HCCA CHC Exam 1 Prep questions and
answers
Stark or Physician Self-Referral LawThe Omnibus Budget Reconciliation Act
bans physicians from referring patients to receive "designated health services" to
any entity with which the physician has a financial relationship. Designated health
servi...
HCCA CHC Exam 1 Prep questions and
answers
Stark or Physician Self-Referral Law✔✔The Omnibus Budget Reconciliation Act
bans physicians from referring patients to receive "designated health services" to
any entity with which the physician has a financial relationship. Designated health
services include lab testing, imaging services, physical or occupational therapy, etc.
(civil only, medicare/medicaid only, strict liability)
Anti-Kickback Statute (AKS)✔✔Prohibits the solicitation, receiving, offering, or
paying any remuneration directly or indirectly in cash or in kind in exchange.
Essentially it prohibits the exchange of anything of value in exchange for or in an
effort to gain the referral of business reimbursable by federal healthcare programs.
(intent, any federal program, civil or criminal)
Physician Payments Sunshine Act (PPSA)✔✔Requires that detailed information
about payments or other "transfers of value" worth over $10 from manufacturers of
drugs, medical devices and biologics to physicians and teaching hospitals be made
available to the public. (Open payment data).
Deficit Reduction Act✔✔A Federal law that grants states the ability to modify their
Medicaid programs. This allows individual states to reform their Medicaid programs
to fit with the present health care environment while maintaining federal guidelines.
False Claims Act✔✔Originally adopted byt U.S. Congress to discourage suppliers
from overcharging the government, it is now legislation that prohibits anyone from
knowingly submitting or causing to be submitted a false or fraudulent claim. DOJ.
Qui Tam Action✔✔Allows persons and entities with evidence of fraud against federal
programs or contracts to sue the wrongdoer on behalf of the United States
Government - based upon private information.
7 Elements of an Effective Compliance Program✔✔1. Policies and Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
HIPAA Privacy Rule✔✔A covered entity may not use of disclose protected health
information except for when it is required or permitted.
, HIPAA Security Rule✔✔Essentially outlines how to protect PHI in an electronic form
(only applies to ePHI). 3 main safeguards: administrative, technical, and physical.
Reportable Breach✔✔1. breach of privacy rule
2. unsecured PHI
3. more than "low probability of compromise"
Breach Notification✔✔1. Notify individual in writing
-if less than 10 are undeliverable, alternate notification method (like email) may be
use
-if more than 10 are undeliverable, must post contact info to web page.
2. Must notify OCR within 60 days of the end of the calendar year
-if it involves 500+ people, must notify OCR immediately
3. Org. must notify media if 501+ individuals in same jurisdiction/state are involved in
breach.
Patient Rights Under HIPAA✔✔o Request for restriction of PHI Use - as long as it is
reasonable i.e. can restrict that information is not given to insurance company, given
that the pt. requests in writing, self-pays, and the info would be typically given to the
insurance company.
o Request for confidential communication (i.e. no voicemails)
o Request Access/Copy of medical record
o Request for Medical Record amendment
o Request to review accounting of disclosures
o Right to receive notification of Breach
o Right to receive notice of privacy practices
Permitted Use/Disclosure of PHI✔✔1. For payment, treatment, and operations.
2. required by law (pt. request or DHHS request)
3. Authorization by Pt. or Pt. Personal Representative
4. Disclosure with opportunity to object
5. other exceptions (which must be on accounting of disclosures)
Business Associate✔✔entities that perform a function on behalf of the covered entity
that receives, creates, transmits or otherwise works with PHI. If a entity is a BA they
must have a BAA (business associate agreement) - essentially outlines what PHI will
be used, how it will be used, protection of information, expectations of security and
destruction, what is to happen in the event of a breach, and termination of the
contract.
Protected Health Information✔✔Information that
1. relates to past, present, or current condition, treatment/care, or payment.
2. Reasonably identifiable
3. Maintained in any form by CE.
De-identified PHI✔✔excludes all 18 identifiers
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