CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations Flashcards
6 cards from real CRCR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations flashcards as text
What is the Stark Law designed to prevent?
Answer: Physicians from referring Medicare and Medicaid patients to entities in which they have a financial relationship unless an exception applies
The Stark Law prohibits physician self-referrals to entities where they have a financial interest to prevent conflicts of interest in federal healthcare programs.
What are the seven elements of an effective compliance program as recommended by the OIG?
Answer: Written standards and policies, compliance oversight, training and education, open communication lines, monitoring and auditing, discipline, and responding to detected violations
The OIG's seven elements provide the framework for an effective healthcare compliance program.
What is the Anti-Kickback Statute designed to prevent?
Answer: Offering, paying, soliciting, or receiving remuneration to induce or reward referrals of items or services covered by federal healthcare programs
The AKS prohibits financial arrangements designed to induce referrals of patients covered by Medicare, Medicaid, or other federal programs.
What is a Corporate Integrity Agreement in healthcare compliance?
Answer: A binding agreement between the OIG and a healthcare provider resolving fraud investigations and requiring specific compliance obligations
A CIA is a negotiated agreement between the OIG and a healthcare entity to resolve an investigation and impose ongoing compliance obligations.
What is the purpose of Medicare's Recovery Audit Contractor program?
Answer: To identify and recover improper Medicare payments through post-payment audits
RACs are private auditors contracted by CMS to identify overpayments and underpayments in Medicare claims on a contingency fee basis.
Under HIPAA, what is a business associate agreement required for?
Answer: Third-party vendors that receive, create, or transmit protected health information on behalf of a covered entity
BAAs are required with any third party that handles PHI on behalf of a covered entity making them contractually bound to HIPAA protections.