PAR Regulatory and Compliance Standards 2 — Questions and Answers
Question 1: Under EMTALA, what is a hospital's obligation when a patient presents to the emergency department requesting examination?
- Provide a medical screening examination regardless of ability to pay (Correct answer)
- Refer the patient to a community clinic if uninsured
- Collect a co-pay before initiating any services
- Obtain insurance authorization before the screening exam
Correct answer: Provide a medical screening examination regardless of ability to pay
EMTALA requires hospitals to provide a medical screening examination to anyone who comes to the ED requesting care, regardless of insurance status or ability to pay.
Question 2: Which federal act established the standards for protection and confidential handling of individually identifiable health information?
- EMTALA
- ADA
- HIPAA (Correct answer)
- COBRA
Correct answer: HIPAA
HIPAA (Health Insurance Portability and Accountability Act) established national standards for protecting individually identifiable health information.
Question 3: A patient requests an accounting of disclosures of their PHI. Under HIPAA, the covered entity must provide this accounting going back how many years?
- 1 year
- 3 years
- 6 years (Correct answer)
- 10 years
Correct answer: 6 years
HIPAA requires covered entities to provide an accounting of disclosures for the six years prior to the request date.
Question 4: The Stark Law (Physician Self-Referral Law) primarily prohibits physicians from referring Medicare/Medicaid patients to entities where the physician has a financial relationship UNLESS:
- The patient consents in writing
- A specific statutory exception applies (Correct answer)
- The referral is under $500 in value
- The physician is board certified
Correct answer: A specific statutory exception applies
The Stark Law prohibits self-referrals unless the arrangement fits within one of the specific statutory or regulatory exceptions defined in the law.
Question 5: Which of the following is NOT a permissible use of PHI under HIPAA's Treatment, Payment, and Healthcare Operations (TPO) provision without patient authorization?
- Sharing records with a treating specialist
- Submitting a claim to the patient's insurer
- Quality improvement activities within the facility
- Sharing records with an employer for job performance review (Correct answer)
Correct answer: Sharing records with an employer for job performance review
Sharing PHI with an employer for job performance review is not permitted under TPO and requires separate written authorization from the patient.
Question 6: The CMS Conditions of Participation (CoPs) apply to which type of facilities?
- Only private physician offices
- Hospitals and other facilities that participate in Medicare and Medicaid (Correct answer)
- Outpatient clinics billing private insurance only
- Federally qualified health centers exclusively
Correct answer: Hospitals and other facilities that participate in Medicare and Medicaid
CMS Conditions of Participation are the health and safety standards that hospitals and other facilities must meet to participate in the Medicare and Medicaid programs.
Question 7: Under the No Surprises Act, which of the following patients is protected from unexpected out-of-network bills for emergency services?
- Only Medicare beneficiaries
- Only Medicaid beneficiaries
- Patients with most private health plans, including employer-sponsored plans (Correct answer)
- Only patients treated in federally funded hospitals
Correct answer: Patients with most private health plans, including employer-sponsored plans
The No Surprises Act protects patients enrolled in most private health plans from unexpected out-of-network bills for emergency and certain non-emergency services.
PAR Regulatory and Compliance Standards 2
Under EMTALA, what is a hospital's obligation when a patient presents to the emergency department requesting examination?