5: REGULATION, ACCREDITATION, AND LEGISLATION Flashcards
- for medicare patients who establish payment based on diagnosis related groups (DRG)
o patient classification scheme - hospitals are paid affects amount per DRG
1983: PROSPECTIVE PAYMENT SYSTEM
- establish out-patient laboratory fee to schedule control cost.
1984: DEFICIT REDUCTION ACT “DEFRA”
- all laboratories must be certified by the federal government with mandated quality assurance, personnel, and proficiency testing standards.
1988: CLINICAL LABORATORY IMPROVEMENT ACT (CLIA) OF 1988
- prevents the physician from referring medicare patients to self-owned lab
1989: PHYSICIAN SELF REFERRAL BAN
- payment for any lab testing done within three calendar days before admission as in-patient will not be reimbursed
1990: THREE-DAY RULE
- establishes OSHA guidelines to limit unnecessary exposure to biological hazards
1992: EXPOSURE TO BLOODBORNE PATHOGEN
- establishes OSHA guidelines to limit unnecessary exposure to hazardous chemicals
OCCUPATIONAL EXPOSURE TO HAZARDOUS CHEMICALS
- this law protects patient from inappropriate dispersion of personal info
- access to Protected Health Info (PHI)
1996: HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY (HIPAA)
- help the laboratories to develop programs that promote high ethical and lawful conduct
1997: OIG COMPLIANCE GUIDELINES
- physicians must know how to select the most appropriate test needed and should avoid the “shotgun” approach to test ordering practices
AUGUST 24, 1998
- replace most local medical review policies which are used to determine whether laboratory tests are medically necessary and reimbursable.
2001: CMS NATIONAL COVERAGE DETERMINATIONS
- deals with shipment of blood and other potentially biohazardous products.
2003: HAZARDOUS MATERIAL REGULATIONS
- contains incentives related to adoption of healthcare information technology and electronic health record.
- provide patient the access to their PHI of which the access provided within 30 days of the request.
2007: HI-TECH ACT (EHR)
- Under the US Department of health and human services
- HHS (Human Health Services) – Comparable to DOH
- For public health safety.
Centers for Disease Control and Prevention (CDC)
- Largest Healthcare medical programs in the US
o Medicare
o Medic Aid
Low – income individuals
Centers for Medicare and Medicaid Services (CMS)
- Enforces standards for disposal of hazardous lab materials
- Hazardous Lab Materials
o Formalin
o Xylene
o Potential Carcinogens
Environmental Protection Agency (EPA)
- Dealing with fair employment practices.
Equal Employment Opportunity Commission (EEOC)
- Part of HHS
- Regulate and Manufactures of biologics ad medical devices and test kits.
Food and Drug Administration (FDA)
- Oversees CMS, OIG, and FDA
Department of Human Health and Services (HHS)
- Provides databases and access to the federal register.
o Lab and regulations are published.
National Archives and Records Administration (NARA)