Industry Regulations Flashcards

Which standard requires healthcare organizations to conduct an annual evaluation of their Environment of Care management plans?

Answer: The Joint Commission Environment of Care Standards

The Joint Commission's Environment of Care standards require accredited organizations to annually evaluate the effectiveness of their EC management plans.

Under the Stark Law (Physician Self-Referral Law), a physician is generally prohibited from referring Medicare patients to entities:

Answer: In which the physician or an immediate family member has a financial relationship

The Stark Law prohibits physicians from referring Medicare patients to designated health services entities in which they or their immediate family have a financial interest, absent an applicable exception.

A residential care facility fails to provide required advance notice before discharging a Medicaid resident. This most likely violates:

Answer: OBRA 1987 transfer and discharge protections

OBRA 1987 established specific resident rights regarding transfer and discharge, requiring facilities to provide written notice with a required number of days' advance warning.

The National Practitioner Data Bank (NPDB) is primarily used by healthcare organizations to:

Answer: Query practitioners' adverse actions, malpractice payments, and licensure history during credentialing

The NPDB is a federal repository that healthcare entities must query when credentialing practitioners to check for malpractice payments and adverse actions.

Which regulation established the requirement for hospitals to have a governing body legally responsible for the conduct of the hospital?

Answer: CMS Conditions of Participation (42 CFR 482.12)

42 CFR 482.12 requires Medicare-participating hospitals to have a governing body that assumes full legal responsibility for determining, implementing, and monitoring policies governing the hospital.

Under the Clinical Laboratory Improvement Amendments (CLIA), laboratories performing high-complexity testing must employ personnel meeting which requirement?

Answer: A laboratory director who is a board-certified physician or doctoral scientist

CLIA requires high-complexity labs to have a laboratory director who meets specific education and experience criteria, typically a board-certified physician or doctoral-level scientist.

An organization's compliance officer discovers a billing error resulting in overpayments from Medicare. Under the Affordable Care Act, overpayments must be reported and returned within:

Answer: 60 days of identification

The ACA's 60-day rule requires providers to report and return identified Medicare and Medicaid overpayments within 60 days of identification or the due date of any corresponding cost report.