HFMA CSPR Course 6 Final Exam Review Q & A 2026 Complete And Study material 24pages LEARNEXAMS

1. What is the primary goal of Utilization Management in healthcare? A) Reducing the quality of care B) Increasing patient C) Balancing cost with quality D) Decreasing healthcare accessibility Answer: C) Balancing cost with quality Rationale: UM aims to optimize healthcare delivery by ensuring patients receive necessary, appropriate, and high-quality care without unnecessary costs. 2. Which of the following is a key function of Utilization Management? A) Patient scheduling B) Clinical documentation C) Resource allocation D) Marketing strategies Answer: C) Resource allocation Rationale: UM involves allocating medical resources effectively to improve patient outcomes and reduce wasteful spending. 3. In Utilization Management, what does the term 'medical necessity' refer to? A) The most expensive treatment available B) Treatments that are elective C) Services or treatments that are reasonable and necessary for diagnosis or treatment D) Services that are requested by the patient Answer: C) Services or treatments that are reasonable and necessary for diagnosis or treatment Rationale: Medical necessity is a cornerstone of UM, ensuring that provided services are essential for the patient's health and well-being. 4. Which entity typically performs Utilization Reviews in a hospital setting? A) The patient's family B) The attending physician C) An independent review organization D) The hospital's marketing department