HCCA

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - CORRECT ANS True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - CORRECT ANS 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals proc...

Stark or Physician Self-Referral Law - CORRECT ANS 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) - CORRECT ANS Prohibits the solicitation, receiving, offering...

HCCA - CHPC Overview QUESTIONS AND ANSWERS 2023 1. HIPAA became law: 1996 2. What is the purpose of HIPAA?: • To make health insurance portable under ERISA; • To move health care onto a nationally standardized electronic billing platform; and • To prevent fraud, waste and abuse 3. Intent: purpose of this subtitle to improve the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the ...

Certified Healthcare Constructor (CHC) QUESTIONS AND ANSWERS 2023 1. What two types of med gas are required in a typical med/surg patient room?: vacuum and oxygen according to Guidelines for Design and Construction of Health Care Facilities. 2. When should medical equipment modality selections ideally be made during the planning, design, and construction process?: Before the end of SDs 3. When should medical equipment manufacturer selections ideally be made for each modality during the p...

HCCA - CHPC Study Questions (MASTER FLASHCARDS) COMPLETED 2023 1. What is the purpose of HIPAA?: • Protect PHI from unauthorized disclosure/use; • Prevent fraud, waste and abuse (via Administrative Simplification); • Make health insurance portable under ERISA; • Move health care onto a nationally standardized electronic billing platform Ref. More on HIPAA: 2. HIPAA resides in which CFR section?: 45 CFR sections 164.102 through 164.534 3. What are the subparts of HIPAA part 164...

What is the purpose of HIPAA? correct answer: • Protect PHI from unauthorized disclosure/use; • Prevent fraud, waste and abuse (via Administrative Simplification); • Make health insurance portable under ERISA; • Move health care onto a nationally standardized electronic billing platform Ref. More on HIPAA: HIPAA resides in which CFR section? correct answer: 45 CFR sections 164.102 through 164.534 What are the subparts of HIPAA part 164? correct answer: HIPAA - 45 CFR 1...

2 Midnight Rule correct answer: Regulation included in the 2014 Medicare inpatient prospective payment rule. Established that inpatient admissions spanning at least two midnights qualify for Medicare Part A payments. Inpatient stays lasting fewer than two midnights must be treated and billed as outpatient services. 340B Pricing Program correct answer: A federal program requiring drug manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at signific...

AntiKickback Statute Highlights correct answer: 1. Criminal/Civil (you go out of business 2. Any federal health program (Medicare, Medicaid, Tri-Care) 3. Requires proof of improper intent (DOJ-Criminal) 4. Applies to any referral source 5. 24 Safe Harbors 6. OIG Advisory Opinions Stark Highlights correct answer: 1. Civil only (no prison time) 2. Medicare only 3. Strict Liability (does not consider knowledge or intent. if X happens, then you are held liable regardless of intent.) 4....

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). correct answer: True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) correct answer: 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals proc...

HIPAA became law correct answer: 1996 What is the purpose of HIPAA? correct answer: • To make health insurance portable under ERISA; • To move health care onto a nationally standardized electronic billing platform; and • To prevent fraud, waste and abuse Intent correct answer: purpose of this subtitle to improve the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health...