CSPR CERTIFIED SPECIALIST PAYMENT

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CSPR CERTIFIED SPECIALIST PAYMENT

REP HFMA ACTUAL EXAM NEWEST 2025

COMPLETE 200 QUESTIONS AND CORRECT

DETAILED ANSWERS (VERIFIED ANSWERS)

|ALREADY GRADED A+ ||BRAND NEW

VERSION!!

A Medicare Advanced Beneficiary Notice (ABN) provides the

following:

• Notifies member of alternative covered services
• Notifies member of a non-authorized procedure
• Notifies member of non-covered service
• Notifies member of guaranteed payment - ANSWER-C)

Notifies member of non-covered service

The appropriate addition of some risk in the exchange of health care to a patient for some form of remuneration, is also known

as: 1 / 4

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• Diagnosis-related groups (DRG's)
• Per diems
• Fee-for-Service reimbursement
• Aligning incentives - ANSWER-B) Per diems

The federal government pays a share of the medical assistance expenditures under each state's Medicaid program. How is that share, known as the federal medical assistance percentage (FMAP), determined?

• None of the above
• By using a formula that compares the states average per

capita income level with the national income average

• By ranking states according to the percentage of residents at

the poverty level

• By averaging the percentage paid in the five previous years -

ANSWER-B) By using a formula that compares the states average per capita income level with the national income average

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The different rates charged on the basis of the number and relationships of the people covered under one employee's plan is

known as:

• Ratings
• Rating tiers
• Structures
• Tier structures - ANSWER-B) Rating tiers

A Patient Centered Medical Home has all the following

characteristics except:

• Comprehensive and continuous care
• Health information technology
• Limited access to care
• Team-based care delivery - ANSWER-C) Limited access to

care

All are areas that a NCQA review covers, EXCEPT:

• Medical records review & Member rights and responsibilities 3 / 4

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• Credentialing review & Preventive and adaptive health

services

• QA review & UM review
• Physician rights and responsibilities & Certification review -

ANSWER-D) Physician rights and responsibilities & Certification review

They are available to everyone, not just employees of a small

business or the self-employed. This is a benefit of:

A) NCQA

B) CDHP

• Medicare
• HSA - ANSWER-C) Medicare

Coordination of Benefits is essential to:

• Identifying the correct primary/secondary insure for proper

payment

• Determining charity care
• Identifying the patient copay at the time of service
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