Cspr- Certified Specialist Payment Rep (Hfma) Exam Questions And Answers

CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS Steps used to control costs of managed care include: - ANSWER- Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER- Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER- HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings option; Private - Include higher patient out-of-pocket expenditures for treatments that can serve to reduce utilization/costs.Managed care organizations (MCO) exist primarily in four forms: - ANSWER- Health Maintenance Organizations (HMO) Preferred Provider Organizations (PPO) Point of Service (POS) Organizations Exclusive Provider Organizations (EPO) Identify the various types of governmentsponsored health coverage: - ANSWER- Medicare - Government; Beneficiaries enrolled in such plans, but, participation in these plans is voluntary. Medicaid Medicaid Managed Care - Medicaid beneficiaries are required to select and enroll in a managed care plan. Medicare Managed Care (a.k.a. Medicare Advantage Plans) Identify some key drivers of increasing healthcare costs - ANSWER- Demographics Chronic Conditions Provider payment systems - Provider