HFMA CSPR Course 7 Final Exam Review Q & A 2026 Complete And Study material 16pages LEARNEXAMS

1. What is the primary goal of managed care organizations (MCOs) in the healthcare system? - A) To increase the cost of healthcare - B) To provide specialized care for chronic conditions - C) To manage the quality and cost of healthcare - D) To focus solely on patient Answer: C) To manage the quality and cost of healthcare Rationale: The main objective of MCOs is to deliver quality care while controlling healthcare 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 and requires referrals for specialist services? - A) Preferred Provider Organization (PPO) - B) Health Maintenance Organization (HMO) - C) Exclusive Provider Organization (EPO) - D) Point of Service (POS) Answer: B) Health Maintenance Organization (HMO) Rationale: HMOs typically require members to select a primary care physician who acts as a gatekeeper to direct access to specialized care, thus emphasizing a strong primary care base. 3. In a capitation payment model, how is the provider compensated? - 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 savings achieved from managing care 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 number or nature of services provided. 4. What is the role of a payor in managed care infrastructure? - A) To deliver healthcare services to patients - B) To negotiate contracts with providers