Legal, Ethical & Regulatory Compliance Flashcards
7 cards from real CTP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Legal, Ethical & Regulatory Compliance flashcards as text
A telehealth provider bills Medicare for a synchronous audio-video visit but the patient only had audio. What is the compliance concern?
Answer: Modifier 95 misuse — video was not used as required for the billed code
Modifier 95 signifies a synchronous telemedicine service using interactive audio-video technology; using it when only audio was provided constitutes fraudulent billing.
Which law specifically prohibits healthcare providers from offering remuneration to induce patient referrals for federally reimbursed services?
Answer: Anti-Kickback Statute (AKS)
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for services covered by federal healthcare programs.
Under the Stark Law, a telehealth organization where a physician holds a financial interest refers patients to that organization's services. This is:
Answer: A potential violation unless a Stark Law exception applies
The Stark Law prohibits physician self-referrals to entities with which the physician has a financial relationship unless a specific regulatory exception applies.
A telehealth patient discloses suicidal ideation. The provider is in a different state than the patient. Which state's duty-to-warn laws apply?
Answer: The state where the patient is physically located
Duty-to-warn obligations are governed by the laws of the state where the patient is physically located at the time of the session.
What does EMTALA require of hospitals that offer telehealth emergency consultations to other facilities?
Answer: Consulting hospitals must accept appropriate transfers if they have the capacity
Under EMTALA, a hospital with specialized capabilities must accept transfers of patients with emergency medical conditions from referring facilities if it has the capacity.
A telehealth provider in a group practice wants to share a patient's mental health records with a colleague for consultation. Which additional protection may apply beyond HIPAA?
Answer: 42 CFR Part 2 if the records involve substance use disorder treatment
42 CFR Part 2 imposes stricter confidentiality requirements on substance use disorder treatment records, requiring patient consent for disclosures even within a treating team.
Which element is REQUIRED for a telehealth informed consent process to be legally valid?
Answer: The patient must demonstrate understanding and voluntarily agree without coercion
Valid informed consent requires that the patient understands the information provided, has decision-making capacity, and agrees voluntarily and without coercion.