CCM - Certified Case Manager Exam Certified Case Manager Healthcare Regulations and Compliance 1

Question 1

Which federal law requires healthcare providers to maintain the privacy and security of patients' protected health information (PHI)?

Accepted Answer

HIPAA

Answer

HIPAA (Health Insurance Portability and Accountability Act) establishes national standards for protecting PHI, governing how healthcare providers, health plans, and clearinghouses must safeguard patient information and limiting its disclosure without patient authorization.

Question 2

Under Medicare's Conditions of Participation, what is a hospital's primary obligation regarding discharge planning?

Accepted Answer

Hospitals must identify patients who need post-acute care and develop a discharge plan in collaboration with the patient and their caregivers

Answer

Medicare's Conditions of Participation require hospitals to identify patients who need post-discharge services early in the stay and to develop a patient-centered discharge plan with input from the patient, family, and caregivers to ensure a safe transition to the appropriate level of care.

Question 3

What does the False Claims Act primarily prohibit in the context of healthcare?

Accepted Answer

Submitting fraudulent claims for payment to federal healthcare programs

Answer

The False Claims Act prohibits knowingly submitting false or fraudulent claims for payment to federal programs like Medicare and Medicaid. It includes a 'qui tam' provision allowing private citizens (whistleblowers) to file suit on behalf of the government and share in any recovery.

Question 4

Which regulation governs the rights of individuals with disabilities to access healthcare facilities and services without discrimination?

Accepted Answer

Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA)

Answer

Section 504 of the Rehabilitation Act and the ADA together prohibit discrimination against people with disabilities in healthcare settings, requiring providers to offer reasonable accommodations and ensure physical and programmatic accessibility.

Question 5

A case manager discovers that a colleague is accepting gifts from a home health agency in exchange for referrals. Under the Anti-Kickback Statute, which action is most appropriate?

Accepted Answer

Report the conduct through the organization's compliance program or to the Office of Inspector General

Answer

The Anti-Kickback Statute prohibits any remuneration intended to induce referrals for federally reimbursed services. Gifts in exchange for referrals are a violation regardless of amount or profession. The correct action is to report through compliance channels or the OIG, as case managers have an ethical and legal obligation to address fraud.

CCM - Certified Case Manager Exam Practice Test

CCM - Certified Case Manager Exam Practice Test

CCM - Certified Case Manager Exam Certified Case Manager Healthcare Regulations and Compliance 1