Regulation, Accreditation, and Legislation Flashcards
concerns from the Centers for Medicare and Medicaid Services (CMS) about fraud and abuse of payments.
The Laboratory Compliance Program
was enacted in 1996, providing standards that protect the confidentiality of health information while allowing interchange of information in appropriate circumstance
Health Insurance Portability and Accountability Act (HIPAA)
established payment based on diagnosis-related group
prospective payment system
Established outpatient laboratory fee schedule to control costs
deficit reduction act
Established that all laboratories must be certified by the federal government with mandated quality assurance, personnel, and proficiency testing standards based on test complexity.
Clinical Laboratory Improvement Act of 1988 (CLIA ‘88)
Prevents physicians from referring Medicare patients to self-owned laboratories
Physician Self-referral Ban
Establish OSHA guidelines for employee safety.
Ergonomic Safety and Health Program Management Guidelines
Payment for any laboratory testing done 3 calendar days before admission as an inpatient is not reimbursed because testing is considered to be part of the hospital stay
Three-day rule
limit unnecessary exposure to hazardous chemicals
Occupational Exposure to Hazardous Chemicals in Laboratories
limit unnecessary exposure to biological hazards.
Occupational Exposure to Blood-Borne Pathogens
Directs how health care information is managed
Health Insurance Portability and Accountability Act
programs that promote high ethical and lawful conduct, especially regarding billing practices and fraud and abuse.
OIG Compliance Guidelines
used to determine whether certain laboratory tests are medically necessary and therefore reimbursable
CMS National Coverage Determinations
Deal with shipment of blood and other potentially biohazardous products (DOT)
Hazardous Material Regulation
provides oversight of public health and safety, including the laboratory
Center for Disease Control and Prevention
