PCE Industry Regulations 3 — Questions and Answers
Question 1: The Anti-Kickback Statute (AKS) in healthcare prohibits:
- Offering remuneration to induce referrals of federally funded healthcare services (Correct answer)
- Physiotherapists accepting tips from satisfied patients
- Clinics advertising discounted services to cash-pay patients
- Hiring staff at above-market compensation rates
Correct answer: Offering remuneration to induce referrals of federally funded healthcare services
The AKS makes it illegal to offer, pay, solicit, or receive anything of value to induce or reward referrals of items covered by federal healthcare programs.
Question 2: Under the Americans with Disabilities Act (ADA), a physiotherapy clinic is MOST likely required to:
- Provide accessible entrances and treatment areas for patients with physical disabilities (Correct answer)
- Hire a minimum percentage of staff members with disabilities
- Offer services free of charge to uninsured patients with disabilities
- Accept all insurance plans that cover patients with disabilities
Correct answer: Provide accessible entrances and treatment areas for patients with physical disabilities
Title III of the ADA requires places of public accommodation, including healthcare facilities, to provide physical accessibility to people with disabilities.
Question 3: Which document outlines the patient's rights regarding their protected health information and must be provided at the first service encounter?
- Notice of Privacy Practices (NPP) (Correct answer)
- Patient Bill of Rights
- Advance Beneficiary Notice (ABN)
- OSHA Safety Data Sheet
Correct answer: Notice of Privacy Practices (NPP)
HIPAA mandates that covered entities provide patients with a Notice of Privacy Practices at the first point of service contact.
Question 4: A physiotherapist working in a hospital is subject to The Joint Commission (TJC) standards. These standards primarily address:
- Quality of patient care and organizational safety within accredited facilities (Correct answer)
- Reimbursement rates for outpatient rehabilitation services
- State licensure renewal requirements for clinicians
- Federal tax obligations of nonprofit healthcare organizations
Correct answer: Quality of patient care and organizational safety within accredited facilities
TJC accredits healthcare organizations and sets performance standards focused on patient safety and quality of care.
Question 5: A physical therapist in a 'direct access' state begins treating a patient without a physician referral. The therapist practices beyond their training in a specialized area. This MOST likely violates:
- The state practice act's scope of practice provisions (Correct answer)
- The federal False Claims Act
- HIPAA Privacy Rule
- OSHA infection control standards
Correct answer: The state practice act's scope of practice provisions
Practicing beyond one's competence or the legally defined scope of practice is a violation of state licensure law.
Question 6: Under OSHA's Bloodborne Pathogens Standard, physical therapy clinics must provide hepatitis B vaccination to:
- Employees with occupational exposure to blood or other potentially infectious materials, at no cost (Correct answer)
- All staff regardless of patient contact, with employee cost-sharing
- Only employees who request it and can demonstrate clinical need
- Staff only after a documented exposure incident occurs
Correct answer: Employees with occupational exposure to blood or other potentially infectious materials, at no cost
OSHA requires employers to offer hepatitis B vaccination at no cost to all employees who have occupational exposure to bloodborne pathogens.
Question 7: Which of the following scenarios MOST clearly constitutes insurance fraud in physical therapy?
- Billing Medicare for 60 minutes of therapeutic exercise when only 30 minutes were provided (Correct answer)
- Accidentally entering the wrong CPT code, which is corrected upon audit
- Providing a service not yet pre-authorized but medically necessary
- Treating a patient whose coverage has lapsed, then billing the patient directly
Correct answer: Billing Medicare for 60 minutes of therapeutic exercise when only 30 minutes were provided
Knowingly billing for services not rendered or for greater units than provided constitutes fraud under federal and state law.
PCE Industry Regulations 3
The Anti-Kickback Statute (AKS) in healthcare prohibits: