HFMA CSPR Course 6 Comprehensive Final Exam Review Q & A 2026 (Complete And Verified Study material) (17pages) LEARNEXAMS

1. What is the primary goal of utilization management in managed care settings? - A) To increase healthcare costs - B) To reduce patient access to care - C) To ensure appropriate use of medical services - D) To limit the autonomy of healthcare providers Answer: C) To ensure appropriate use of medical services Rationale: Utilization management aims to ensure that patients receive the necessary care at the right time, avoiding underuse or overuse of medical services. 2. Which of the following best describes case management in managed care? - A) A process focused solely on cost reduction - B) A method to deny necessary medical services to patients - C) A collaborative process of assessment, planning, and coordination of care - D) An approach to increase healthcare provider workload Answer: C) A collaborative process of assessment, planning, and coordination of care Rationale: Case management involves a team-oriented approach to ensure that a patient's healthcare needs are met efficiently and effectively. 3. How does evidence-based practice influence utilization management decisions? - A) It has no impact on decision-making - B) It relies on anecdotal experiences rather than research - C) It guides decisions based on the best available research evidence - D) It prioritizes cost over quality of care Answer: C) It guides decisions based on the best available research evidence Rationale: Evidence-based practice ensures that utilization management decisions are informed by the latest and most reliable medical research, promoting quality care. 4. In the context of managed care, what is the role of a gatekeeper? - A) To prevent patients from receiving any medical care