NHI Healthcare Regulations & Compliance 3 — Questions and Answers
Question 1: Under HIPAA's Breach Notification Rule, covered entities must notify affected individuals of an unsecured PHI breach within:
- 30 days
- 45 days
- 60 days (Correct answer)
- 90 days
Correct answer: 60 days
The HIPAA Breach Notification Rule requires covered entities to notify affected individuals without unreasonable delay and no later than 60 days after discovery.
Question 2: The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to:
- Provide free care to all uninsured patients
- Screen and stabilize any patient who presents to the emergency department (Correct answer)
- Accept all Medicare and Medicaid patients regardless of capacity
- Treat only patients within their designated service area
Correct answer: Screen and stabilize any patient who presents to the emergency department
EMTALA mandates that hospitals with emergency departments perform a medical screening exam and stabilize patients with emergency medical conditions, regardless of ability to pay.
Question 3: The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare patients to entities for designated health services if:
- The entity is out-of-network
- The physician has a financial relationship with that entity (Correct answer)
- The patient has not provided written consent
- The service is not medically necessary
Correct answer: The physician has a financial relationship with that entity
The Stark Law prohibits physician self-referrals to entities where the physician or an immediate family member has a financial relationship, unless a specific exception applies.
Question 4: Which of the following is an example of 'upcoding' in medical billing?
- Submitting a claim for a service not rendered
- Billing a higher-level service than was actually provided (Correct answer)
- Using outdated procedure codes
- Billing for two procedures when only one was performed
Correct answer: Billing a higher-level service than was actually provided
Upcoding involves billing for a more complex or expensive service than was actually provided, which constitutes healthcare fraud.
Question 5: A covered entity's Notice of Privacy Practices (NPP) must be provided to new patients:
- Within 30 days of first service
- No later than the first date of service (Correct answer)
- Only upon patient request
- Annually regardless of new visits
Correct answer: No later than the first date of service
Under HIPAA, covered entities must make a good faith effort to provide the NPP to patients no later than the first date of service and obtain written acknowledgment.
Question 6: Which law established the Health Insurance Marketplace and required most Americans to obtain health insurance coverage?
- COBRA
- The Affordable Care Act (ACA) (Correct answer)
- ERISA
- SCHIP
Correct answer: The Affordable Care Act (ACA)
The Affordable Care Act (ACA) of 2010 established Health Insurance Marketplaces, expanded Medicaid, and introduced the individual mandate requiring most Americans to obtain coverage.
Question 7: Under OSHA's Bloodborne Pathogens Standard, employers must offer hepatitis B vaccination to at-risk employees:
- Within 90 days of hire
- After a needlestick exposure occurs
- At no cost, within 10 working days of initial assignment (Correct answer)
- Only if the employee requests it in writing
Correct answer: At no cost, within 10 working days of initial assignment
OSHA's Bloodborne Pathogens Standard requires employers to offer hepatitis B vaccination to occupationally at-risk employees at no cost within 10 working days of initial assignment.
NHI Healthcare Regulations & Compliance 3
Under HIPAA's Breach Notification Rule, covered entities must notify affected individuals of an unsecured PHI breach within: