Legal and Regulatory Compliance Flashcards
6 cards from real CHAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Legal and Regulatory Compliance flashcards as text
Under EMTALA, what constitutes an 'appropriate transfer' of a patient from one facility to another?
Answer: A transfer where the receiving facility has agreed to accept, the patient is stabilized or the benefits of transfer outweigh risks, and medical records are sent
EMTALA defines an appropriate transfer as one where the patient is stabilized, the receiving facility agrees and has capacity, and medical records accompany the patient.
What are the penalties for HIPAA violations, and how are they structured?
Answer: Penalties range from $100 to $50,000 per violation based on a tiered structure reflecting the level of culpability, with an annual maximum of $1.5 million per violation category
HIPAA civil penalties follow a four-tier structure based on the violator's level of awareness and neglect.
What is the Red Flags Rule, and how does it apply to patient access?
Answer: It requires healthcare providers to implement an identity theft prevention program to detect, prevent, and mitigate identity theft
The Red Flags Rule requires creditor entities including healthcare providers to have programs to detect and respond to identity theft red flags.
What does the No Surprises Act require regarding emergency services?
Answer: That patients cannot be balance billed for emergency services at out-of-network facilities beyond in-network cost-sharing amounts
The No Surprises Act protects patients from surprise balance billing for emergency services.
What is the purpose of Conditions of Participation (CoPs) in Medicare compliance?
Answer: They set the minimum health and safety standards that healthcare facilities must meet to participate in the Medicare program
CoPs establish the baseline requirements that hospitals must meet to be certified to participate in Medicare and Medicaid.
A state law provides stronger privacy protections for substance abuse treatment records than HIPAA. Which standard applies?
Answer: The stricter state law applies because HIPAA defers to more protective state regulations
When state law provides greater privacy protections, the more stringent state law applies. Additionally, 42 CFR Part 2 provides federal protections for substance use disorder records.