PAR Regulatory and Compliance Standards 3

Question 1

What is the primary purpose of the False Claims Act (FCA) in healthcare?

Accepted Answer

To penalize the submission of fraudulent claims to federal healthcare programs

Answer

The False Claims Act imposes liability on individuals and organizations that submit false or fraudulent claims for payment to federal programs such as Medicare and Medicaid.

Question 2

An Advance Beneficiary Notice (ABN) must be given to a Medicare patient when:

Accepted Answer

Medicare is likely to deny payment for a service due to medical necessity

Answer

An ABN is required when a provider believes Medicare will likely deny payment so the patient can decide whether to receive the service and accept financial responsibility.

Question 3

Which organization accredits hospitals and publishes quality performance data that patient access staff must be aware of for compliance purposes?

Accepted Answer

The Joint Commission (TJC)

Answer

The Joint Commission accredits and certifies healthcare organizations and programs, and its standards are widely used as a benchmark for quality and compliance.

Question 4

Under HIPAA's Minimum Necessary standard, when a staff member accesses PHI they should:

Accepted Answer

Access only the information needed to accomplish the intended purpose

Answer

The Minimum Necessary standard requires that PHI disclosures and internal uses be limited to the least amount of information needed to accomplish the task.

Question 5

The OIG Exclusion List is important to patient access because:

Accepted Answer

Providers and employees on the list cannot participate in federal healthcare programs

Answer

Hiring or contracting with individuals or entities on the OIG Exclusion List can result in significant civil monetary penalties for the healthcare organization.

(PAR) Patient Access Representative Certification Practice Test

(PAR) Patient Access Representative Certification Practice Test

PAR Regulatory and Compliance Standards 3