Industry Regulations Flashcards
7 cards from real PCE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Industry Regulations flashcards as text
Under HIPAA, which of the following is considered a covered entity required to comply with privacy regulations?
Answer: A physical therapy private practice billing insurance
Healthcare providers who transmit health information electronically in connection with covered transactions are considered covered entities under HIPAA.
A physiotherapist discovers that a colleague has been billing for services not rendered. The MOST appropriate first action is to:
Answer: Report the issue through the facility's compliance or ethics reporting process
Suspected fraud should first be reported internally through established compliance channels, which then determines escalation steps.
Which federal act primarily governs workplace safety standards relevant to physiotherapy clinic settings in the US?
Answer: Occupational Safety and Health Act (OSHA)
OSHA establishes and enforces workplace safety and health standards, including those applicable to healthcare settings.
The Stark Law (Physician Self-Referral Law) primarily prohibits:
Answer: Physicians referring Medicare patients to entities in which they have a financial relationship
The Stark Law bans physician self-referrals to designated health services providers, including physical therapy, where a financial relationship exists.
A patient requests a copy of their medical records. Under HIPAA, the covered entity must generally provide access within:
Answer: 30 days, with one 30-day extension if needed
HIPAA requires covered entities to provide access to records within 30 days, with a single 30-day extension permitted if the entity notifies the patient.
Which of the following best describes 'upcoding' in the context of physical therapy billing?
Answer: Billing for a higher-complexity service than was actually provided
Upcoding is fraudulent billing that involves submitting codes for more intensive or expensive services than those actually delivered.
State practice acts for physiotherapy primarily serve to:
Answer: Define the legal scope of practice and licensure requirements within the state
State practice acts are laws enacted by state legislatures that define who can practice physiotherapy and what they are legally permitted to do.