Cspr - Certified Specialist Payment Rep (Hfma) |125 Questions| With Correct Answers.

The following are tools for optimizing contract performance, EXCEPT: {Ans: Contract language}All of the following are effective contract evaluation criteria, EXCEPT: {Ans: Detailed contract performance assessments}Identify the various types of private health plan coverage {Ans: 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.}Medical Cost Ratio (MCR) or Medical Loss Ratio (MLR) is defined as: {Ans: Total Medical Expenses divided by Total Premiums}Health Maintenance Organizations (HMO) {Ans: Referrals PCP Patients must use an in-network provider for their services to be covered. Reimbursement - majority of services offered are reimbursed through capitation payments (PMPM)}As the healthcare industry moves to control growth in medical spending, what initiative can NOT help hospitals maintain their margins? {Ans: -Pay-for-performance programs -Health savings accounts -Price transparency}How is the term carve-out used when discussing managed care? {Ans: To refer to specific benefits or services}Provider service organizations (PSOs) function like health maintenance organizations (HMOs) in all of the following ways: {Ans: -Risk pooling -Capitalization -Network management}Which options are a focus of the HIPAA Title II series of laws?