CPB Exam Questions and answers, 100% Accurate, rated A+
0 view 0 purchase
Course
CPB
Institution
CPB
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 fe...
rated a abuse an action that results in unnecessary costs to a federal healthcare program
directly or indirectly anti kickback knowingly and
Written for
CPB
All documents for this subject (327)
Seller
Follow
QuickPass
Reviews received
Content preview
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.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller QuickPass. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.49. You're not tied to anything after your purchase.
