CH 5: Healthcare Regulatory and Certifying Agencies Flashcards
A nurse working in a hospital learns that the facility was fined due to non-compliance with a federal healthcare regulation. Which regulatory agency is most likely responsible for imposing this fine?
A. The Joint Commission
B. Occupational Safety and Health Administration (OSHA)
C. Centers for Medicare & Medicaid Services (CMS)
D. American Nurses Association (ANA)
C. Centers for Medicare & Medicaid Services (CMS)
Rationale: CMS is a federal regulatory agency that ensures healthcare organizations comply with federal regulations, particularly those related to Medicare and Medicaid funding. CMS can impose fines and penalties on facilities that fail to meet compliance standards.
A nurse is educating new staff members on the role of healthcare regulatory agencies. Which of the following are functions of these agencies? (SATA)
A. Investigate consumer complaints
B. Ensure healthcare organizations follow federal and state regulations
C. Provide voluntary accreditation for healthcare facilities
D. Set operational standards for healthcare organizations
E. Offer legal representation to healthcare practitioners facing malpractice claims
A. Investigate consumer complaints
B. Ensure healthcare organizations follow federal and state regulations
D. Set operational standards for healthcare organizations
Rationale: Healthcare regulatory agencies are responsible for setting standards for healthcare operations, ensuring compliance with laws, and investigating consumer complaints. Voluntary accreditation (C) is typically provided by organizations such as The Joint Commission, which is not a regulatory agency. Legal representation (E) is not a function of regulatory agencies.
A nurse manager is reviewing new policies to ensure compliance with state healthcare regulations. Which action best demonstrates compliance with a state regulatory agency?
A. Implementing evidence-based practice guidelines from a professional nursing organization
B. Following safety protocols mandated by the Occupational Safety and Health Administration (OSHA)
C. Obtaining accreditation from The Joint Commission
D. Adhering to state-mandated nurse-to-patient staffing ratios
D. Adhering to state-mandated nurse-to-patient staffing ratios
Rationale: State regulatory agencies enforce healthcare policies, including nurse staffing ratios, to ensure patient safety and quality care. Federal agencies like OSHA regulate workplace safety, while accreditation organizations such as The Joint Commission provide voluntary evaluations.
A nurse is attending a hospital training session on regulatory compliance. Which of the following can result in fines for healthcare organizations due to non-compliance? (SATA)
A. Failing to report sentinel events as required by The Joint Commission
B. Violation of infection control protocols mandated by the Centers for Disease Control and Prevention (CDC)
C. Non-compliance with patient privacy regulations established by the Health Insurance Portability and Accountability Act (HIPAA)
D. Failing to meet billing and reimbursement guidelines set by the Centers for Medicare & Medicaid Services (CMS)
E. Lack of participation in voluntary hospital accreditation programs
A. Failing to report sentinel events as required by The Joint Commission
C. Non-compliance with patient privacy regulations established by the Health Insurance Portability and Accountability Act (HIPAA)
D. Failing to meet billing and reimbursement guidelines set by the Centers for Medicare & Medicaid Services (CMS)
Rationale: Fines can be issued for non-compliance with mandatory reporting of sentinel events (A), patient privacy laws under HIPAA (C), and billing violations under CMS regulations (D). The CDC provides guidelines but does not impose fines (B), and hospital accreditation (E) is voluntary and does not result in fines for non-participation.
A nurse is concerned about unsafe patient care practices at her hospital. She wants to report the issue to a regulatory agency that can investigate and enforce compliance. Which agency should the nurse contact?
A. The Joint Commission
B. The State Department of Health
C. The American Hospital Association (AHA)
D. The National League for Nursing (NLN)
B. The State Department of Health
Rationale: State regulatory agencies, such as the State Department of Health, oversee healthcare facility compliance, investigate complaints, and enforce penalties for violations. The Joint Commission focuses on accreditation but does not enforce state regulations. The AHA and NLN are professional organizations that do not regulate healthcare facilities.
A Federal agency that is charged with promotion of health and quality of life by preventing and controlling disease, injury, and disability.
CDC (Centers for Disease Control and Prevention)
Federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness.
NIOSH (National Institute for Occupational Safety and Health)
Labor Dept. entity charged with ensuring the safety & health of America’s workers by setting & enforcing standards, providing training, education, & encouraging continual improvement in workplace safety.
OSHA (Occupational Safety and Health Administration)
A nurse is educating a new hospital administrator about healthcare accreditation agencies. Which statement by the administrator indicates a correct understanding of the purpose of accreditation?
A. “The main goal of accreditation is to inspire continuous improvement in patient safety and high-quality care.”
B. “Accreditation is mandatory for all healthcare organizations to receive any insurance reimbursement.”
C. “Accreditation agencies focus primarily on financial audits rather than clinical outcomes.”
D. “Healthcare organizations can operate without accreditation without any impact on reimbursement from government programs.”
