CPB Exam Questions and answers,
100% Accurate, rated A+
Abuse - ✔✔-An action that results in unnecessary costs to a federal healthcare program, directly or
indirectly.
Anti-kickback - ✔✔-Knowingly and willfully offering or accepting rewards or remuneration for services
that are billable to a federal healthcare plan.
Benefiiciary - ✔✔-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 - ✔✔-Clearinghouse and 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 statute setting criminal and civil penalties for falsely billing the
government; over representing the amount of a delivered product, or under stating an obligation to the
government.
Fraud - ✔✔-Making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal HC program.
HIPAA-Health Insurance Portability and Accountability Act of 1996 - ✔✔-Federal law in which the
primary goal is to make it easier for people to keep insurance, protect the confidentiality and security of
HC info and help control administration costs.
, PPO-Preferred Provider Organization - ✔✔-Managed care organization of Drs, hospitals and other
providers who agree with insurer to provide HC at reduced rates to their clients.
PHI-Protected Health informaion - ✔✔-Individually identifiable health information, reasonably used to
identify an individual.
Qui Tam Action - ✔✔-A lawsuit brought by a private citizen against a person or company who is believed
to have violated the law in the performance contact with the government of in violation of government
regulation.
Stark Law - ✔✔-A federal law that places limitations of certain physician referrals.
Truth in Lending Act - ✔✔-An act which requires lenders to inform borrowers of all direct, indirect and
true costs of credit.
ACO-Accountable Care Organizations - ✔✔-HC organization characterized by a payment and care
delivery model rust seeks to tie provider reimbursements to quality metrics and reductions in the total
cost of care for an assigned population of patients.
Capitation - ✔✔-Fixed payment remitted at regular intervals to a medical provider by a managed care
organization for an enrolled patient.
Carve-out - ✔✔-Service not covered in an insurance contract, usually reimbursed according to a
different arrangement or rate formula.
CDHP-Consumer Driven Health Plans - ✔✔-Third tier insurance plans giving members more control over
their heath budgets.
CSC-Customized Sub-capitation - ✔✔-Managed care plan in which HC expenses are funded by insurance
coverage, individual selects one of each type of provider to create customized premium.
100% Accurate, rated A+
Abuse - ✔✔-An action that results in unnecessary costs to a federal healthcare program, directly or
indirectly.
Anti-kickback - ✔✔-Knowingly and willfully offering or accepting rewards or remuneration for services
that are billable to a federal healthcare plan.
Benefiiciary - ✔✔-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 - ✔✔-Clearinghouse and 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 statute setting criminal and civil penalties for falsely billing the
government; over representing the amount of a delivered product, or under stating an obligation to the
government.
Fraud - ✔✔-Making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal HC program.
HIPAA-Health Insurance Portability and Accountability Act of 1996 - ✔✔-Federal law in which the
primary goal is to make it easier for people to keep insurance, protect the confidentiality and security of
HC info and help control administration costs.
, PPO-Preferred Provider Organization - ✔✔-Managed care organization of Drs, hospitals and other
providers who agree with insurer to provide HC at reduced rates to their clients.
PHI-Protected Health informaion - ✔✔-Individually identifiable health information, reasonably used to
identify an individual.
Qui Tam Action - ✔✔-A lawsuit brought by a private citizen against a person or company who is believed
to have violated the law in the performance contact with the government of in violation of government
regulation.
Stark Law - ✔✔-A federal law that places limitations of certain physician referrals.
Truth in Lending Act - ✔✔-An act which requires lenders to inform borrowers of all direct, indirect and
true costs of credit.
ACO-Accountable Care Organizations - ✔✔-HC organization characterized by a payment and care
delivery model rust seeks to tie provider reimbursements to quality metrics and reductions in the total
cost of care for an assigned population of patients.
Capitation - ✔✔-Fixed payment remitted at regular intervals to a medical provider by a managed care
organization for an enrolled patient.
Carve-out - ✔✔-Service not covered in an insurance contract, usually reimbursed according to a
different arrangement or rate formula.
CDHP-Consumer Driven Health Plans - ✔✔-Third tier insurance plans giving members more control over
their heath budgets.
CSC-Customized Sub-capitation - ✔✔-Managed care plan in which HC expenses are funded by insurance
coverage, individual selects one of each type of provider to create customized premium.
