Question 1

What does AHA stand for and for what literature are they responsible?

Accepted Answer

Amer. Hospital Association
Responsible for: a plain language brochure called the Pt Care Partnership, which states how a pt and fam can expect to be treated in a healthcare situation.
Replaced the patient bill of rights, adopted in the 1970’s.

Question 2

What are the expectations set by the American Hospital Association in the Patient Care Partnership brochure?

Accepted Answer

A patient can expect:
High quality hospital care
A clean and safe environment 
Involvement in their care
Protection of your privacy 
Help when leaving the hospital
Help with their billing claims

Question 3

What does HIPPA stand for and what does it mean/do?

Accepted Answer

Health Insurance Portability and Accountability Act:
Creates national standards for insurers,HMO’s,and employer plans (including self insured) for safe and accurate exchange of pt info.

Question 4

What does PHI stand for and what is it?
List some examples

Accepted Answer

Protected Health Information - protected under HIPPA. Any data that could be used, individually or in combo to match patients with medical records.
Examples: Name, DOB, address, phone #, employer info, SSN, cert # (ex: pacemaker serial number)

Question 5

When can PHI (protected health information be shared without explicit consent?

When can it NOT be shared without explicit consent?

Accepted Answer

For:
Treatment
Payment
Healthcare Operations 
(TPO)

CANNOT: 
For marketing purposes
With law enforcement agencies (without consent or proper notification to the pt or a warrant)

Question 6

Can a provider or insurer use 3rd party vendors?

Accepted Answer

Yes, but they must sign a business associate agreement that obligated them to treat PHI on the same basis as covered entities.

Question 7

Talk about the Administrative Simplification Rules set forth by the HIPPA Privacy Act:

Accepted Answer

There were sections in HIPPA that were supposed to make the process better and less expensive for providers but have not saved money for most providers for many reasons. (Eg. most payers haven’t standardized their info requirements.)

Question 8

What does PSDA stand for and what does it do?

Accepted Answer

Patient Self Determination Act
Makes sure pt understands their right to participate re: healthcare and provide a means to ensure it. This is where advance directives come into play.

Question 9

What is an advance directive?

Accepted Answer

Written statements of a patient’s wishes re: medical treatment in the event they become unable to make such decisions.
- Living Will
- Healthcare POA or Durable POA for Healthcare 
- DNR Order

Question 10

What is a Living Will and example of and what does it do?

Accepted Answer

It is an advance directive.
Specifies what trtmt a pt does and does not want to receive.
Makes the difficult decisions for end of life care and organ donation while the patient is still alert.

Question 11

What is a Healthcare POA or Durable POA for Healthcare?

Accepted Answer

An advance directive that designates someone else (known as a healthcare surrogate, agent or proxy) to make decisions on the patient’s behalf if they are unable to.

Question 12

What is a DNR Order?

Accepted Answer

A Do Not Resusitate Order is an advance directive that states that the patient does not want to have CPR or similar interventions in the event of a medical emergency.

Question 13

What does PPACA stand for and what it is?

Accepted Answer

Patient Protection and Affordable Care Act
Together with the Health Care and Education Refonciliation Act, represents the largest regulatory overhaul of the US healthcare system since MC and MA were passed in 1965.

Question 14

What was the purpose of the PPACA?

What means did they use to do these things?

Accepted Answer

Aimed to decrease the number of uninsured Americans and reduce the overall cost of healthcare.
Mandates, subsidies and tax credits for employers and individuals.

Question 15

What does PPACA require of all insurance companies?

Accepted Answer

To cover all applicants and offer the same rates regardless of pre-existing condition or gender.

Congressional Budget Office projected that PPACA will lower future deficits and Medicare spending.

