignmentl ofl ambulatoryl paymentl classifications
Q:l Medicarel Paymentsl tol Physicians
Answer:
Partl B
Q:l Purposel ofl Medicarel Valuel Basedl purchasingl (VBP)l programs
Answer: 1 / 3
Providesl differentiall paymentsl tol physiciansl basedl onl thel qualityl ofl carel provided
Q:l MSPQ
Answer:
Questionsl tol bel askedl tol patientsl inl orderl tol helpl determinel ifl Medicarel isl primaryl orl secondaryl forl thel patient'sl servicel thatl isl aboutl tol bel provided.
Q:l Advancedl Beneficiaryl Noticel (ABN)
Answer:
documentl givenl tol medicarel beneficiariesl indicatingl thel servicesl medicarel isl unlikelyl tol payl for
Q:l Medicarel Outpatientl Observationl Noticel (MOON)
Answer:
Al forml givenl tol Medicarel beneficiariesl tol informl theml ofl theirl outpatientl observationl statusl andl tol explainl tol theml whatl thatl mayl meanl financially.
Q:l Consumerl Billl ofl Rights
Answer:
codifiedl thel ethicsl ofl exchangel betweenl buyersl andl sellers,l includingl rightsl tol safety,l tol bel informed,l tol choose,l andl tol bel heard.
Q:l Financiall disclosure
Answer:
Physiciansl arel requiredl tol disclosel tol Medicarel anyl financiall arrangementsl thatl createl incentivel forl limitingl care
Q:l Participationl inl treatmentl decisions
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Answer:
Addressesl communicationl aboutl Treatmentl optionsl andl Advancel directives;l Physicians'l financiall disclosure'l andl Prohibitionl againstl gagl rules
Q:l Confidentialityl ofl healthl information
Answer:
Requiresl MAl plansl tol safeguardl thel privacyl ofl anyl informationl thatl identifiesl al particularl enrolee.
Q:l Overalll functionl ofl Medicaid
Answer:
Payl forl medicall assistancel forl certainl individualsl andl low-incomel families
Q:l Medicall Lossl Ratiol (MLR)
Answer:
Thel differencel ofl healthcarel costsl tol revenuel received.l Calculatedl asl totall medicall expensel dividedl byl totall revenue.
Q:l Provider-sponsoredl organizationl (PSO)
Answer:
Typel ofl point-of-servicel planl inl whichl thel physiciansl thatl practicel inl al regionall orl communityl hospitall organizel thel plan
Q:l Costl Sharing
Answer:
Provisionl ofl al healthcarel insurancel policyl thatl requiresl policyholdersl tol payl forl al portionl ofl theirl healthcarel services;l al cost-controll mechanism.
Q:l Gatekeeper
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