CPAR EXAM QUESTIONSWITHCORRECT
ANSWERS 2026
(ABN)Advanced beneficiary notice - CORRECT ANSWERS -advanced notice that the patient may
have to pay for lab testing that medicare will not cover.
Insurance - CORRECT ANSWERS -a way of reducing a person's exposure to risk of loss because
another party (insurance company) assumes the risk.
Reimbursement - CORRECT ANSWERS -the compensation or repayment for healthcare services.
First party - CORRECT ANSWERS -the patient or the person responsible for the healthcare bill
Second party - CORRECT ANSWERS -the physician, hospital, clinic, nursing home, or other
healthcare entity that rendered the care; called providers because they provide health care.
Third party - CORRECT ANSWERS -the insurance company that pays the second party (provider)
for the services rendered to the first party (patient).
Fee - CORRECT ANSWERS -a set amount or a set price
Charges - CORRECT ANSWERS -what a healthcare provider has established as a fee for service
Claim - CORRECT ANSWERS -a list of the fees or charges for each service submitted to a third-
party payer (insurance company) for payment
Clean claim - CORRECT ANSWERS -a request for payment submitted to a third-party payer that
contains no errors in the data submitted
,Fee-for-service reimbursement - CORRECT ANSWERS -provider receives payment for each
service rendered
Fee schedule - CORRECT ANSWERS -a pre-established list of set fees that the third-party payer
will allow for payment.
UCR - CORRECT ANSWERS -stands for usual, customary, and reasonable
Usual - CORRECT ANSWERS -refers to the provider's usual fee
Customary - CORRECT ANSWERS -refers to the customary fee in the community
Reasonable - CORRECT ANSWERS -refers to the reasonable fee for the situation
Managed care - CORRECT ANSWERS -the various forms of managed care include HMOs (health
maintenance organizations), EPOs (exclusive provider organizations), POS (point-of service)
plans, and PPOs (preferred provider organizations).
Episode-of-care reimbursement - CORRECT ANSWERS -the providers receive one lump sum for
all of the services provided
Capitation - CORRECT ANSWERS -third-party payer reimburses provider a fixed, per-capita
amount for a specified period
Global payment - CORRECT ANSWERS -third-party payer makes one combined payment to cover
the services of multiple providers who are treating a single episode of care.
, Policy holder - CORRECT ANSWERS -refers to the purchasers (individual or groups) of healthcare
plans (also called insurers).
Certificate holders - CORRECT ANSWERS -refers to the employees who receive certificates of
insurance coverage (also called subscribers)
Dependent - CORRECT ANSWERS -refers to the spouses and other family members of the policy
holders
Covered services - CORRECT ANSWERS -those specific services that are stipulated in the
healthcare plan that the plan will pay for
Medical necessity - CORRECT ANSWERS -a service provided to a patient that is deemed to be
necessary and appropriate for the patient's condition
Benefits - CORRECT ANSWERS -the general services that the healthcare plan will pay for
Cost-sharing - CORRECT ANSWERS -a provision in the health plan that requires the policy holder
to bear some of the financial burden
Formulary - CORRECT ANSWERS -a health plan's list of preferred drugs that they will pay for
Exclusions - CORRECT ANSWERS -situations whereby the health plan stipulates that it will not
pay for benefits
Coordination of benefits - CORRECT ANSWERS -when policy holders have multiple healthcare
insurance carriers providing benefits. The primary insurer is responsible for the majority of the
expenses, and the secondary insurer is responsible for the remainder of the expenses
ANSWERS 2026
(ABN)Advanced beneficiary notice - CORRECT ANSWERS -advanced notice that the patient may
have to pay for lab testing that medicare will not cover.
Insurance - CORRECT ANSWERS -a way of reducing a person's exposure to risk of loss because
another party (insurance company) assumes the risk.
Reimbursement - CORRECT ANSWERS -the compensation or repayment for healthcare services.
First party - CORRECT ANSWERS -the patient or the person responsible for the healthcare bill
Second party - CORRECT ANSWERS -the physician, hospital, clinic, nursing home, or other
healthcare entity that rendered the care; called providers because they provide health care.
Third party - CORRECT ANSWERS -the insurance company that pays the second party (provider)
for the services rendered to the first party (patient).
Fee - CORRECT ANSWERS -a set amount or a set price
Charges - CORRECT ANSWERS -what a healthcare provider has established as a fee for service
Claim - CORRECT ANSWERS -a list of the fees or charges for each service submitted to a third-
party payer (insurance company) for payment
Clean claim - CORRECT ANSWERS -a request for payment submitted to a third-party payer that
contains no errors in the data submitted
,Fee-for-service reimbursement - CORRECT ANSWERS -provider receives payment for each
service rendered
Fee schedule - CORRECT ANSWERS -a pre-established list of set fees that the third-party payer
will allow for payment.
UCR - CORRECT ANSWERS -stands for usual, customary, and reasonable
Usual - CORRECT ANSWERS -refers to the provider's usual fee
Customary - CORRECT ANSWERS -refers to the customary fee in the community
Reasonable - CORRECT ANSWERS -refers to the reasonable fee for the situation
Managed care - CORRECT ANSWERS -the various forms of managed care include HMOs (health
maintenance organizations), EPOs (exclusive provider organizations), POS (point-of service)
plans, and PPOs (preferred provider organizations).
Episode-of-care reimbursement - CORRECT ANSWERS -the providers receive one lump sum for
all of the services provided
Capitation - CORRECT ANSWERS -third-party payer reimburses provider a fixed, per-capita
amount for a specified period
Global payment - CORRECT ANSWERS -third-party payer makes one combined payment to cover
the services of multiple providers who are treating a single episode of care.
, Policy holder - CORRECT ANSWERS -refers to the purchasers (individual or groups) of healthcare
plans (also called insurers).
Certificate holders - CORRECT ANSWERS -refers to the employees who receive certificates of
insurance coverage (also called subscribers)
Dependent - CORRECT ANSWERS -refers to the spouses and other family members of the policy
holders
Covered services - CORRECT ANSWERS -those specific services that are stipulated in the
healthcare plan that the plan will pay for
Medical necessity - CORRECT ANSWERS -a service provided to a patient that is deemed to be
necessary and appropriate for the patient's condition
Benefits - CORRECT ANSWERS -the general services that the healthcare plan will pay for
Cost-sharing - CORRECT ANSWERS -a provision in the health plan that requires the policy holder
to bear some of the financial burden
Formulary - CORRECT ANSWERS -a health plan's list of preferred drugs that they will pay for
Exclusions - CORRECT ANSWERS -situations whereby the health plan stipulates that it will not
pay for benefits
Coordination of benefits - CORRECT ANSWERS -when policy holders have multiple healthcare
insurance carriers providing benefits. The primary insurer is responsible for the majority of the
expenses, and the secondary insurer is responsible for the remainder of the expenses
