HFMA Certified Specialist Payment & Reimbursement (CSPR) Exam Guide (Latest Update 2025 / 2026) Full Course Questions & Answers | Grade A | 100% Correct (Verified Solutions)
Question:
claims adjudication
Answer:
Term used in the insurance industry for the process of paying or denying claims based on the patient's plan/coverage
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Patient Bill of Rights
Answer:
Established in 1973, a list of rights that are designed to protect both the patient and HCP
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Question:
Leapfrog Group
Answer:
Organization that promotes healthcare safety by giving consumers the information they need to make better-informed choices about the hospitals they choose
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HSA -health savings account
Answer:
An account used in association with a medical plan that carries a high deductible
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ACO Benefits
Answer:
A system of providers and facilities that can work in concert to care for a given patient population.
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Question:
Healthcare Report Cards groups
Answer:
Required National Performance Measurement Reporting Initiatives, Voluntary National Performance Measurement Reporting Initiatives, Employer Coalition Performance Measure Reporting Initiatives.
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COBRA (Consolidated Omnibus Budget Reconciliation Act)
Answer:
Provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. 60 Days
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EMTALA (Emergency Medical Treatment and Active Labor Act)
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Governs when and how a patient presenting at a hospital may be refused treatment or may be transferred from one hospital to another when in an unstable condition
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URAC (Utilization Review Accreditation Commission)
Answer:
This independent, nonprofit organization, since 1991 through the beginning of 1996, has offered a specialty accreditation program for utilization review functions.
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Recovery Audit Contractor (RAC)
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A 3rd-party entity working under the direction of CMS to detect improper Medicare payments through review of providers' medical records an Medicare claims data
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DNV GL
Answer:
Accreditation utilizing the ISO 9001 quality management system that emphasizes continual improvement and requires an annual onsite survey. A hospital must be certified to the ISO 9001 requirements within two years of its initial accreditation.
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