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 Physician Payments Sunshine Act (Open Payments), manufacturers must report payments or transfers of value to physicians exceeding which threshold per item?
Answer: $10
The Sunshine Act requires reporting of individual payments over $10 and aggregate payments over $100 per year from applicable manufacturers to covered recipients.
A patient enrolled in a Medicare Advantage plan presents for care. For billing purposes, the family physician should:
Answer: Bill the Medicare Advantage plan using its specific contract and coding requirements
Medicare Advantage plans are administered by private insurers and require billing the specific plan, not traditional Medicare Part B, using the plan's contract terms.
The Drug Enforcement Administration (DEA) requires that Schedule II controlled substance prescriptions in most states must be:
Answer: Written or electronic with no refills permitted
Schedule II prescriptions must be written or transmitted electronically (EPCS) and cannot be refilled; a new prescription is required for each dispensing.
Under the Americans with Disabilities Act (ADA), a medical practice is required to provide 'reasonable accommodations' to a qualified employee with a disability unless doing so would cause:
Answer: Undue hardship to the practice
The ADA requires reasonable accommodations unless they impose an undue hardship on the employer, defined as significant difficulty or expense relative to the employer's resources.
Which of the following best describes the purpose of a Notice of Privacy Practices (NPP) under HIPAA?
Answer: It informs patients of their rights regarding their PHI and how the entity may use or disclose it
The NPP is a document covered entities must provide to patients informing them of their privacy rights and how the entity uses and discloses PHI.
A family medicine clinic receives a subpoena for a patient's records as part of civil litigation. Without a court order or patient authorization, the physician should:
Answer: Consult legal counsel and notify the patient before releasing records
A subpoena alone does not override HIPAA; the physician should consult legal counsel and provide the patient with notice and an opportunity to object before disclosing records.
Under the Medicare Shared Savings Program (MSSP), an Accountable Care Organization (ACO) earns shared savings when:
Answer: Its per-capita expenditures fall below its benchmark by more than the minimum savings rate
MSSP ACOs earn shared savings when their actual per-capita spending falls below the benchmark by at least the minimum savings rate, with the amount shared depending on the track elected.