HFMAl CSPRl Examl Reviewl (Latestl 2025/l 2026l Update)l Questionsl &l Answers|l Gradel A|l 100%l Correctl (Verifiedl Solutions)
Q:l Thel appropriatel additionl ofl somel riskl inl thel exchangel ofl healthl carel tol al patientl
forl somel forml ofl remuneration,l isl alsol knownl as:l
A)l Diagnosis-relatedl groupsl (DRG's) B)l Perl diems C)l Fee-for-Servicel reimbursementl D)l Aligningl incentives
Answer:
B)l Perl diems
Q:l Thel federall governmentl paysl al sharel ofl thel medicall assistancel expendituresl underl eachl state'sl Medicaidl program.l Howl isl thatl share,l knownl asl thel federall medicall assistancel percentagel (FMAP),l determined?
A)l Nonel ofl thel above B)l Byl usingl al formulal thatl comparesl thel statesl averagel perl capital incomel levell withl thel nationall incomel average C)l Byl rankingl statesl accordingl tol thel percentagel ofl residentsl atl thel povertyl levell D)l Byl averagingl thel percentagel paidl inl thel fivel previousl years
Answer:
B)l Byl usingl al formulal thatl comparesl thel statesl averagel perl capital incomel levell withl thel nationall incomel average
Q:l Thel differentl ratesl chargedl onl thel basisl ofl thel numberl andl relationshipsl ofl thel
peoplel coveredl underl onel employee'sl planl isl knownl as:
A)l Ratings 1 / 3
B)l Ratingl tiers C)l Structures D)l Tierl structures
Answer:
B)l Ratingl tiers
Q:l Al Patientl Centeredl Medicall Homel hasl alll thel followingl characteristicsl except:
A)l Comprehensivel andl continuousl care B)l Healthl informationl technology C)l Limitedl accessl tol care D)l Team-basedl carel delivery
Answer:
C)l Limitedl accessl tol care
Q:l Alll arel areasl thatl al NCQAl reviewl covers,l EXCEPT:l
A)l Medicall recordsl reviewl &l Memberl rightsl andl responsibilitiesl B)l Credentialingl reviewl &l Preventivel andl adaptivel healthl services C)l QAl reviewl &l UMl review D)l Physicianl rightsl andl responsibilitiesl &l Certificationl review
Answer:
D)l Physicianl rightsl andl responsibilitiesl &l Certificationl review
Q:l Theyl arel availablel tol everyone,l notl justl employeesl ofl al smalll businessl orl thel
self-employed.l Thisl isl al benefitl of:l
A)l NCQA B)l CDHP C)l Medicare D)l HSA
Answer:
C)l Medicare
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Q:l Coordinationl ofl Benefitsl isl essentiall to:l
A)l Identifyingl thel correctl primary/secondaryl insurel forl properl payment B)l Determiningl charityl care C)l Identifyingl thel patientl copayl atl thel timel ofl service D)l Ensuringl appropriatel carel isl provided
Answer:
A)l Identifyingl thel correctl primary/secondaryl insurel forl properl payment
Q:l Patientl and/orl enrolleel identification,l age,l gender,l datel ofl service,l andl diagnosisl
codesl arel alll regardedl as:l
A)l Informationl notl necessaryl forl claimsl processing B)l Requiredl informationl forl healthl plansl reportingl C)l Informationl usedl tol establishl expectedl reimbursement D)l Informationl requiredl forl claimsl processing
Answer:
D)l Informationl requiredl forl claimsl processing
Q:l Whenl modelingl thel proposedl payer'sl contractuall reimbursement,l youl shouldl
include:
A)l Alll claiml data B)l Alll Medicarel claiml data C)l Alll commerciall claiml data D)l Payerl specificl claiml data
Answer:
D)l Payerl specificl claiml data
Q:l Whichl ofl thel followingl isl notl examinedl inl al concurrentl utilizationl managementl review?
A)l Casel management B)l Dischargel Planning C)l Physicianl group
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