Reimbursement CSPR Exam

HFMA Certified Specialist Payment & Reimbursement (CSPR) Exam (Latest Update 2025 / 2026) Review Questions & Answers | Grade A | 100% Correct (Verified Solutions)

Question:

The legislation that governs health benefit plans of self-insured, self-funded

employers in the United States is known as:

• The Employee Retirement Income Security Act of 1974 (ERISA)
• Det Norske Veritas
• The 1986 Consolidated Omnibus Budget Reconciliation Act (COBRA)
• The Health Maintenance Organization Act of 1973

Answer:

• The Employee Retirement Income Security Act of 1974 (ERISA)

• / 4

Question:

To promote healthcare quality through accreditation and certification

programs, is the purpose of:

A) URAC

B) ERISA

C) COBRA

D) EMTALA

Answer:

A) URAC

Question:

The law that encompasses all health benefit issues of a self-funded health

insurance plan, including administrator competence, is called the:

• HMO Act
• Employee Self-Funded Plan Act (ESPA)
• Employee Retirement Income Security Act (ERISA)
• Affordable Care Act (ACA)

Answer:

• Employee Retirement Income Security Act (ERISA)
• / 4

Question:

Hospitals, health systems, and large physician groups are likely to have robust governance models with supporting organizational infrastructure to oversee and carry out managed care operations. Small Physician groups could have all

of the following, EXCEPT:

• Relationships with large provider organizations to share managed care

operations

• Outsource managed care operations
• Similar operations only for chargemaster price estimation
• Reliance on a core set of individuals to direct and administer managed care

operations

Answer:

• Similar operations only for chargemaster price estimation

Question:

The Patient Centered Medical Home model is expected to reduce costs by:

• All of the above
• Reducing emergency room visits
• Reducing inpatient admissions
• Increasing preventive care

Answer:

• All of the above 3 / 4

Question:

One way that the term carve-out is used when discussing managed care is:

• Referring to benefits that are administered separately from the rest of

Medicaid

• Referring to specific benefits or services that are administered together

with the rest of managed care plan

• Referring to a broad range of benefits or services that are administered

separately from the rest of the managed care plan

• Referring to specific benefits or services that are administered separately

from the rest of the managed care plan

Answer:

• Referring to specific benefits or services that are administered separately

from the rest of the managed care plan

Question:

The following are quality-related outcomes that can be measured except:

• Transplant quality indicators
• Risk-adjusted mortality rates
• Level of physician compensation
• Readmission rates

Answer:

• Level of physician compensation
• / 4