Regulatory Frameworks & Compliance Flashcards

Which law prohibits Medicare and Medicaid fraud, including billing for services not rendered or upcoding procedures?

Answer: False Claims Act

The False Claims Act (31 U.S.C. §§ 3729–3733) prohibits knowingly submitting false or fraudulent claims to federal healthcare programs. Violations can result in treble damages, civil monetary penalties, and criminal prosecution.

Under 21 CFR 1020.31, the minimum source-to-skin distance (SSD) for a stationary fluoroscope is:

Answer: 38 cm (15 inches)

21 CFR 1020.31 requires a minimum SSD of 38 cm (15 inches) for stationary fluoroscopes and 30 cm (12 inches) for mobile units. This minimum distance protects the patient's skin from high skin entrance doses.

The Joint Commission accreditation standards require that radiation dose be included in patient records for:

Answer: Fluoroscopic procedures with cumulative air kerma above a specific level

The Joint Commission requires documentation of patient radiation dose for fluoroscopic procedures with cumulative air kerma ≥500 mGy or total fluoroscopy time ≥30 minutes, as part of their radiation safety requirements.

The purpose of a Notice of Privacy Practices (NPP) under HIPAA is to:

Answer: Inform patients how their protected health information may be used and disclosed

The Notice of Privacy Practices (NPP) is a HIPAA-required document that informs patients of their rights regarding their protected health information (PHI) and describes how the facility may use and disclose PHI.

Which document sets the framework for radiation protection principles worldwide, influencing both NCRP and NRC regulations?

Answer: ICRP Publications (especially ICRP 103)

The International Commission on Radiological Protection (ICRP) Publications — especially Publication 103 (2007) — set the international framework for radiation protection principles (justification, optimization, dose limitation) that underpin most national regulatory systems including US standards.

State radiation control programs have the authority to:

Answer: Set standards equal to or more stringent than federal regulations for X-ray equipment and user licensing

State radiation control programs (Agreement States and non-Agreement States) can set X-ray equipment standards and operator licensing requirements that are equal to or more stringent than federal standards — but not less stringent.