HFMA CSPR EXAM AND STUDYGUIDE NEWEST

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HFMA CSPR EXAM AND STUDYGUIDE NEWEST

2025 ACTUAL EXAM COMPLETE 200

QUESTIONS AND CORRECT DETAILED

ANSWERS (VERIFIED ANSWERS) |100%

GUARANTEED PASS!

HFMA CSPR EXAM

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:

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• Medical records review & Member rights and

responsibilities

• 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:

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• Identifying the correct primary/secondary insure for

proper payment

• Determining charity care
• Identifying the patient copay at the time of service
• Ensuring appropriate care is provided - ANSWER-A)

Identifying the correct primary/secondary insure for proper payment

Patient and/or enrollee identification, age, gender, date of

service, and diagnosis codes are all regarded as:

• Information not necessary for claims processing
• Required information for health plans reporting
• Information used to establish expected reimbursement
• Information required for claims processing -

ANSWER-D) Information required for claims processing

When modeling the proposed payer's contractual

reimbursement, you should include: 3 / 4

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• All claim data
• All Medicare claim data
• All commercial claim data
• Payer specific claim data - ANSWER-D) Payer

specific claim data

Which of the following is not examined in a concurrent utilization management review?

• Case management
• Discharge Planning
• Physician group
• Length of stay - ANSWER-C) Physician group

Which option is NOT a utilization management technique?

• Retrospective UM Techniques
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