Reimbursement CSPR Exam

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

Question:

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

Question:

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)

Answer:

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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Question:

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.

Question:

Recovery Audit Contractor (RAC)

Answer:

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

Question:

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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