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HFMA CSPR LATEST TEST REVIEW Q & S 2024
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HFMA CSPR LATEST TEST REVIEW Q & S 2024HFMA CSPR LATEST TEST REVIEW Q & S 2024HFMA CSPR LATEST TEST REVIEW Q & S 2024HFMA CSPR LATEST TEST REVIEW Q & S 2024
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HFMACSPR
LATEST FINAL TEST REVIEW
Q&S
©2024/2025
,1. In a managed care environment, which model emphasizes a
capitated payment system?
a) Fee-for-service
b) Value-based care
c) Direct primary care
d) Health Maintenance Organization (HMO)
Answer: d) Health Maintenance Organization (HMO)
Rationale: HMOs typically operate on a capitated payment
system where providers are paid a set amount for each enrolled
person assigned to them, per period of time, whether or not that
person seeks care.
2. Which legislative act is primarily concerned with the reduction
of healthcare fraud and enforcement of standards for health
information?
a) The Affordable Care Act (ACA)
b) The Health Insurance Portability and Accountability Act
(HIPAA)
c) The Patient Protection Act
d) The Balanced Budget Act
©2024/2025
, Answer: b) The Health Insurance Portability and
Accountability Act (HIPAA)
Rationale: HIPAA includes provisions for preventing healthcare
fraud and mandates standards for electronic health records and
transactions.
3. What is the primary goal of benefit coordination in a managed
care setting?
a) To ensure the highest level of care for the patient
b) To minimize the risk of over-insurance
c) To reduce the cost of care by coordinating benefits among
multiple insurers
d) To streamline the process of care delivery
Answer: c) To reduce the cost of care by coordinating benefits
among multiple insurers
Rationale: Benefit coordination aims to avoid duplication of
benefits and ensure that the payment of benefits is coordinated
between multiple insurance plans, thus reducing overall costs.
4. Which reimbursement model incentivizes providers to focus on
quality and cost-effectiveness of care?
a) Capitation
b) Fee-for-service
c) Pay-for-performance
©2024/2025
, d) Bundled payments
Answer: c) Pay-for-performance
Rationale: Pay-for-performance models provide financial
incentives to healthcare providers to meet certain performance
measures for quality and efficiency.
5. A managed care organization (MCO) implements a new policy
that penalizes providers for exceeding the expected cost of care.
This is an example of:
a) A cost-sharing incentive
b) A cost-control incentive
c) A utilization review
d) A provider network restriction
Answer: b) A cost-control incentive
Rationale: Cost-control incentives are designed to control the
costs of healthcare by penalizing providers who do not meet
predetermined cost expectations.
6. What does the term 'risk adjustment' refer to in managed care
payment rates?
a) Adjusting payments based on the health status and risk profile
of patients
b) The redistribution of funds from lower-risk to higher-risk
patients
©2024/2025
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