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

A fixed payment amount based upon the number of members assigned to a provider, and does not vary based upon the number of services rendered, is known as: {Ans: Capitation}What is a non-directed PPO? {Ans: A payer that has contracted either directly or indirectly with the provider to access preferred rates}Which option is a practice used to control costs of managed care? {Ans: -Making advance payment to providers for all services needed to care for a member -Combining services provided and bundling the associated charges -Agreement between the payer and provider on reasonable payment for each service.}Identify some key drivers of increasing healthcare costs {Ans: Demographics Chronic Conditions Provider payment systems - Provider payment systems that are designed to reward volume rather than quality, outcomes, and prevention Consumer Perceptions Health Plan pressure Physician Relationships Supply Chain}Which of the following is an anticipated change in the relationships between consumers and providers? {Ans: Providers will face many new service demands and consumers will have virtually unfettered access to those services}Medicare is composed of four parts: {Ans: Part A - provides inpatient/hospital, hospice, and skilled nursing coverage Part B - provides outpatient/medical coverage Part C - an