CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) QUESTIONS AND ANSWERS

CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) QUESTIONS AND ANSWERS
Question :Steps used to control costs of managed care
include:
Bundled codesCapitation Payer and Provider to agree on
reasonable payment
Correct Answer:Bundled codesCapitation Payer and
Provider to agree on reasonable payment
Question :DRG is used to classify
Inpatient admissions for the purpose of reimbursing hospitals
for each case in a given category w/a negotiated fixed fee,
regardless of the actual costs incurred
Correct Answer:Inpatient admissions for the purpose of
reimbursing hospitals for each case in a given category w/a
negotiated fixed fee, regardless of the actual costs incurred
Question :Identify the various types of private health plan
coverage
HMOConventionalPPO and POSHDHP/SO plans - highdeductible health plans with a savings option; Private -
Include higher patient out-of-pocket expenditures for
treatments that can serve to reduce utilization/costs.
Correct Answer:HMOConventionalPPO and
POSHDHP/SO plans - high-deductible health plans with a
savings option; Private - Include higher patient out-of-pocket
expenditures for treatments that can serve to reduce
utilization/costs.

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