HCCA CHC Exam Prep – 75 Questions And
Answers/Distinction Rated
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
Answers/Distinction Rated
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