A. “The main goal of accreditation is to inspire continuous improvement in patient safety and high-quality care.”
Rationale: Accreditation agencies evaluate healthcare organizations based on validated standards to ensure they provide safe, effective, and high-quality care. While accreditation is voluntary, it plays a crucial role in reimbursement from programs such as Medicare and Medicaid.
A nurse manager is reviewing accreditation requirements with the hospital leadership team. Which statement best explains the relationship between accreditation and insurance reimbursement?
A. “Medicare and Medicaid may refuse to reimburse hospitals that do not meet accreditation standards.”
B. “Private insurance companies do not consider accreditation status when approving claims.”
C. “Hospitals without accreditation can still receive full reimbursement from all insurance providers.”
D. “Accreditation primarily affects research funding rather than insurance reimbursements.”
A. “Medicare and Medicaid may refuse to reimburse hospitals that do not meet accreditation standards.”
Rationale: While accreditation is voluntary, failing to obtain accreditation can impact reimbursement from government programs such as Medicare and Medicaid, which may refuse to pay for services provided in non-accredited facilities.
A nurse is explaining the benefits of healthcare accreditation to a group of nursing students. Which of the following statements accurately describe the role of accreditation agencies? (SATA)
A. They help healthcare organizations meet established best practices.
B. They focus solely on financial oversight of healthcare organizations.
C. They promote continuous quality improvement in patient care.
D. They enforce legal penalties on hospitals that do not meet standards.
E. They set validated standards to evaluate healthcare organizations.
A. They help healthcare organizations meet established best practices.
C. They promote continuous quality improvement in patient care.
E. They set validated standards to evaluate healthcare organizations.
Rationale: Accreditation agencies support healthcare organizations in meeting best practices, fostering continuous quality improvement, and establishing validated standards for evaluation. They do not focus solely on financial oversight or enforce legal penalties.
A nurse is preparing a presentation on healthcare accreditation for new employees. Which statement should be included in the presentation?
A. “Accreditation agencies ensure hospitals are compliant with federal laws and provide legal enforcement.”
B. “Accreditation is required by law, and all healthcare facilities must be accredited to operate.”
C. “Accreditation is voluntary but can impact an organization’s ability to receive reimbursement from Medicare and Medicaid.”
D. “The main role of accreditation agencies is to oversee the financial stability of healthcare organizations.”
C. “Accreditation is voluntary but can impact an organization’s ability to receive reimbursement from Medicare and Medicaid.”
Rationale: Accreditation is not legally required but is highly recommended because many insurers, including Medicare and Medicaid, may refuse reimbursement to non-accredited organizations. Accreditation agencies focus on improving healthcare quality rather than enforcing laws or monitoring financial stability.
T/F
The Joint Commission—It is the predominant standards-setting and accrediting body in health care in the United States.
true
A nurse is educating a group of nursing students about The Joint Commission (TJC). Which statement best describes the primary mission of this organization?
A. “The Joint Commission works to continuously improve the safety and quality of healthcare through accreditation and performance improvement services.”
B. “The Joint Commission primarily focuses on financial audits of healthcare organizations.”
C. “The Joint Commission is a government-run organization that enforces healthcare regulations.”
D. “The Joint Commission only accredits hospitals and does not evaluate other types of healthcare organizations.”
A. “The Joint Commission works to continuously improve the safety and quality of healthcare through accreditation and performance improvement services.”
Rationale: The Joint Commission is an independent, not-for-profit organization that accredits healthcare facilities and promotes continuous quality and safety improvements. It does not primarily focus on financial audits or government enforcement.
A hospital administrator is preparing for an upcoming accreditation survey by The Joint Commission. Which of the following statements best describes the nature of The Joint Commission’s role?
A. “The Joint Commission is a government agency responsible for creating healthcare laws.”
B. “Accreditation from The Joint Commission is mandatory for all healthcare facilities.”
C. “The Joint Commission is an independent organization that evaluates healthcare facilities for quality and safety standards.”
D. “Only hospitals need to be accredited by The Joint Commission; other healthcare facilities are exempt.”
C. “The Joint Commission is an independent organization that evaluates healthcare facilities for quality and safety standards.”
Rationale: The Joint Commission is an independent, not-for-profit organization that accredits over 25,000 healthcare organizations, helping them improve their quality and safety standards. While accreditation is not legally mandatory, it is often required for reimbursement from Medicare and Medicaid.
A nursing instructor is discussing The Joint Commission with students. Which of the following statements are true about The Joint Commission? (SATA)
A. It is an independent, not-for-profit organization.
B. It was previously known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
C. It primarily focuses on financial stability rather than patient safety.
D. It accredits more than 25,000 healthcare organizations.
E. It is a government agency that enforces healthcare regulations.
A. It is an independent, not-for-profit organization.
B. It was previously known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
D. It accredits more than 25,000 healthcare organizations.
Rationale: The Joint Commission is an independent, not-for-profit organization that accredits and evaluates healthcare organizations for quality and safety improvement. It was previously known as JCAHO and accredits over 25,000 healthcare organizations. It does not primarily focus on financial stability, nor is it a government agency.
