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CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023
- Exam (elaborations) • 18 pages • 2023
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CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 
Steps used to control costs of managed care include: 
Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
 
 
 
DRG is used to classify 
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 
HMO 
Conventional 
PPO and POS 
H...
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CSBI – HFMA QUESTIONS ANSWERED 100% CORRECT, SCORED A+
- Exam (elaborations) • 12 pages • 2023
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CSBI – HFMA QUESTIONS ANSWERED 100% CORRECT, SCORED A+ 
What has changed for Healthcare Analytics? 
1 - Increased computing power and storage, decrease in cost; 
2 - increased abundance of data in healthcare; 
3 - increase in individuals having strong competencies 
 
 
 
Big Data 
Refers to the Growth in available data, massive continually increasing volume of live and stored data for analysis; and the increase in tools available for highly sophisticated ways to combine and analyze data to yie...
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CSBI HFMA Exam With 100% Correct verified Answers 2024
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CSBI HFMA Exam With 100% Correct verified Answers 2024 
 
Patient-centric - CORRECT The healthcare industry is shifting towards this approach. Based on the patient's condition and prospects for improvement, services are rendered in relation to the situation, as opposed to only considering how an individual progress through a series of facilities. 
 
HIPAA Act - CORRECT Health Insurance Portability and Accountability Act 
 
HITECH Act - CORRECT Health Information Technology Economic and Clinical...
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HFMA EXAM 2024 WITH 100% ACCURATE ANSWERS
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HFMA EXAM 2024 WITH 100% ACCURATE ANSWERS 
 
 
Definition of cost - correct answer Can be the amount paid for the service. It can also be the amount paid for salaries or to other vendors 
 
Direct Cost - correct answer Are the costs that can be traced directly to a department, product, or service (Salaries, Employee benefits, medications, supplies, aging and equipment maintenance contract 
 
Direct cost in a health Plan - correct answer Would be the actual claims payments made by the plan on beh...
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HFMA CRCR EXAM QUESTIONS WITH 100% CORRECT ANSWERS 2024
- Exam (elaborations) • 61 pages • 2024
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HFMA CRCR EXAM QUESTIONS WITH 100% 
CORRECT ANSWERS 2024 
What are collection agency fees based on? - ANSWERS A percentage of dollars 
collected 
Self-funded benefit plans may choose to coordinate benefits using the gender rule or 
what other rule? - ANSWERS Birthday 
In what type of payment methodology is a lump sum or bundled payment negotiated 
between the payer and some or all providers? - ANSWERS Case rates 
What customer service improvements might improve the patient accounts departmen...
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HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS
- Exam (elaborations) • 33 pages • 2024
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HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND 
CORRECT ANSWERS(VERIFIED ANSWERS) 
Pre-Service activities 1. Requested service is screened for med necessity, health 
coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated 
within guidelines of NSA and state regulations. 
2. Patient notified of financial responsibility including copayment and health plan deductibles, 
eligibility of financial assistance assessed. 
3. Patient is scheduled 
4. Encounte...
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HFMA CRCR 2023//2024
- Exam (elaborations) • 13 pages • 2024
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HFMA CRCR 
2023//2024 
Through what document does a hospital establish compliance standards? - ANSWER 
code of conduct 
What is the purpose OIG work plant? - ANSWER Identify Acceptable compliance 
programs in various provider setting 
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG 
window rule? - ANSWER Non-diagnostic service provided on Tuesday through Friday 
What does a modifier allow a provider to do? - ANSWER Report a specific 
circumstance that...
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HFMA CRCR EXAM QUESTIONS WITH 100% CORRECT ANSWERS 2024
- Exam (elaborations) • 61 pages • 2024
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HFMA CRCR EXAM QUESTIONS WITH 100% 
CORRECT ANSWERS 2024 
What are collection agency fees based on? - ANSWERS A percentage of dollars 
collected 
Self-funded benefit plans may choose to coordinate benefits using the gender rule or 
what other rule? - ANSWERS Birthday 
In what type of payment methodology is a lump sum or bundled payment negotiated 
between the payer and some or all providers? - ANSWERS Case rates 
What customer service improvements might improve the patient accounts departmen...
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HFMA CRCR 2023//2024
- Exam (elaborations) • 13 pages • 2024
- Available in package deal
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- $14.09
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HFMA CRCR 
2023//2024 
Through what document does a hospital establish compliance standards? - ANSWER 
code of conduct 
What is the purpose OIG work plant? - ANSWER Identify Acceptable compliance 
programs in various provider setting 
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG 
window rule? - ANSWER Non-diagnostic service provided on Tuesday through Friday 
What does a modifier allow a provider to do? - ANSWER Report a specific 
circumstance that...
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HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS
- Exam (elaborations) • 33 pages • 2024
- Available in package deal
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- $17.99
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HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND 
CORRECT ANSWERS(VERIFIED ANSWERS) 
Pre-Service activities 1. Requested service is screened for med necessity, health 
coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated 
within guidelines of NSA and state regulations. 
2. Patient notified of financial responsibility including copayment and health plan deductibles, 
eligibility of financial assistance assessed. 
3. Patient is scheduled 
4. Encounte...
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