AAPC CPB Terms Questions with 100%
Verified Correct Answers
Abuse
An action that results in unnecessary costs to a federal healthcare program, either directly or
indirectly
Anti-Kickback
Knowingly and willfully offering or accepting rewards or remuneration for services that are
billable to a federal healthcare plan
Beneficiary
An individual that is eligible for Medicare or Medicaid benefits based on the CMS guidelines
Conditions of Participation (COP)
Conditions that healthcare organizations must meet in order to participate with the plan or
program.
Covered Entity
According to HIPAA, defined as health plans, healthcare clearinghouses, and healthcare
providers who electronically transmit any health information in connection with transactions
for which HHS has adopted standards
Criminal Healthcare Fraud Act
Scheme to willingly defraud any healthcare benefit program
False Claims Act
, Federal statue setting criminal and civil penalties for falsely billing the government, over-
representing the amount of a delivered product or understating an obligation to the
government
Fraud
Making false statements or misrepresenting facts to obtain an undeserved benefit or payment
from a federal healthcare program
Health Insurance Probability and Accountability Act of 1996 (HIPAA)
Federal law which the primary goal is to make it easier for people to keep health insurance,
protect the confidentiality and security of healthcare information and help the healthcare
industry control administrative cost
Preferred Provider Organization (PPO)
Manage care organization of medical doctors, hospitals, and other healthcare providers who
have agreed with an insurer or a third-party administrator to provide healthcare at reduced
rates to insurers or administrators clients
Protected Health Information (PHI)
Individually identifiable health information that includes many common identifiers such as
demographic data, name, address, birthdate, and social security number. It also includes
information that relates to an individuals past, present, or future physical or mental health or
condition; the provision of healthcare to the individual; or the past, present, or future payment
for the provision of healthcare to the individual, which reasonably may be used to identify an
individual
Qui Tam Action
Verified Correct Answers
Abuse
An action that results in unnecessary costs to a federal healthcare program, either directly or
indirectly
Anti-Kickback
Knowingly and willfully offering or accepting rewards or remuneration for services that are
billable to a federal healthcare plan
Beneficiary
An individual that is eligible for Medicare or Medicaid benefits based on the CMS guidelines
Conditions of Participation (COP)
Conditions that healthcare organizations must meet in order to participate with the plan or
program.
Covered Entity
According to HIPAA, defined as health plans, healthcare clearinghouses, and healthcare
providers who electronically transmit any health information in connection with transactions
for which HHS has adopted standards
Criminal Healthcare Fraud Act
Scheme to willingly defraud any healthcare benefit program
False Claims Act
, Federal statue setting criminal and civil penalties for falsely billing the government, over-
representing the amount of a delivered product or understating an obligation to the
government
Fraud
Making false statements or misrepresenting facts to obtain an undeserved benefit or payment
from a federal healthcare program
Health Insurance Probability and Accountability Act of 1996 (HIPAA)
Federal law which the primary goal is to make it easier for people to keep health insurance,
protect the confidentiality and security of healthcare information and help the healthcare
industry control administrative cost
Preferred Provider Organization (PPO)
Manage care organization of medical doctors, hospitals, and other healthcare providers who
have agreed with an insurer or a third-party administrator to provide healthcare at reduced
rates to insurers or administrators clients
Protected Health Information (PHI)
Individually identifiable health information that includes many common identifiers such as
demographic data, name, address, birthdate, and social security number. It also includes
information that relates to an individuals past, present, or future physical or mental health or
condition; the provision of healthcare to the individual; or the past, present, or future payment
for the provision of healthcare to the individual, which reasonably may be used to identify an
individual
Qui Tam Action
