Healthcare Compliance and Regulations Flashcards
7 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 7 Healthcare Compliance and Regulations flashcards as text
A revenue cycle staff member accesses a celebrity patient's record out of curiosity without a treatment need. Which HIPAA rule is violated?
Answer: Privacy Rule minimum necessary standard
The HIPAA Privacy Rule's minimum necessary standard limits access to PHI to only what is needed for a legitimate job function.
Under the Medicare Conditions of Participation, how long must hospitals generally retain medical records for adult patients?
Answer: 5 years from date of discharge
Medicare Conditions of Participation require hospitals to retain patient medical records for at least 5 years from the date of discharge.
Which element is NOT required for a valid HIPAA-compliant authorization for the release of PHI?
Answer: Patient's Social Security Number
A valid HIPAA authorization does not require the patient's Social Security Number; required elements focus on purpose, recipient, and patient rights.
An exclusion from participation in federal healthcare programs is managed by which federal office?
Answer: Office of Inspector General (OIG)
The OIG maintains the List of Excluded Individuals/Entities (LEIE) and has authority to impose exclusions from federal healthcare programs.
What is the primary purpose of a Corporate Integrity Agreement (CIA) entered with the OIG?
Answer: To outline compliance obligations as an alternative to exclusion
A CIA is a negotiated agreement requiring a healthcare entity to implement specific compliance measures in exchange for not being excluded from federal programs.
Which regulatory body oversees enforcement of HIPAA's Privacy and Security Rules?
Answer: Office for Civil Rights (OCR)
HHS Office for Civil Rights (OCR) is responsible for enforcing HIPAA's Privacy and Security Rules and investigating complaints.
Under the No Surprises Act, which document must providers give patients before scheduled services involving potential out-of-network costs?
Answer: Good Faith Estimate (GFE)
The No Surprises Act requires providers to give uninsured and self-pay patients a Good Faith Estimate of expected charges before scheduled services.