Cspr Study guides, Class notes & Summaries

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What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? correct answer: HMO Act of 1973 ACA correct answer: Affordable Care Act HMO (Health Maintenance Organization) correct answer: The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment correct answer: part of prospective payment in which healthcare p...

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CSPR - Certified Specialist Payment Rep (HFMA)

CSPR - Certified Specialist Payment Rep (HFMA) Steps used to control costs of managed care include: - CORRECT ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - CORRECT ANSWER-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 - CORRECT ANSWER-HMO Conventional ...

CSPR - Certified Specialist Payment Rep (HFMA) Exam Questions With 100% Complete Solutions..