CCM Healthcare Regulations & Compliance 2

Question 1

Under EMTALA, what is a hospital's obligation when a patient presents to the emergency department requesting examination?

Accepted Answer

Provide a medical screening examination regardless of ability to pay

Answer

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?

Accepted Answer

42 CFR Part 2

Answer

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?

Accepted Answer

Allows private citizens to file suit on behalf of the government and share in recovered damages

Answer

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?

Accepted Answer

Stark Law (Physician Self-Referral Law)

Answer

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?

Accepted Answer

Health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically

Answer

Under HIPAA, covered entities are health plans, healthcare clearinghouses, and healthcare providers who electronically transmit any health information in connection with HIPAA-covered transactions.

(CCM) Certified Care Management Professional Practice Test

(CCM) Certified Care Management Professional Practice Test

CCM Healthcare Regulations & Compliance 2