A hospital seeking accreditation is preparing for an evaluation by The Joint Commission. Which of the following best describes the impact of accreditation by The Joint Commission?
A. “Accreditation by The Joint Commission ensures automatic approval for Medicare and Medicaid reimbursement.”
B. “The Joint Commission helps healthcare organizations improve performance, safety, and quality of care.”
C. “Accreditation by The Joint Commission is only required for large hospitals, not smaller healthcare facilities.”
D. “The Joint Commission’s primary focus is on penalizing hospitals for failing to meet standards.”
B. “The Joint Commission helps healthcare organizations improve performance, safety, and quality of care.”
Rationale: The Joint Commission focuses on improving healthcare organizations by evaluating their quality and safety measures. While accreditation can support Medicare and Medicaid reimbursement, it does not guarantee automatic approval. The organization does not focus on penalizing hospitals but rather on driving continuous improvement.
What is the main focus of regulation and accreditation?
maintain standards for organizations that focus on continual improvement in health care for the public
T/F
Accreditation does not validate the effectiveness & safety of the care being delivered.
false, it does
One of the most common standards of The Joint Commission (TJC) that affects nursing care deals with the management of pain. The standard includes the following:
A.Documentation of assessment of pain
B.Documentation of the relief of pain
C.Use of therapeutics to manage pain and assessment of therapeutics
D.All of the above
D.All of the above
Which agency provides national and world leadership to prevent work-related illnesses and injuries and conducts a range of efforts in the areas of research, guidance, information, and service?
A.Centers for Disease Control and Prevention (CDC)
B.National Institute for Occupational Safety and Health (NIOSH)
C.The Joint Commission (TJC)
D.Centers for Medicare & Medicaid Services (CMS)
B.National Institute for Occupational Safety and Health (NIOSH)
____________________is a health care accreditation agency that integrates the ISO 9001 quality management system with the Medicare conditions of participation.
A.DNV
B.TJC
C.AOA
D.NIOSH
A.DNV
TJC standards address an organization’s level of performance in key functional areas, such as:
A.Patient rights, patient treatment, high quality care
B.Patient rights, patient assessment, pain control
C.Infection control, pain control, falls
D.Infection control, safe care, injection safety
C.Infection control, pain control, falls
The Occupational Safety and Health Administration (OSHA) has provided guidelines for minimizing patient lifting to prevent health care musculoskeletal injuries. Within these guidelines, OSHA recommends the following:
A.Patients be allowed to decide whether safe lifting equipment should be used when transferring out of bed
B.Manual lifting of residents be minimized and eliminated when feasible
C.Only specific types of lifting equipment be used, such as a ceiling-mounted patient lift with a sling
D.Institutions should be allowed to decide based on patient population whether safe lifting equipment should be used
B.Manual lifting of residents be minimized and eliminated when feasible
One benefit of accreditation by TJC is that it:
A.Leads to improved patient care and demonstrates the organizations commitment to safety and quality
B.Allows for increased financial gain through Medicare and Medicaid reimbursement and offers employee assistance programs
C.Influences the improved design of care processes, creating a nonpunitive environment to enhance error reporting and allows participation in error reporting and analysis
D.Offers an educational off-site survey experience
B.Allows for increased financial gain through Medicare and Medicaid reimbursement and offers employee assistance programs
TJC’s evaluation and accreditation services are provided for the following types of organizations:
A.State department of health and town senior housing services
B.Physicians’ offices and freestanding laboratory service agencies
C.Home hemodialysis and peritoneal dialysis
D.Critical access hospital, home care organizations, and nursing homes
D.Critical access hospital, home care organizations, and nursing homes
The U.S. Department of Health and Human Services (USDHHS) is the most important federal actor in health care. What are some of the other federal agencies with major health services roles?
A.Department of Veterans Affairs
B.Department of Treasury and Taxation
C.Department of Corrections and Law
D.Department of Agriculture and Taxation
A.Department of Veterans Affairs
An example of what the CDC would evaluate is:
A.A toxic spill on a state highway
B.An outbreak of rubella at a school
C.A flu shot clinic at a pharmaceutical company
D.An outbreak of respiratory syncytial virus in a neonatal intensive care unit
B.An outbreak of rubella at a school
NIOSH is:
A.The agency that works closely with TJC and hospital accreditation
B.A local agency that coordinates patient care and patient services
C.A state agency that is part of the CDC in the USDHHS
D.The federal agency responsible for conducting research and making recommendations for the prevention of work-related injury
D.The federal agency responsible for conducting research and making recommendations for the prevention of work-related injury
