Federal Agencies and Regulations Flashcards

Question

What does the acronym "HIPAA" stand for?

Answer 1

Health Insurance Portability and Accountability Act

Answer 2

HIPAA included sections devoted to administrative simplification. The Administrative Simplification Rules had a huge impact on healthcare providers that is still being sorted out years later. The hoped-for savings have not materialized for most providers for many reasons. Most payers have not standardized their information requirements and often ask for non-standard information in situational fields. While many payers offer electronic remittance advices (ERAs), patient accounting software firms can charge prohibitive fees for parsing the ERA for posting purposes.

Answer 3

Patient Self-Determination Act (PSDA)

Answer 4

Patient Self-Determination Act

Answer 5

Congress passed the Patient Self-Determination Act (PSDA) to ensure that patients understood their right to participate in decisions about their own healthcare and to provide a means to ensure it. The act deals with **advance directives**, which are written statements of a patient’s wishes regarding medical treatment in the event that he or she becomes unable to make certain decisions.

Answer 6

* Living Will * Healthcare Power of Attorney or Durable Power of Attorney for Healthcare * Do Not Resuscitate (DNR) Order

Answer 7

a document that specifies what treatments a patient does and does not wish to receive; it means that difficult decisions about future care are made while the person is alert; patients can choose the circumstances under which they will die; and patients' desires regarding organ donation are made known

Answer 8

a document that designates someone else (known as a healthcare surrogate, agent, or proxy) to make decisions on the patient’s behalf if he or she is unable to do so

Answer 9

a document that states that the patient does not wish to have CPR or similar interventions performed in the event of a medical emergency

Answer 10

Patient Protection and Affordable Care Act

Answer 11

* Also known as simply the Affordable Care Act (ACA) * Aimed at decreasing the number of uninsured Americans and reducing the overall costs of healthcare. * Provides a number of mechanisms — including mandates, subsidies, and tax credits — to employers and individuals in order to increase the coverage rate.

Answer 12

* Intentional or illegal deception or misrepresentation made for the purpose of personal gain, or to harm or manipulate another person or organization * Includes incorrect reporting of diagnosis and procedure codes to maximize payments, billing for services not furnished, altering claims to receive payment, accepting kickbacks, the routine waiver of deductible and coinsurance amounts, etc.

Answer 13

* Incidents or practices of healthcare workers that, although not usually considered fraudulent, are inconsistent with accepted sound practices * Some forms of healthcare abuse include excessive or unwarranted use of technology, pharmaceuticals, and services; abuse of authority; and abuse of privacy, confidentiality, or duty to care. It also includes improper billing practices (like billing Medicare instead of primary insurer), increasing charges to Medicare beneficiaries but not to other patients, unbundling of services, and unnecessary transfers of patients.

Answer 14

This protects against Fraud. The False Claims Act prohibits making a false record or statement to get a false/fraudulent claim paid by the government, submission of false/fraudulent claims, and conspiring to have false/fraudulent claims paid by the government.

Answer 15

* Denial or revocation of the provider number application * Suspension of provider payments * Impose Civil Monetary Penalties (CMPs)

Answer 16

Civil Monetary Penalties (CMPs)

Answer 17

Telephone Consumer Protection Act

Answer 18

prohibits contact with a debtor on a cell phone using automated dialing equipment without express consent and limits the use of artificial or prerecorded voice messages, SMS (Short Message Service, or text) messages, and fax machines.

Answer 19

* Also known as Regulation Z * Deals with the **disclosure** of information before credit is extended * Requires that annual percentage rates (APR) and finance charges are clearly and conspicuously identified * Requires that written disclosures must be provided to the consumer

Answer 20

the Truth in Lending Act

Answer 21

* Protects consumers from inaccurate or **unfair practices by issuers of open-ended credit**. * The act requires creditors to inform debtors of their rights and of the responsibilities of the creditor

Answer 22

* Created to define what information from "consumer **reports**" can be used, by whom, and when. * The act provides the maximum protection of a consumer’s right to privacy and confidentiality of credit reports.

Answer 23

* The FDCPA was the result of evidence that debt collectors were using abusive, deceptive, and unfair **collection** practices. * This act imposes strict limitations on: Acquisition of information regarding the location of the debtor; Communication with the debtor or others in collection of a debt * The act prohibits: Harassment or abuse in the collection process; Use of false or misleading information in the collection process * The act prohibits the collector from communicating with the consumer: At any unusual/inconvenient time (not between 8am-9pm) or place (at the consumer's place of employment), if the collector knows legal counsel represents the debtor

Answer 24

Equal Credit Opportunity Act

Answer 25

Prohibits credit **discrimination** on the basis of race, color, religion, national origin, sex, marital status, age, or because someone receives public assistance. Creditors may ask for most of the information, but they may not use it when deciding whether to give a person credit or when setting the terms of the credit.

Answer 26

* If the applicant is widowed or divorced. A creditor may use only the terms: married, unmarried, or separated. * Information about the applicant’s marital status if applying for a separate, unsecured account. * Information about the spouse, except: if the spouse is applying with the person, if the spouse will be allowed to use the account, if the person is relying on the spouse’s income or on alimony or child support income from a former spouse, or if the person lives in a community property state

Answer 27

The Emergency Medical Treatment and Active Labor Act

Answer 28

Federal Anti-Dumping Statute

Answer 29

The Emergency Medical Treatment and Active Labor Act (EMTALA)

Answer 30

* Also known as the Federal Anti-Dumping Statute. * Enacted in response to concerns that hospitals were refusing to treat patients without insurance and even transferring them to other facilities and leaving them there, sometimes without notifying the receiving facility. * EMTALA establishes the following general requirements: Medical screening examination; Necessary stabilizing treatment; Restricting transfer until stabilization * While registration staff is allowed to gather basic demographic information from a patient seeking treatment, questions about how the patient intends to pay are prohibited until he or she has received a medical screening exam.

Answer 31

Clinical Laboratory Improvement Amendment

Answer 32

* Requires that all clinical laboratory services furnished to Medicare beneficiaries must be performed by a provider who has a CLIA certificate. * All qualifying providers of laboratory services are issued a CLIA number, which should be reported on the claim. * A state can become exempt from CLIA status if its legal requirements are equal to or more stringent than CLIA’s statutory and regulatory requirements. Presently only two states are exempt: **New York** and **Washington**.

Answer 33

* Private agency that seeks to protect and improve the quality and safety of care. * CMS allows TJC to accredit hospitals. * TJC inspects facilities and provides education on issues affecting patient care and safety. It has many standards meant to protect quality and safety. * Not all hospitals are accredited by TJC; some are accredited by their states or other agencies.

Answer 34

* Advanced directives * Patient rights and responsibilities * Organizational ethics * Continuum of care * Management of environment of care * Confidentiality * Privacy * Security * Communication

Answer 35

TJC will conduct an audit of a **hospital every 39 months** and of a **laboratory every two years**. The organization can audit a healthcare facility **without advance notice**, and as early as **9-30 months after an initial audit**.