5: REGULATION, ACCREDITATION, AND LEGISLATION Flashcards

1
Q
  • for medicare patients who establish payment based on diagnosis related groups (DRG)
    o patient classification scheme
  • hospitals are paid affects amount per DRG
A

1983: PROSPECTIVE PAYMENT SYSTEM

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2
Q
  • establish out-patient laboratory fee to schedule control cost.
A

1984: DEFICIT REDUCTION ACT “DEFRA”

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3
Q
  • all laboratories must be certified by the federal government with mandated quality assurance, personnel, and proficiency testing standards.
A

1988: CLINICAL LABORATORY IMPROVEMENT ACT (CLIA) OF 1988

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4
Q
  • prevents the physician from referring medicare patients to self-owned lab
A

1989: PHYSICIAN SELF REFERRAL BAN

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5
Q
  • payment for any lab testing done within three calendar days before admission as in-patient will not be reimbursed
A

1990: THREE-DAY RULE

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6
Q
  • establishes OSHA guidelines to limit unnecessary exposure to biological hazards
A

1992: EXPOSURE TO BLOODBORNE PATHOGEN

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7
Q
  • establishes OSHA guidelines to limit unnecessary exposure to hazardous chemicals
A

OCCUPATIONAL EXPOSURE TO HAZARDOUS CHEMICALS

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8
Q
  • this law protects patient from inappropriate dispersion of personal info
  • access to Protected Health Info (PHI)
A

1996: HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY (HIPAA)

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9
Q
  • help the laboratories to develop programs that promote high ethical and lawful conduct
A

1997: OIG COMPLIANCE GUIDELINES

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10
Q
  • physicians must know how to select the most appropriate test needed and should avoid the “shotgun” approach to test ordering practices
A

AUGUST 24, 1998

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11
Q
  • replace most local medical review policies which are used to determine whether laboratory tests are medically necessary and reimbursable.
A

2001: CMS NATIONAL COVERAGE DETERMINATIONS

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12
Q
  • deals with shipment of blood and other potentially biohazardous products.
A

2003: HAZARDOUS MATERIAL REGULATIONS

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13
Q
  • 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.
A

2007: HI-TECH ACT (EHR)

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14
Q
  • Under the US Department of health and human services
  • HHS (Human Health Services) – Comparable to DOH
  • For public health safety.
A

Centers for Disease Control and Prevention (CDC)

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15
Q
  • Largest Healthcare medical programs in the US
    o Medicare
    o Medic Aid
     Low – income individuals
A

Centers for Medicare and Medicaid Services (CMS)

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16
Q
  • Enforces standards for disposal of hazardous lab materials
  • Hazardous Lab Materials
    o Formalin
    o Xylene
    o Potential Carcinogens
A

Environmental Protection Agency (EPA)

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17
Q
  • Dealing with fair employment practices.
A

Equal Employment Opportunity Commission (EEOC)

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18
Q
  • Part of HHS
  • Regulate and Manufactures of biologics ad medical devices and test kits.
A

Food and Drug Administration (FDA)

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19
Q
  • Oversees CMS, OIG, and FDA
A

Department of Human Health and Services (HHS)

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20
Q
  • Provides databases and access to the federal register.
    o Lab and regulations are published.
A

National Archives and Records Administration (NARA)

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21
Q
  • Enforces federal guidelines for the proper use of non-military nuclear facilities.
A

Nuclear Regulatory Commission (NRC)

22
Q
  • Performing and maintaining quality control for drug abuse testing.
A

National Institute on Drug Abuse (NIDA)

23
Q
  • Part of HHS
  • Provides research, information, and training in the field of occupational safety and health
  • Recommendations regarding health hazards
  • No authorities with enforcing.
A

National Institute for Occupational Safety and Health (NIOSH)

24
Q
  • World Leader in Medical Research.
A

National Institute of Health (NIH)

25
Q
  • Commerce Department
  • Contributed to the development of many healthcare products.
A

National Institute of Standards and Technology (NIST)

26
Q
  • Part of HHS
  • Responsible for auditing, inspecting, and identifying fraud and abuse in CMS programs.
A

Office of Inspector General (OIG)

27
Q
  • Department of Labor
  • Develops and enforces workplace standards to protect employees’ safety and health.
A

Occupational Safety and Health Administration (OSHA)

28
Q
  • Identifies, regulates, and may inspect high-risk chemical facilities and radiation sources that may be risks for terrorism.
A

Department of Homeland Security (DHS)

29
Q
  • A pear professional group that offers a blood bank accreditation.
A

American Association of Blood Banks (AABB)

30
Q
  • The largest organization for laboratory professionals and offers certification for various specialties.
A

American Society for Clinical Pathology (ASCP)

31
Q
  • Offers the largest proficiency program in the US.
A

College of American Pathologists (CAP)

32
Q
  • Develops standardized criteria regarding laboratory practices.
A

Clinical and Laboratory Standards Institute (CLSI)

33
Q
  • A nonprofit organization that provide assistance to physician office laboratories.
A

Commission on Office Laboratory Accreditation (COLA)

34
Q
  • A nonprofit organization that accredits nearly 17,000 health care organization and program-based quality standards.
A

The Joint Commission (TJC)

35
Q
  • A laboratory in a government hospital that had been designated by the DOH to provide special functions and services for specific diseases.
    o Confirmatory
    o Training
    o Research
    o EQAS – External Quality Assurance and Services
    o Validate test kits & Reagents (RGTS)
A

NATIONAL REFERENCE LABORATORIES

36
Q
  • Clinical Chemistry
A

Lung Center of the Philippines (LCP)

37
Q
  • Hematology
  • Immunohematology
  • Immunopathology
  • Anatomical Pathology
A

National Kidney Transplant Institute (NKTI)

38
Q
  • Drug Testing
  • Water Microbiology
A

East Avenue Medical Center (EAMC)

39
Q
  • SACCL – STS/AIDS Central Cooperative Laboratory.
  • Serology
A

San Lazaro Hospital (SLH)

40
Q
  • Microbiology - Bacteria
  • Parasitology - Parasite
  • Mycology - Fungi
  • Virology – Virus
A

Research Institute for Tropical Medicine (RITM)

41
Q

PROSPECTIVE PAYMENT SYSTEM

A

1983

42
Q

DEFICIT REDUCTION ACT “DEFRA”

A

1984

43
Q

CLINICAL LABORATORY IMPROVEMENT ACT (CLIA)

A

1988

44
Q

PHYSICIAN SELF REFERRAL BAN

A

1989

45
Q

THREE-DAY RULE

A

1990

46
Q

EXPOSURE TO BLOODBORNE PATHOGEN

A

1992

47
Q
  • establishes OSHA guidelines to limit unnecessary exposure to hazardous chemicals
A

OCCUPATIONAL EXPOSURE TO HAZARDOUS CHEMICALS

48
Q

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY (HIPAA)

A

1996

49
Q

OFFICE OF INSPECTOR GENERAL (OIG) COMPLIANCE GUIDELINES

A

1997

50
Q

CMS NATIONAL COVERAGE DETERMINATIONS

A

2001

51
Q

HAZARDOUS MATERIAL REGULATIONS

A

2003

52
Q

HI-TECH ACT

A

2007