Regulations and Compliance Flashcards
7 cards from real AMCA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Regulations and Compliance flashcards as text
The False Claims Act imposes liability on individuals or entities that:
Answer: Knowingly submit false claims for payment to federal healthcare programs
The False Claims Act creates liability for anyone who knowingly submits or causes the submission of a false or fraudulent claim to the federal government for payment.
Under HIPAA, which of the following is NOT considered protected health information (PHI)?
Answer: De-identified health information with no identifying data
De-identified health information that meets HIPAA's de-identification standards is not considered PHI and is not subject to HIPAA protections.
Which federal regulation governs the disposal of pharmaceutical waste classified as hazardous in medical offices?
Answer: RCRA (Resource Conservation and Recovery Act)
The EPA's Resource Conservation and Recovery Act (RCRA) regulates the management and disposal of hazardous pharmaceutical waste generated by healthcare facilities.
A medical assistant notices a physician billing for a more complex service than was actually provided. This practice is known as:
Answer: Upcoding
Upcoding refers to billing for a higher-level service than was actually performed, which constitutes Medicare/Medicaid fraud.
Under the Stark Law (Physician Self-Referral Law), a physician is generally prohibited from referring patients to entities:
Answer: In which the physician or an immediate family member has a financial relationship
The Stark Law prohibits physicians from referring Medicare/Medicaid patients to entities providing designated health services if the physician or family member has a financial relationship with that entity.
When must a covered entity under HIPAA notify affected individuals following a breach of unsecured PHI?
Answer: Without unreasonable delay and no later than 60 days after discovery
HIPAA's Breach Notification Rule requires covered entities to notify affected individuals without unreasonable delay and no later than 60 calendar days after discovery of a breach.
Which type of CLIA certificate is required for a medical office performing only waived tests such as urine dipsticks and glucose monitoring?
Answer: Certificate of Waiver
A CLIA Certificate of Waiver is required for facilities that perform only those simple tests categorized as waived because they pose minimal risk of error.