HFMA CSPR Course 1 Comprehensive Final Exam Review Q & A 2026 Complete And Study material 25pages LEARNEXAMS

1. What is the primary goal of managed care? a) To provide unlimited healthcare services b) To manage the cost of healthcare c) To centralize healthcare services d) To deregulate the healthcare industry Answer: b) To manage the cost of healthcare Rationale: Managed care aims to control healthcare costs while maintaining quality of care through various mechanisms such as network selection, negotiated rates, and utilization review. 2. Which of the following is a key feature of Health Maintenance Organizations (HMOs)? a) Fee-for-service payment model b) Out-of-network coverage c) Gatekeeper model for specialist services d) High-deductible health plans Answer: c) Gatekeeper model for specialist services Rationale: HMOs typically require a primary care physician to act as a gatekeeper to specialist services, which helps to control costs and ensure coordinated care. 3. What does capitation payment involve? a) Providers are paid for each service rendered b) Providers are paid a set amount for each enrolled person assigned to them c) Patients pay out-of-pocket for all healthcare services d) Providers receive bonuses for high patient scores Answer: b) Providers are paid a set amount for each enrolled person assigned to them Rationale: Capitation is a payment arrangement where providers are paid a set fee per patient regardless of how many services the patient uses, incentivizing efficient care delivery. 4. Which entity is primarily responsible for accrediting managed care organizations? a) The Centers for Medicare & Medicaid Services (CMS) b) The National Committee for Quality Assurance (NCQA) c) The Joint Commission