Industry Regulations Flashcards
7 cards from real ABFM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Industry Regulations flashcards as text
Under the Medicare Access and CHIP Reauthorization Act (MACRA), the Quality Payment Program (QPP) offers two participation pathways. Which of the following is NOT one of those pathways?
Answer: Accountable Care Organization Shared Savings Program (MSSP)
MACRA's QPP offers two pathways: MIPS and Advanced APMs; the Medicare Shared Savings Program is a type of APM but is not itself one of the two main QPP tracks.
The Office for Civil Rights (OCR) may impose HIPAA civil monetary penalties on a covered entity that had no knowledge of a violation and could not have known with reasonable diligence. Which penalty tier applies?
Answer: $100–$50,000 per violation, up to $25,000 per year
The lowest HIPAA penalty tier ($100–$50,000 per violation, annual cap $25,000) applies when the covered entity did not know and could not reasonably have known of the violation.
Which of the following is a key requirement under the CMS Promoting Interoperability (PI) program for eligible professionals?
Answer: Demonstrating meaningful use of certified electronic health record technology
The PI program (formerly Meaningful Use) requires eligible professionals to demonstrate meaningful use of certified EHR technology to receive incentive payments or avoid Medicare payment adjustments.
A patient requests an amendment to their medical record under HIPAA. The covered entity may deny the request if:
Answer: The record was not created by the covered entity
A covered entity may deny an amendment request if it did not create the record, unless the originating entity is no longer available.
Under the Ryan Haight Online Pharmacy Consumer Protection Act, prescribing controlled substances via telemedicine without a prior in-person evaluation is generally:
Answer: Prohibited unless specific DEA exceptions or waivers apply
The Ryan Haight Act generally requires an in-person evaluation before prescribing controlled substances via telemedicine, with limited exceptions such as DEA-registered telemedicine practitioners.
The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency departments to provide:
Answer: A medical screening examination and stabilization to all patients, regardless of ability to pay
EMTALA mandates that any individual presenting to an ED receive a medical screening examination and necessary stabilizing treatment regardless of insurance status or ability to pay.
Which of the following actions constitutes 'upcoding' under the False Claims Act?
Answer: Billing for a complex E&M visit when only a brief visit was performed
Upcoding means billing a higher-level service than was actually provided, which violates the False Claims Act and constitutes Medicare/Medicaid fraud.