CRCR Regulatory and Compliance Knowledge 2

Question 1

What is a covered entity under HIPAA?

Accepted Answer

Health plans, healthcare clearinghouses, and healthcare providers that transmit health information electronically

Answer

HIPAA's covered entity definition includes health plans, clearinghouses, and any provider that transmits PHI electronically in connection with standard transactions.

Question 2

What are the potential penalties for a HIPAA breach resulting from willful neglect that is not corrected?

Accepted Answer

Up to $1.9 million per violation category per year plus potential criminal charges

Answer

HIPAA's tiered penalty structure imposes the highest fines for willful neglect that is not corrected.

Question 3

What do the Conditions of Participation refer to in healthcare compliance?

Accepted Answer

Federal standards that healthcare facilities must meet to participate in the Medicare and Medicaid programs

Answer

CoPs are CMS's baseline standards for quality and patient safety that must be met for facilities to participate in Medicare and Medicaid.

Question 4

What is the role of CMS in US healthcare compliance?

Accepted Answer

To administer Medicare and Medicaid, set coverage policies, issue billing regulations, and establish quality standards for participating providers

Answer

CMS is the federal agency responsible for operating Medicare and Medicaid and setting the regulatory framework for both programs.

Question 5

What is exclusion from Medicare and Medicaid participation and what triggers it?

Accepted Answer

A federal sanction that bars an individual or entity from billing Medicare or Medicaid triggered by fraud convictions, license revocations, or other specified conduct

Answer

OIG exclusion bars individuals and entities from participation in federal healthcare programs which is one of the most serious compliance sanctions available.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Regulatory and Compliance Knowledge 2