Regulatory Compliance and HIPAA Flashcards
6 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Regulatory Compliance and HIPAA flashcards as text
What is the OIG Exclusion Database and why must providers check it?
Answer: The List of Excluded Individuals/Entities (LEIE) — a registry of providers barred from participating in federal healthcare programs; employers must check it to avoid employing excluded individuals
The LEIE is the OIG's registry of individuals and entities excluded from federal healthcare programs. Employing or contracting with an excluded person can result in civil monetary penalties for every claim submitted involving that person.
What is the purpose of a HIPAA Notice of Privacy Practices (NPP)?
Answer: To inform patients of how their PHI may be used and disclosed, their privacy rights, and the covered entity's legal duties regarding PHI
The NPP is a document that covered entities must provide to patients describing their privacy rights, how PHI may be used and disclosed, the covered entity's privacy obligations, and how patients can exercise their rights.
What is the Stark Law's 'in-office ancillary services exception'?
Answer: An exception that permits physicians to refer patients to their own practice or group practice for designated health services (DHS) that are provided in the same building and supervised by the referring physician
The in-office ancillary services exception allows physician practices to provide and bill for certain DHS (like lab, imaging, PT) within their practice, provided specific location, supervision, and billing requirements are met.
What is CMS's Conditions of Participation (CoPs) for hospitals?
Answer: Federal health and safety standards that hospitals must meet to receive Medicare and Medicaid reimbursement
CoPs are the minimum health and safety standards established by CMS that healthcare organizations (hospitals, home health agencies, SNFs, etc.) must meet to participate in Medicare and Medicaid programs.
What is the purpose of a corporate integrity agreement (CIA)?
Answer: An agreement between the OIG and a provider who has settled a fraud investigation, requiring the provider to implement compliance measures under OIG monitoring for a defined period
A CIA is a settlement component in OIG fraud cases where the provider agrees to implement specific compliance measures (training, auditing, reporting) and submit to OIG oversight for 5 years as an alternative to exclusion.
What is the purpose of the Medicare/Medicaid exclusion screening requirement?
Answer: To ensure that no federal healthcare program payments are made for services provided by an excluded individual or entity, protecting program integrity
Exclusion screening ensures that providers, employees, contractors, and vendors who are barred from federal programs are not involved in Medicare/Medicaid service delivery or billing, preventing improper payments.