CSPR CERTIFIED SPECIALIST PAYMENT REP

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CSPR CERTIFIED SPECIALIST PAYMENT REP

HFMA ACTUAL EXAM NEWEST 2025

COMPLETE 200 QUESTIONS AND CORRECT

DETAILED ANSWERS (VERIFIED ANSWERS)

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VERSION!!

The No Surprise Act was a product of:

• The Health Insurance Portability Act
• The Consolidation Appropriations Act
• The Treaty of Algeron
• The Affordable Care Act
• The Affordable Care Act

Correct answer: B) The Consolidation Appropriations Act

Which of the following is an advantage of direct contracting?

• Providers do not have to adjudicate claims for payment
• Employers can save the cost of working with an insurance

company

• It allows the patients to have a choice of providers and

physicians

• Providers can work directly with employers to reduce the

cost of providing insurance

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• Providers can work directly with employers to reduce the

cost of providing insurance

Correct answer: B) Employers can save the cost of working with

an insurance company

Accountable Care Organizations (ACOs) have all of the

following characteristics EXCEPT:

• Patient centric care model
• Financial incentive for quantity of care
• Integrated care coordination
• Electronic Medical Record System
• Financial incentive for quantity of care

Correct answer: B) Financial incentive for quantity of care

The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient may be transferred from one hospital to

another when in a(n) condition:

• Life threatening
• Non-emergency
• Stable
• Chronic
• Life threatening

Correct answer: A) Life threatening

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STAR ratings are used to indicate the quality of:

• Accountable Care Organizations performance
• Medicare Advantage health plan performance
• Services provided by hospitals
• Services provided by physicians
• Medicare Advantage health plan performance

Correct answer: B) Medicare Advantage health plan

performance

To evaluate an organization's compliance with the CMS COP standards and other accreditation requirements, is the purpose

of:

• A comprehensive accreditation process
• Recovery Audits
• The American Osteopathic Association
• A clean claim
• A comprehensive accreditation process

Correct answer: A) A comprehensive accreditation process

What is tiering?

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• Typically fixed dollar amounts paid by the insured directly to

the practitioner per episode of care

• Healthcare coverage products featuring narrow networks,

high cost sharing and very low premiums

• An effort by insurers to increase premiums and to address

calls from employers and the public for improved quality

• The ranking or classifying of one or more of the provider

delivery system components to influence choice

• The ranking or classifying of one or more of the provider

delivery system components to influence choice

Correct answer: D) The ranking or classifying of one or more of

the provider delivery system components to influence choice

Which piece of information is NOT necessary for claims processing?

• Provider or referring provider identification
• Family medical history
• Type of service
• Procedure code
• Family medical history

Correct answer: B) Family medical history