Question 16

Define Fraud

List examples

Accepted Answer

Intentional/illegal deception or misrep for the purpose of personal gain or to harm or manipulate a person or org.
Ex: reporting wrong DX to Max pmts, billing unprovided svc., altering claims to be paid,taking kickbacks,  routine waiver of ded/co-ins

Question 17

Define Abuse

List examples

Accepted Answer

Incidents/practices of HC workers that, although not consider fraudulent, are inconsistent with accepted practices.
Excessive/unwarranted use of tech, pharma or svcs. 
Abuse of authority, privacy, confidentiality or duty to care, improper billing, etc

Question 18

What does the False Claims Act do?

Accepted Answer

Prohibits making a false record or statement to get a false/fraudulent claim paid by the government, submission of false/fraudulent claims and conspiring to have false/fraudulent claims paid by the government.

Question 19

What are the punishments called for a provider who violates the false claims act? 
List them.

Accepted Answer

Administrative Sanctions

- denial or revocation of the provider number application.
- suspension of provider pmts
- civil monetary penalties (CMP’s)

Question 20

What does TCPA stand for and what is it?

Accepted Answer

The Telephone Consumer Protection Act
Restricts telemarketing and  the use of automated phone equipment. 
Prohibits use  express consent and limits use of recordings to convey messages. (Including texts and faxes.

Question 21

Truth in Lending Act
aka: Regulation Z

Accepted Answer

Requires disclosure of info before credit is extended. Annual % rates and finance charges must be clearly and conspicuously identified. This must also be provided to the consumer in writing.

Question 22

Fair Credit Billing Act

Accepted Answer

Protects consumers from inaccurate or unfair practices when issued open-ended credit. Requires creditors to inform debtors of their rights and of the responsibilities of the creditor.

Question 23

Fair Credit Reporting Act

Accepted Answer

Created to define what info from consumer reports can be used, by whom, and when. Provides maximum protection of consumer’s right to privacy and confidentiality of credit reports.

Question 24

FDCPA - what is it and what does it put strict limitations on? 
(Prohibits will be asked on another card)

Accepted Answer

Fair Debt Collection Practices Act
Imposes strict limitations on:
- acquisition of info re: location of the debtor
-communications with the debtor or others in collection of a debt.

Question 25

Fair Debt Collection Practices Act -what does it PROHIBIT?

Accepted Answer

- harrassment or abuse
- using false/misleading info 
-communicating w/ the consumer:
 at any unusual time or place (before 8am & after 9pm in debtor’s time zone)
-contacting if they are represented by legal counsel unless there is atty consent.

Question 26

ECOA

Accepted Answer

Equal Credit Opportunity Act
Prohibits discrimination based on any of the usual things as well as b/c they receive public assistance. 
Can ask the questions but cannot consider them when deciding whether to extend credit or terms of the credit.

Question 27

What questions does the ECOA prohibit?

Accepted Answer

Equal Credit Opportunity Act prohibits asking:
- ask if widowed or divorced (can ask only: Married, Unmarried, Separated)
- ask marital status if applying for a separate, unsecured acct.

Question 28

EMTALA - what is it and why

Accepted Answer

Emergency Medical Trtmt and Active Labor Act:
aka: Federal Anti-Dumping Statute
- is a response to concerns that hospitals were refusing trmt to pts w/o ins and xferring them to other facilities without notification.

Question 29

EMTALA - what does it require?

Applies not just to ER, but to any location on a hospital’s campus and to all patients, not just ER patients.

Accepted Answer

The Emergency Medical Trtmt and Active Labor Act aka: the Anti-Dumping Act:
Requires prior to asking how they intend to pay: 
- medical screening exam
-Necessary stabilizing trtmt 
-Restricting xfer until stabilized

Question 30

What is the CLIA and what does it require?

Accepted Answer

Clinical Laboratory Improvement Ammendment:
Requ providers furnishing clinical lab svcs to MC beneficiaries have a CLIA cert, which should be reported on the claim. 
States can be exempt if state laws are = or more stringent. Currently, only NY and WA.

Question 31

What is TJC and what does it do?

