Federal Agencies And Regulations

Question 1

NIH

Answer 1

National Institutes of Health

Question 2

FDA

Answer 2

Food and Drug Administration

Question 3

CDC

Answer 3

Centers for Disease Control and Prevention

Question 4

ATSDR

Answer 4

Agency for Toxic Substances and Disease Registry

Question 5

IHS

Answer 5

Indian Health Service

Question 6

HRSA

Answer 6

Health Resources and Services Adminiatration

Question 7

SAM-HSA

Answer 7

Substance Abuse and Mental Health Services Administration

Question 8

AHRQ

Answer 8

Agency for Health Research and Quality

Question 9

CMS

Answer 9

Center for Medicare and Medicaid Services

Question 10

ACF

Answer 10

Administration for Children and Families

Question 11

ACL

Answer 11

Administration for Community Living

Question 12

Quality Improvement Organization (QIO) Program

Answer 12

Administered by CMS to monitor and improve utilization and quality of care for Medicare beneficiaries.

Question 13

Office of Inspector General (OIG)

Answer 13

Protects the integrity of HHS programs and the health and welfare of the beneficiaries of those programs. Investigate fraud and abuse.

Question 14

What are the two main governing bodies affecting healthcare change?

Answer 14

CMS and OIG

Question 15

What are other names for Medicare and Medicaid programs?

Answer 15

Title XVIII and Title XIX

Question 16

What CMS program is used to monitor and improve utilization and quality of care for Medicare beneficiaries?

Answer 16

Quality Improvement Organization (QIO)

Question 17

Federal Regulations

Answer 17

-Patient Rights
-Administration Simplification
-Affordable Care
-Anti-Fraud and Abuse
-Telephone consumer Protection
-Credit and Collections
-Patient Anti-Dumping
-Performance Improvement

Question 18

Patient Rights

Answer 18

A brochure that states what a patient/their family can expect during a hospital stay:
-high quality hospital care
-a clean and safe environment
-involvement in your care
-protection of your privacy
-help when leaving the hospital
-help with your billing claims

Question 19

HIPAA

Answer 19

The Health Insurance Portability and Accountability Act

Question 20

PHI

Answer 20

Protected Health Information

Question 21

Privacy and Security Rules

Answer 21

Issued by HHS as part of HIPAA to protect an individuals’ medical records and other personal health information.

Question 22

Protected Health Information (PHI)

Answer 22

Any individually identifiable patient information that can be used individually or in combination to patients with medical information. (Examples: name, DOB, address, phone number, email address, SSN, MRN, employer’s name/address, etc.)

Question 23

Administrative Simplification

Answer 23

A rule made in order to to provide savings for providers that has not yet been seen partially due to payers requiring nonstandard information requirements and patient accounting softwares charging prohibitive fees for Electronic Remittance Advices (ERAs).

Question 24

ERAs

Answer 24

Electronic Remittance Advices: an explanation from the health plan to provider about claim payment.

Question 25

PSDA

Answer 25

Patient Self-Determination Act

Question 26

Patient Self-Determination Act

Answer 26

Passed by congress to ensure patients understand their right to participate in decisions about their own healthcare. Specifically addressing Advanced Directives.

Question 27

Advanced Directives

Answer 27

Written Statements detailing a patient’s wishes regarding medical treatment in the event they become unable to make certain decisions.

Question 28

Living Will

Answer 28

A document specifying what treatments a patient does or does not wish to receive. Patients choose the circumstances in which they will die and also regarding organ donation.

Question 29

Healthcare Power of Attorney/Durable Power of Attorney

Answer 29

A document that designates a healthcare surrogate/agent/proxy for decision making on the patient’s behalf when they are not able to make those decisions.

Question 30

Do Not Resuscitate (DNR) Order

Answer 30

A document stating a patient does not wish to have CPR or similar interventions performed in the event of a medical emergency.

Question 31

PPACA

Answer 31

The Patient Protection and Affordable Care Act

Question 32

Fraud

Answer 32

Intentional or illegal deception or misrepresentation made for the purpose of personal gain, or to harm or manipulate another person or organization. Example: incorrect reporting for maximized payment, billing for services not furnished, altering claims to receive payment, accepting kickbacks, etc.

Question 33

Abuse

Answer 33

Incidents or practices of healthcare workers that, although not usually considered fraud, are inconsistent with accepted sound practices.

Question 34

What administrative sanctions can CMS take if inappropriate/fraudulent behavior have occurred?

Answer 34

1. Denial of revocation of the provider number application 2. Suspension of provider payments 3. Application of Civil Monetary Penalties (CMPs)

Question 35

TCPA

Answer 35

Telephone Consumer Protection Act Restricts telephone solicitations and use of automated telephone equipment.

Question 36

FDCPA

Answer 36

Fair Debt Collection Practices Act

Question 37

Fair Debt Collection Practices Act imposes and prohibits

Answer 37

Imposes strict limitations on -acquisition of info regarding debtors locations -communication with debtor or others in collection of debt Prohibits -Harassment or abuse during collection process -Use of false/misleading info during collection process -the collector from communicating at an unusual time (typically before 8am or after 9pm) -the collector from communicating with the debtor if there in known legal counsel representation, unless given consent by attorney to communicate with the debtor. -communicating with debtor at place of employment if believed that such employer prohibits the consumer from receiving such communication.

Question 38

ECOA

Answer 38

Equal Credit Opportunity Act

Question 39

CLIA

Answer 39

Clinical Laboratory Improvement Act

Question 40

CLIA Requires

Answer 40

That’s all laboratory services furnished to Medicare beneficiaries must be performed by a provider who has a CLIA certificate. Their CLIA number should be listed on the claim submission.

Question 41

Exemption from certain regulations occur when

Answer 41

When the state law is more stringent or offer more protection for the consumer than the federal laws do.

Question 42

TJC

Answer 42

The Joint Commission

Question 43

The Joint Commission

Answer 43

A private agency that seeks to protect and improve the quality and safety of care

Question 44

TJC surveys what areas for Patient Access

Answer 44

1. Distribution and discussion about advanced directives 2. Patient rights and responsibilities 3. Organizational ethics 4. Continuum of care 5. Management of environment of care 6. Confidentiality 7. Privacy 8. Security 9. Communication

Question 45

Patient Care Partnership Brochure

Answer 45

Replaced the “Patient’s Bill of Rights” Was adopted by the AHA Is a plain-language brochure