Cspr - Certified Specialist Payment Rep (Hfma) Study Guide Rated A+

Which three components are used to determine the total RVU value for a service? {Ans: -Malpractice expense -Lowest market price for services used -Medicare discounts}Which statement is false concerning ABNs? {Ans: ABN began establishing new requirements for managed care plans participating in the Medicare program.}All of the following should be analyzed prior to and/or during contract negotiations: {Ans: -Member volumes by product type -Historical reimbursement levels by product type -Historical claims payment and/or submission problems}What is a clean claim? {Ans: A properly completed billing form}Managed care organizations (MCO) exist primarily in four forms: {Ans: Health Maintenance Organizations (HMO) Preferred Provider Organizations (PPO) Point of Service (POS) Organizations Exclusive Provider Organizations (EPO)}Which option is included in the set of new value propositions and tools that emerged in the early 2000s? {Ans: -Product development focused on employee contribution strategies, network access, and funding options. -Medical management philosophies based on retrospective evaluation of care, rather than prospective review and management. -A proliferation of self-service technologies to reduce administrative costs.}