- Certified Case Manager Healthcare Regulations and Compliance Questions and Answers Flashcards
6 cards from real CCM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 - Certified Case Manager Healthcare Regulations and Compliance Questions and Answers flashcards as text
What is the False Claims Act and why is it relevant to case managers?
Answer: A federal law imposing liability for false claims to the government, with whistleblower protections
The FCA imposes liability for submitting false claims and includes qui tam whistleblower provisions.
Under the ADA, what constitutes a 'reasonable accommodation'?
Answer: A modification enabling a qualified person with a disability to perform essential functions without undue hardship
A reasonable accommodation enables performance of essential job functions without causing undue hardship to the employer.
What is the purpose of the Patient Self-Determination Act?
Answer: Requiring facilities to inform patients of their rights to make care decisions and create advance directives
The PSDA requires facilities to inform patients about their decision-making rights and advance directives.
What compliance obligation does the HITECH Act impose?
Answer: Strengthens HIPAA with increased penalties and breach notification requirements
HITECH strengthened HIPAA enforcement with increased penalties and mandatory breach notification.
What is the role of the OIG in healthcare compliance?
Answer: Investigates fraud, waste, and abuse and issues compliance guidance
The OIG detects and prevents fraud in federal healthcare programs and issues compliance guidance.
What is the two-midnight rule for Medicare inpatient admission?
Answer: Inpatient admission is appropriate when the physician expects care spanning at least two midnights
The two-midnight rule establishes that inpatient admission is appropriate when care is expected to span at least two midnights.