pg. 1
HFMA CSPR NEWEST 2024 COMPLETE 100 QUESTIONS
AND 100% CORRECT VERIFIED ANSWERS/ AGRADE
ASSURED!
The appropriate addition of some risk in the exchange of health care to a patient for
some form of remuneration, is also known as:
- Diagnosis-related groups (DRG's)
- Per diems
- Fee-for-Service reimbursement
- Aligning incentives - Correct Answer - B) Per diems
Prospective performance and Retrospective performances are considered:
- Private health plans
- Contract performance models
- Rating tiers
- Consumer Directed Health Plans (CDHP) - Correct Answer - B) Contract
performance models
Reporting initiative including: Required Nation Performance Measurement, Voluntary National Performance Measurement, and Employer Coalition Performance Measure,
are all:
- Group advocacy goals intended to reduced consumer spending
- Consumer advocacy and healthcare value efforts
- Healthcare report cards available to the public
- Reports that contain public information regarding all healthcare issues - Correct
- / 3
Answer - C) Healthcare report cards available to the public
pg. 2 Identify which option is NOT a payment type that comprises a large percentage of Medicare expenditures.
- Inpatient prospective Payment Systems
- Outpatient Prospective Payment System
- Medicare payments to physicians
- MS-DRG payment - Correct Answer - C) Medicare payments to physicians
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 - Correct 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 - Correct Answer - C) Limited access to care
All are areas that a NCQA review covers, EXCEPT:
- Medical records review & Member rights and responsibilities
- Credentialing review & Preventive and adaptive health services
- QA review & UM review
- Physician rights and responsibilities & Certification review - Correct 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:
- / 3
pg. 3
A) NCQA
B) CDHP
- Medicare
- HSA - Correct 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
- Ensuring appropriate care is provided - Correct 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 - Correct Answer - D) Information required
for claims processing
When modeling the proposed payer's contractual reimbursement, you should include:
- All claim data
- All Medicare claim data
- All commercial claim data
- Payer specific claim data - Correct Answer - D) Payer specific claim data
Which of the following is not examined in a concurrent utilization management review?
- Case management
- Discharge Planning
- / 3