Healthcare Analyst Risk Assessment & Compliance Flashcards

Which federal law requires healthcare organizations to implement administrative, physical, and technical safeguards to protect electronic PHI?

Answer: HIPAA Security Rule

The HIPAA Security Rule specifically mandates administrative, physical, and technical safeguards for electronic protected health information (ePHI).

A healthcare analyst discovers that a vendor accessing patient data has not signed a Business Associate Agreement (BAA). What is the primary compliance risk?

Answer: HIPAA breach due to unauthorized PHI disclosure

Without a signed BAA, any vendor access to PHI constitutes an unauthorized disclosure under HIPAA, creating significant breach liability.

In healthcare risk assessment, what does the term 'residual risk' refer to?

Answer: Risk remaining after mitigation controls are implemented

Residual risk is the level of risk that remains after an organization has applied its risk management and mitigation controls.

Which CMS program penalizes hospitals for excessive rates of hospital-acquired conditions (HACs)?

Answer: HAC Reduction Program

The CMS Hospital-Acquired Condition (HAC) Reduction Program penalizes hospitals in the worst-performing quartile for HAC rates with a 1% payment reduction.

An analyst is assessing compliance risk related to physician self-referrals. Which law is most directly applicable?

Answer: Stark Law (Physician Self-Referral Law)

The Stark Law (42 U.S.C. § 1395nn) directly prohibits physicians from referring Medicare patients to entities with which they have a financial relationship unless an exception applies.

What is the purpose of a healthcare organization's compliance hotline?

Answer: To provide an anonymous channel for reporting suspected violations

A compliance hotline provides employees with a confidential or anonymous mechanism to report suspected fraud, waste, abuse, or other compliance violations without fear of retaliation.

Under OIG guidelines, which element is NOT one of the seven components of an effective compliance program?

Answer: Mandatory profit-sharing agreements with physicians

The OIG's seven compliance program components do not include physician profit-sharing; they focus on policies, training, communication, auditing, enforcement, and response to detected offenses.