CPB INSURANCE BILLING COMPLIANCE
2026 FINAL PAPER QUESTIONS ANSWERS
◉ Conditions of Participation (CoP) - Intro to Healthcare
Answer: Conditions that healthcare organizations must meet in
order to participate with the plan or program.
◉ Covered Entity - Intro to Healthcare
Answer: According to HIPPA, 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.
◉ False Claims Act (FCA) - Intro to Healthcare
Answer: 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 - Intro to Healthcare
Answer: Making false statements or misrepresenting facts to obtain
an undeserved benefit or payment from a federal healthcare
program.
,◉ Health Insurance Portability and Accountability Act of 1996
(HIPAA) - Intro to Healthcare
Answer: Federal law in 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 costs.
◉ Preferred Provider Organization (PPO) - Intro to Healthcare
Answer: Manged care organization of medical doctors, hospitals, and
other healthcare providers who have agreed with an insurer or
third-party administrator to provide healthcare at reduced rates to
the insurer's or administrator's clients.
◉ Protected Health Information (PHI) - Intro to Healthcare
Answer: Individually identifiable health information that includes
many common identifiers, such as demographic data, name, address,
birthday and SS number. It also includes information that relates to
an individual's 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 - Intro to Healthcare
,Answer: A lawsuit brought by a private citizen against a person or
company who is believed to have violated the law in the
performance of a contract with the government or in violation of a
government regulation, when there is a statute which provides for a
penalty for such violations.
◉ Truth in Lending Act (TILA) - Intro to Healthcare
Answer: Designed to assure that every customer who needs
consumer credit is given meaningful information concerning the
cost of such credit.
◉ Accountable Care Organization (ACO) -Cpt 2 Models & Plans
Answer: A healthcare organization characterized by a payment and
care delivery model that seeks to tie provider reimbursements to
quality metrics and reductions in the total cost of care for an
assigned population of patients.
◉ Capitation -Cpt 2 Models & Plans
Answer: Fixed payment remitted at regular intervals to a medical
provider by a managed care organization for an enrolled patient.
◉ Carve-out -Cpt 2 Models & Plans
Answer: A service not covered in a health insurance contract, usually
reimbursed according to a different arrangement or rate formula
than those services specified under the contract umbrella.
, ◉ Consumer Driven Health Plan (CDHP) -Cpt 2 Models & Plans
Answer: Third tier insurance plan that gives the members more
control over their health budgets
◉ Credentialing -Cpt 2 Models & Plans
Answer: A process that is used to evaluate the qualifications and
practice history of a physician which includes a review of a
physician's completed education, training, residency, and licenses.
◉ Customized Sub-Capitation (CSC) -Cpt 2 Models & Plans
Answer: Managed care plan in which healthcare expenses are
funded by insurance coverage; the individual selects one of each
type of provider to create a customized insurance premium.
◉ DEERS (Defense Enrollment Eligibility Reporting System) -Cpt 2
Models & Plans
Answer: A worldwide computerized database of all uniformed
service members, their spouses, and family members and others
who are eligible for TRICARE.
◉ Employer's Liability Insurance -Cpt 2 Models & Plans
Answer: Insurance that protects an employer from damages from a
lawsuit resulting from an injury due to the employer's negligence.
2026 FINAL PAPER QUESTIONS ANSWERS
◉ Conditions of Participation (CoP) - Intro to Healthcare
Answer: Conditions that healthcare organizations must meet in
order to participate with the plan or program.
◉ Covered Entity - Intro to Healthcare
Answer: According to HIPPA, 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.
◉ False Claims Act (FCA) - Intro to Healthcare
Answer: 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 - Intro to Healthcare
Answer: Making false statements or misrepresenting facts to obtain
an undeserved benefit or payment from a federal healthcare
program.
,◉ Health Insurance Portability and Accountability Act of 1996
(HIPAA) - Intro to Healthcare
Answer: Federal law in 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 costs.
◉ Preferred Provider Organization (PPO) - Intro to Healthcare
Answer: Manged care organization of medical doctors, hospitals, and
other healthcare providers who have agreed with an insurer or
third-party administrator to provide healthcare at reduced rates to
the insurer's or administrator's clients.
◉ Protected Health Information (PHI) - Intro to Healthcare
Answer: Individually identifiable health information that includes
many common identifiers, such as demographic data, name, address,
birthday and SS number. It also includes information that relates to
an individual's 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 - Intro to Healthcare
,Answer: A lawsuit brought by a private citizen against a person or
company who is believed to have violated the law in the
performance of a contract with the government or in violation of a
government regulation, when there is a statute which provides for a
penalty for such violations.
◉ Truth in Lending Act (TILA) - Intro to Healthcare
Answer: Designed to assure that every customer who needs
consumer credit is given meaningful information concerning the
cost of such credit.
◉ Accountable Care Organization (ACO) -Cpt 2 Models & Plans
Answer: A healthcare organization characterized by a payment and
care delivery model that seeks to tie provider reimbursements to
quality metrics and reductions in the total cost of care for an
assigned population of patients.
◉ Capitation -Cpt 2 Models & Plans
Answer: Fixed payment remitted at regular intervals to a medical
provider by a managed care organization for an enrolled patient.
◉ Carve-out -Cpt 2 Models & Plans
Answer: A service not covered in a health insurance contract, usually
reimbursed according to a different arrangement or rate formula
than those services specified under the contract umbrella.
, ◉ Consumer Driven Health Plan (CDHP) -Cpt 2 Models & Plans
Answer: Third tier insurance plan that gives the members more
control over their health budgets
◉ Credentialing -Cpt 2 Models & Plans
Answer: A process that is used to evaluate the qualifications and
practice history of a physician which includes a review of a
physician's completed education, training, residency, and licenses.
◉ Customized Sub-Capitation (CSC) -Cpt 2 Models & Plans
Answer: Managed care plan in which healthcare expenses are
funded by insurance coverage; the individual selects one of each
type of provider to create a customized insurance premium.
◉ DEERS (Defense Enrollment Eligibility Reporting System) -Cpt 2
Models & Plans
Answer: A worldwide computerized database of all uniformed
service members, their spouses, and family members and others
who are eligible for TRICARE.
◉ Employer's Liability Insurance -Cpt 2 Models & Plans
Answer: Insurance that protects an employer from damages from a
lawsuit resulting from an injury due to the employer's negligence.
