CHA CHA Regulatory and Legal Framework 1

Question 1

Under the Medicare Hospice Benefit, which federal regulation outlines the Conditions of Participation (CoPs) that hospice programs must meet?

Accepted Answer

42 CFR Part 418

Answer

42 CFR Part 418 contains the Medicare Hospice Conditions of Participation that all certified hospice agencies must comply with.

Question 2

The False Claims Act (FCA) primarily protects the government against which type of hospice misconduct?

Accepted Answer

Submitting fraudulent claims for Medicare reimbursement

Answer

The FCA imposes liability on individuals and organizations that submit false or fraudulent claims to government programs like Medicare.

Question 3

Which federal agency is responsible for conducting surveys to certify hospice programs for Medicare participation?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

CMS oversees the certification process for hospice programs, typically through State Survey Agencies acting on its behalf.

Question 4

A hospice patient electing the Medicare Hospice Benefit must have a prognosis of how long to live if the illness runs its normal course?

Accepted Answer

6 months or less

Answer

To elect the Medicare Hospice Benefit, two physicians must certify the patient has a terminal prognosis of 6 months or less if the disease runs its normal course.

Question 5

Which law established the anti-kickback statute that prohibits hospices from offering financial incentives to physicians for patient referrals?

Accepted Answer

Social Security Act Section 1128B(b)

Answer

The federal Anti-Kickback Statute under Social Security Act Section 1128B(b) prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for federally reimbursed services.

CHA - Certified Hospice Administrator Practice Test

CHA - Certified Hospice Administrator Practice Test

CHA CHA Regulatory and Legal Framework 1