CHA Regulatory and Legal Framework Flashcards
6 cards from real CHA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CHA Regulatory and Legal Framework flashcards as text
Under the Medicare Hospice Benefit, which federal regulation outlines the Conditions of Participation (CoPs) that hospice programs must meet?
Answer: 42 CFR Part 418
42 CFR Part 418 contains the Medicare Hospice Conditions of Participation that all certified hospice agencies must comply with.
The False Claims Act (FCA) primarily protects the government against which type of hospice misconduct?
Answer: Submitting fraudulent claims for Medicare reimbursement
The FCA imposes liability on individuals and organizations that submit false or fraudulent claims to government programs like Medicare.
Which federal agency is responsible for conducting surveys to certify hospice programs for Medicare participation?
Answer: Centers for Medicare & Medicaid Services (CMS)
CMS oversees the certification process for hospice programs, typically through State Survey Agencies acting on its behalf.
A hospice patient electing the Medicare Hospice Benefit must have a prognosis of how long to live if the illness runs its normal course?
Answer: 6 months or less
To elect the Medicare Hospice Benefit, two physicians must certify the patient has a terminal prognosis of 6 months or less if the disease runs its normal course.
Which law established the anti-kickback statute that prohibits hospices from offering financial incentives to physicians for patient referrals?
Answer: Social Security Act Section 1128B(b)
The federal Anti-Kickback Statute under Social Security Act Section 1128B(b) prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for federally reimbursed services.
Under HIPAA, a hospice's Notice of Privacy Practices (NPP) must be provided to patients at which point?
Answer: At the first service delivery encounter
HIPAA's Privacy Rule requires covered entities, including hospices, to provide patients with a Notice of Privacy Practices no later than the date of first service delivery.