CPB Exam Questions And Answers Verified 100% Correct!!

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. DEERS-Defense Enrollment Eligibility Reporting System - Database of all uniformed service members, their spouses and family members and others who are eligible for Tricare.