CHA Regulatory and Legal Framework Flashcards
6 cards from real CHA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CHA Regulatory and Legal Framework flashcards as text
What is the primary purpose of a hospice compliance program as outlined in OIG guidance?
Answer: Prevent, detect, and correct fraud, waste, and abuse
A compliance program is designed to prevent, detect, and correct violations of laws, regulations, and internal policies, including fraud and abuse.
When a hospice receives a CMS Immediate Jeopardy (IJ) citation, what must the hospice do to avoid termination from Medicare?
Answer: Submit an acceptable allegation of compliance immediately
An Immediate Jeopardy finding requires the hospice to submit an acceptable allegation of compliance as quickly as possible, typically within days, to avoid termination from Medicare.
Under HIPAA, which entity classification applies to a hospice organization that handles protected health information?
Answer: Covered entity
Hospices are covered entities under HIPAA because they are healthcare providers that transmit health information electronically in connection with standard transactions.
Which federal program requires hospices to report quality data through the CASPER system or face a payment reduction?
Answer: Hospice Quality Reporting Program (HQRP)
The HQRP requires hospices to submit quality data including the HIS and CAHPS Hospice Survey to CASPER or face a 2-percentage-point reduction in their annual market basket update.
A condition-level deficiency during a CMS hospice survey differs from a standard deficiency because it:
Answer: Indicates noncompliance with an entire Condition of Participation
A condition-level deficiency means the hospice is out of compliance with an entire Condition of Participation and places Medicare certification at risk.
Which law requires hospice employers to screen staff against the OIG List of Excluded Individuals and Entities (LEIE) prior to hire?
Answer: Social Security Act exclusion provisions
The Social Security Act prohibits hospices from employing or contracting with individuals on the OIG LEIE, as payments for their services cannot be reimbursed by Medicare or Medicaid.