CEHRS Regulatory Compliance and Quality Assurance 2 — Questions and Answers
Question 1: Which federal law established the Medicare and Medicaid programs and introduced the Conditions of Participation for healthcare facilities?
- HIPAA of 1996
- Social Security Act of 1965 (Correct answer)
- HITECH Act of 2009
- Affordable Care Act of 2010
Correct answer: Social Security Act of 1965
The Social Security Act of 1965 created Medicare and Medicaid and established Conditions of Participation that facilities must meet to receive federal reimbursement.
Question 2: A covered entity discovers a breach affecting 600 patients. Within how many days must it notify the Secretary of HHS?
- 30 days
- 45 days
- 60 days
- 60 calendar days from discovery (Correct answer)
Correct answer: 60 calendar days from discovery
Under the HIPAA Breach Notification Rule, covered entities must notify HHS of breaches affecting 500 or more individuals within 60 calendar days of discovery.
Question 3: Which quality improvement model uses Plan-Do-Study-Act (PDSA) cycles to test changes in healthcare processes?
- Six Sigma
- Lean methodology
- Model for Improvement (Correct answer)
- Root Cause Analysis
Correct answer: Model for Improvement
The Model for Improvement, developed by Associates in Process Improvement, uses PDSA cycles to iteratively test and refine process changes.
Question 4: Under HIPAA, which of the following is NOT considered a covered entity?
- Health insurance company
- Hospital billing department
- Life insurance company (Correct answer)
- Pharmacy chain
Correct answer: Life insurance company
Life insurance companies are not covered entities under HIPAA because they do not conduct electronic healthcare transactions covered by the rule.
Question 5: The ONC's Cures Act Final Rule prohibits which practice related to EHR data access?
- Charging for data storage
- Information blocking (Correct answer)
- Requiring patient portals
- Using certified EHR technology
Correct answer: Information blocking
The 21st Century Cures Act Final Rule prohibits information blocking practices that interfere with the access, exchange, or use of electronic health information.
Question 6: Which accreditation standard requires hospitals to maintain a complete medical record for every patient and defines minimum content requirements?
- CMS Conditions of Participation (Correct answer)
- HITECH meaningful use
- PCMH recognition
- URAC accreditation
Correct answer: CMS Conditions of Participation
CMS Conditions of Participation (42 CFR 482.24) specify that hospitals must maintain a medical record for every patient with defined minimum content elements.
Question 7: A hospital's coding team identifies that a coder consistently upcodes diagnoses for higher reimbursement. This constitutes:
- A documentation deficiency
- Healthcare fraud under the False Claims Act (Correct answer)
- A coding guideline deviation
- An administrative error requiring retraining
Correct answer: Healthcare fraud under the False Claims Act
Intentional upcoding to increase reimbursement constitutes healthcare fraud under the False Claims Act, which carries civil and criminal penalties.
CEHRS Regulatory Compliance and Quality Assurance 2
Which federal law established the Medicare and Medicaid programs and introduced the Conditions of Participation for healthcare facilities?