Legal and Regulatory Compliance Flashcards
6 cards from real CCHT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Legal and Regulatory Compliance flashcards as text
Which federal agency sets the Conditions for Coverage (CfC) that dialysis facilities must meet to receive Medicare reimbursement?
Answer: The Centers for Medicare & Medicaid Services (CMS)
CMS establishes the Conditions for Coverage (CfC) for ESRD facilities, which are the minimum health and safety standards facilities must meet to participate in the Medicare program. CMS conducts or oversees surveys to verify compliance.
A dialysis patient asks to see their own medical records. Under HIPAA, how should the facility respond?
Answer: Provide access within 30 days (or 60 days with one 30-day extension) at a reasonable cost
Under the HIPAA Privacy Rule, patients have the right to access their own protected health information (PHI), including medical records. Facilities must respond within 30 days (extendable to 60 days with notice) and may charge a reasonable cost-based fee for copying records.
What is the role of the ESRD Network Organization in dialysis quality oversight?
Answer: They provide quality improvement assistance and patient grievance services under a CMS contract
ESRD Network Organizations are nonprofit organizations under contract with CMS that provide quality improvement support to dialysis facilities and serve as a patient grievance resource. They collect outcome data, assist facilities with quality improvement projects, and can investigate patient complaints.
Under CMS Conditions for Coverage, what is required regarding informed consent for hemodialysis treatment?
Answer: Informed consent must be documented before initiating treatment, with the patient having the right to refuse or withdraw consent at any time
CMS CfC requires that patients provide informed consent prior to treatment, with documentation in the medical record. Patients retain the right to refuse or withdraw consent at any time, even mid-treatment, with appropriate documentation of the refusal and consequences discussed.
What is the purpose of the ESRD Quality Incentive Program (QIP)?
Answer: To reduce Medicare payments to dialysis facilities with poor performance on quality measures
The ESRD Quality Incentive Program (QIP) is a CMS value-based purchasing program that penalizes dialysis facilities with substandard performance on clinical and operational quality measures by reducing their total performance score-based Medicare payments by up to 2%.
A dialysis technician witnesses a co-worker falsifying a treatment record by entering a blood flow rate that was not actually achieved. What is the appropriate action?
Answer: Report the falsification to the supervisor or through the facility's compliance reporting mechanism
Falsification of medical records is fraud and a serious patient safety issue—inaccurate blood flow rate documentation could mask inadequate dialysis delivery (low Kt/V). The correct action is to report the incident to a supervisor or through the facility's compliance/ethics reporting system.