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
Which exception to the Stark Law allows a hospital to pay a physician for services personally performed by that physician at fair market value?
Answer: Personal Services Arrangements Exception
The Personal Services Arrangements Exception permits compensation to physicians for services they personally provide at fair market value under a written agreement.
Billing for a service that was never performed is classified as which type of fraud?
Answer: Phantom billing
Phantom billing refers to submitting claims for services, procedures, or supplies that were never actually provided to the patient.
Under the Anti-Kickback Statute, the safe harbor for personal services requires that the aggregate compensation be set in advance and not exceed what standard?
Answer: Fair market value
The personal services safe harbor requires that aggregate compensation is set in advance, consistent with fair market value, and not determined by volume or value of referrals.
A hospital submits a claim using procedure codes that should be billed together under a single bundled code. This practice is called:
Answer: Unbundling
Unbundling is the practice of billing separately for services that payers require to be billed under a single bundled code, resulting in higher reimbursement.
Which CMS program uses statistical analysis to identify aberrant billing patterns and flag providers for potential audit?
Answer: Fraud Prevention System (FPS)
The Fraud Prevention System (FPS) uses predictive analytics and data mining to identify aberrant billing patterns before and after payment.
What is the term for a voluntary self-disclosure program through which providers report potential fraud to the OIG in exchange for reduced penalties?
Answer: Self-Disclosure Protocol
The OIG's Self-Disclosure Protocol allows providers to voluntarily report potential fraud violations and typically results in reduced civil monetary penalties.
Under EMTALA, which patients must receive a medical screening examination at a hospital emergency department?
Answer: Any individual who comes to the emergency department requesting examination
EMTALA requires hospitals to provide a medical screening examination to any individual who comes to the ED requesting examination or treatment, regardless of insurance status.