CTP Legal, Ethical & Regulatory Compliance 4

Question 1

A telehealth provider bills Medicare for a synchronous audio-video visit but the patient only had audio. What is the compliance concern?

Accepted Answer

Modifier 95 misuse — video was not used as required for the billed code

Answer

Modifier 95 signifies a synchronous telemedicine service using interactive audio-video technology; using it when only audio was provided constitutes fraudulent billing.

Question 2

Which law specifically prohibits healthcare providers from offering remuneration to induce patient referrals for federally reimbursed services?

Accepted Answer

Anti-Kickback Statute (AKS)

Answer

The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for services covered by federal healthcare programs.

Question 3

Under the Stark Law, a telehealth organization where a physician holds a financial interest refers patients to that organization's services. This is:

Accepted Answer

A potential violation unless a Stark Law exception applies

Answer

The Stark Law prohibits physician self-referrals to entities with which the physician has a financial relationship unless a specific regulatory exception applies.

Question 4

A telehealth patient discloses suicidal ideation. The provider is in a different state than the patient. Which state's duty-to-warn laws apply?

Accepted Answer

The state where the patient is physically located

Answer

Duty-to-warn obligations are governed by the laws of the state where the patient is physically located at the time of the session.

Question 5

What does EMTALA require of hospitals that offer telehealth emergency consultations to other facilities?

Accepted Answer

Consulting hospitals must accept appropriate transfers if they have the capacity

Answer

Under EMTALA, a hospital with specialized capabilities must accept transfers of patients with emergency medical conditions from referring facilities if it has the capacity.

(CTP) Certified Telehealth Practitioner Practice Test

(CTP) Certified Telehealth Practitioner Practice Test

CTP Legal, Ethical & Regulatory Compliance 4