CCM Healthcare Regulations & Compliance 2 — Questions and Answers
Question 1: Under EMTALA, what is a hospital's obligation when a patient presents to the emergency department requesting examination?
- Provide a medical screening examination regardless of ability to pay (Correct answer)
- Require insurance verification before screening
- Transfer the patient immediately to a facility that accepts their insurance
- Obtain written consent before any examination
Correct answer: Provide a medical screening examination regardless of ability to pay
EMTALA mandates that any individual who comes to an ED requesting examination must receive a medical screening examination regardless of their ability to pay or insurance status.
Question 2: Which federal regulation governs the confidentiality of substance use disorder patient records in healthcare settings?
- HIPAA Privacy Rule
- 42 CFR Part 2 (Correct answer)
- HITECH Act
- Stark Law
Correct answer: 42 CFR Part 2
42 CFR Part 2 provides stricter confidentiality protections for records of patients treated in federally assisted substance use disorder programs, beyond standard HIPAA protections.
Question 3: The False Claims Act imposes liability on individuals who knowingly submit false claims to federal healthcare programs. What is the qui tam provision?
- Allows private citizens to file suit on behalf of the government and share in recovered damages (Correct answer)
- Prohibits physicians from referring patients to facilities in which they have financial interests
- Requires mandatory reporting of healthcare fraud to the OIG
- Establishes criminal penalties for fraudulent billing
Correct answer: Allows private citizens to file suit on behalf of the government and share in recovered damages
The qui tam provision of the False Claims Act allows private individuals (whistleblowers) to file lawsuits on behalf of the government and receive a portion of any recovered funds.
Question 4: A care manager discovers that a physician is self-referring patients to a physical therapy clinic in which the physician has an undisclosed financial interest. This likely violates which law?
- Anti-Kickback Statute only
- Stark Law (Physician Self-Referral Law) (Correct answer)
- HIPAA Privacy Rule
- EMTALA
Correct answer: Stark Law (Physician Self-Referral Law)
The Stark Law prohibits physicians from referring Medicare/Medicaid patients to entities for designated health services if the physician has a financial relationship with that entity.
Question 5: What does the term 'covered entity' mean under HIPAA?
- Any business that handles financial data
- Health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically (Correct answer)
- Only hospitals and large health systems
- Any organization receiving federal funding
Correct answer: Health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically
Under HIPAA, covered entities are health plans, healthcare clearinghouses, and healthcare providers who electronically transmit any health information in connection with HIPAA-covered transactions.
Question 6: Which accreditation body is most commonly used by hospitals seeking to meet CMS Conditions of Participation through deemed status?
- URAC
- NCQA
- The Joint Commission (TJC) (Correct answer)
- CARF
Correct answer: The Joint Commission (TJC)
The Joint Commission has CMS-granted deeming authority, meaning hospitals accredited by TJC are deemed to meet Medicare and Medicaid Conditions of Participation.
Question 7: Under the ADA, what is a healthcare organization required to provide to ensure effective communication with a patient who is deaf?
- Written notes only
- Qualified interpreters or other auxiliary aids and services at no cost to the patient (Correct answer)
- Access to a telephone relay service only
- A family member interpreter upon request
Correct answer: Qualified interpreters or other auxiliary aids and services at no cost to the patient
The ADA requires covered entities to provide qualified interpreters or other effective auxiliary aids and services to individuals with hearing disabilities, at no cost, to ensure equal access.
CCM Healthcare Regulations & Compliance 2
Under EMTALA, what is a hospital's obligation when a patient presents to the emergency department requesting examination?