- Certified Case Manager Healthcare Regulations and Compliance Questions and Answers Flashcards

What is the primary purpose of EMTALA?

Answer: To ensure anyone presenting to an ED receives screening and stabilization regardless of ability to pay

EMTALA requires Medicare-participating hospitals to provide medical screening and stabilization to all regardless of insurance or ability to pay.

Under the ACA, what does the 'essential health benefits' requirement mandate?

Answer: Individual and small group plans must cover ten categories of services

The ACA requires individual and small group plans to cover ten essential health benefit categories.

What is the Stark Law and how does it impact referral practices?

Answer: A federal self-referral prohibition preventing physicians from referring Medicare patients to entities where they have financial interest

The Stark Law prohibits physician self-referrals to entities where they have financial relationships.

What does the Anti-Kickback Statute impose on healthcare referrals?

Answer: It prohibits offering or receiving anything of value to induce referrals for federal healthcare program services

The AKS makes it criminal to exchange anything of value to induce referrals for federal healthcare services.

What is the minimum necessary standard under HIPAA?

Answer: Limit PHI use and disclosure to the minimum amount necessary for the intended purpose

The standard requires limiting PHI access and disclosure to only what is needed for the purpose.

What are key provisions of the 21st Century Cures Act relevant to case management?

Answer: Promotes health information exchange, bans information blocking, and supports EHR interoperability

The Cures Act promotes information exchange, prohibits information blocking, and mandates EHR interoperability.