HFMA CSPR Course 3 Final Exam Review Q & A 2026 (Complete And Verified Study material) (21pages) LEARNEXAMS

1. What is the primary goal of Managed Care Organizations (MCOs)? a) To increase healthcare costs b) To provide comprehensive services c) To limit access to healthcare providers d) To manage patient care and control healthcare costs Answer: d) To manage patient care and control healthcare costs Rationale: MCOs aim to provide quality care while controlling costs through various mechanisms such as provider networks, negotiated rates, and utilization review. 2. Which model of managed care emphasizes a strong primary care foundation? a) Preferred Provider Organization (PPO) b) Health Maintenance Organization (HMO) c) Point of Service (POS) d) Exclusive Provider Organization (EPO) Answer: b) Health Maintenance Organization (HMO) Rationale: HMOs typically require members to choose a primary care physician who coordinates all healthcare services and provides referrals to specialists. 3. In a Capitation payment model, how are providers paid? a) Based on the number of services provided b) A set fee for each enrolled person assigned to them, per period of time c) Based on the quality outcomes of the care provided d) A percentage of the reduced costs they achieve for the MCO Answer: b) A set fee for each enrolled person assigned to them, per period of time Rationale: Capitation involves payment of a fixed amount for each patient assigned to a provider for a set period, regardless of the actual number or nature of services provided. 4. What is the role of a Gatekeeper in an HMO? a) To process insurance claims b) To provide specialized care c) To coordinate patient care and control access to specialists d) To negotiate contracts with providers