HFMA CSPR Course 10 Final Exam Review Q & A 2026 (Complete And Verified Study material) (8pages) LEARNEXAMS

1. What is the primary difference between direct contracting and thirdparty contracting in the healthcare industry? A. Direct contracting involves an agreement between the payer and provider, while third-party contracting involves a third-party intermediary. B. Direct contracting involves a fixed fee schedule, while third-party contracting involves a negotiated fee-for-service arrangement. C. Direct contracting is limited to specific services, while third-party contracting covers a range of services. D. Direct contracting is more expensive than third-party contracting due to administrative costs. Answer: A - Direct contracting involves an agreement between the payer and provider, while third-party contracting involves a third-party intermediary. Rationale: Direct contracting allows for direct negotiation between the payer and provider, while third-party contracting involves a third-party intermediary, such as an insurance company or managed care organization. 2. What is a Silent PPO in the context of healthcare contracting? A. A type of PPO that doesn't require prior authorization for services. B. A PPO that operates without the knowledge or consent of the provider. C. A PPO that offers discounted rates to members but not to providers. D. A PPO that only covers services from out-of-network providers. Answer: B - A PPO that operates without the knowledge or consent of the provider. Rationale: A Silent PPO is a type of PPO that allows payers to access discounted rates without the knowledge or consent of the provider, often leading to lower reimbursement rates. 3. What is the main difference between a non-directed PPO and a traditional PPO? A. Non-directed PPOs require members to choose a primary care provider, while traditional PPOs do not. B. Non-directed PPOs prioritize cost savings over network choice, while traditional PPOs focus on provider network access. C. Non-directed PPOs only cover services from in-network providers, while traditional PPOs offer out-of-network coverage. D. Non-directed PPOs are typically more expensive for members