CCM - Certified Case Manager Healthcare Regulations and Compliance Questions and Answers 3

Question 1

What is the False Claims Act and why is it relevant to case managers?

Accepted Answer

A federal law imposing liability for false claims to the government, with whistleblower protections

Answer

A law about false advertising

Answer

Only about clinical documentation accuracy

Answer

A state law about claim filing deadlines

Question 2

Under the ADA, what constitutes a 'reasonable accommodation'?

Accepted Answer

A modification enabling a qualified person with a disability to perform essential functions without undue hardship

Answer

Any accommodation regardless of cost

Answer

Only physical modifications

Answer

Only for employees disabled more than one year

Question 3

What is the purpose of the Patient Self-Determination Act?

Accepted Answer

Requiring facilities to inform patients of their rights to make care decisions and create advance directives

Answer

Allowing patients to choose any doctor

Answer

Self-determining discharge dates

Answer

Allowing patients to set treatment protocols

Question 4

What compliance obligation does the HITECH Act impose?

Accepted Answer

Strengthens HIPAA with increased penalties and breach notification requirements

Answer

All workers trained in IT

Answer

Mandates specific EHR software

Answer

Applies only to tech companies

Question 5

What is the role of the OIG in healthcare compliance?

Accepted Answer

Investigates fraud, waste, and abuse and issues compliance guidance

Answer

Provides direct patient care

Answer

Approves new medications

Answer

Manages Medicare enrollment

Question 6

What is the two-midnight rule for Medicare inpatient admission?

Accepted Answer

Inpatient admission is appropriate when the physician expects care spanning at least two midnights

Answer

Patients must stay at least three nights for coverage

Answer

The hospital must discharge within three midnights

Answer

Medicare only covers the first three nights