Accepted Answer

The Joint Commission
Private agy seeking to improve quality & safety of care. CMS allows them to accredit hospitals. Inspect and provides edu on issues of pt care and safety. 
*not all hospitals use TJC, some are accredited by the state/other agencies.

Question 32

How often does TJC inspect?

Accepted Answer

The Joint Commission
Conducts audit of a hospital every 39 mos
Audits a lab every 2 years
-can audit a healthcare facility without notice as early as 9-30 months after it’s initial audit.

Question 33

What aspects of Patient Access does TJC audit?

Accepted Answer

The Joint Commission:
- distribution and discussion of advance directives
- pt rights and responsibilities
- organizational ethics
- continuum of care
- mngmt of environmental care
- privacy/confidentiality/security
-communication

Question	Answer
What does AHA stand for and for what literature are they responsible?	Amer. Hospital Association Responsible for: a plain language brochure called the Pt Care Partnership, which states how a pt and fam can expect to be treated in a healthcare situation. Replaced the patient bill of rights, adopted in the 1970’s.
What are the expectations set by the American Hospital Association in the Patient Care Partnership brochure?	A patient can expect: High quality hospital care A clean and safe environment Involvement in their care Protection of your privacy Help when leaving the hospital Help with their billing claims
What does HIPPA stand for and what does it mean/do?	Health Insurance Portability and Accountability Act: Creates national standards for insurers,HMO’s,and employer plans (including self insured) for safe and accurate exchange of pt info.
What does PHI stand for and what is it? List some examples	Protected Health Information - protected under HIPPA. Any data that could be used, individually or in combo to match patients with medical records. Examples: Name, DOB, address, phone #, employer info, SSN, cert # (ex: pacemaker serial number)
When can PHI (protected health information be shared without explicit consent? When can it NOT be shared without explicit consent?	For: Treatment Payment Healthcare Operations (TPO) CANNOT: For marketing purposes With law enforcement agencies (without consent or proper notification to the pt or a warrant)
Can a provider or insurer use 3rd party vendors?	Yes, but they must sign a business associate agreement that obligated them to treat PHI on the same basis as covered entities.
Talk about the Administrative Simplification Rules set forth by the HIPPA Privacy Act:	There were sections in HIPPA that were supposed to make the process better and less expensive for providers but have not saved money for most providers for many reasons. (Eg. most payers haven’t standardized their info requirements.)
What does PSDA stand for and what does it do?	Patient Self Determination Act Makes sure pt understands their right to participate re: healthcare and provide a means to ensure it. This is where advance directives come into play.
What is an advance directive?	Written statements of a patient’s wishes re: medical treatment in the event they become unable to make such decisions. - Living Will - Healthcare POA or Durable POA for Healthcare - DNR Order
What is a Living Will and example of and what does it do?	It is an advance directive. Specifies what trtmt a pt does and does not want to receive. Makes the difficult decisions for end of life care and organ donation while the patient is still alert.
What is a Healthcare POA or Durable POA for Healthcare?	An advance directive that designates someone else (known as a healthcare surrogate, agent or proxy) to make decisions on the patient’s behalf if they are unable to.
What is a DNR Order?	A Do Not Resusitate Order is an advance directive that states that the patient does not want to have CPR or similar interventions in the event of a medical emergency.
What does PPACA stand for and what it is?	Patient Protection and Affordable Care Act Together with the Health Care and Education Refonciliation Act, represents the largest regulatory overhaul of the US healthcare system since MC and MA were passed in 1965.
What was the purpose of the PPACA? What means did they use to do these things?	Aimed to decrease the number of uninsured Americans and reduce the overall cost of healthcare. Mandates, subsidies and tax credits for employers and individuals.
What does PPACA require of all insurance companies?	To cover all applicants and offer the same rates regardless of pre-existing condition or gender. Congressional Budget Office projected that PPACA will lower future deficits and Medicare spending.
Define Fraud List examples	Intentional/illegal deception or misrep for the purpose of personal gain or to harm or manipulate a person or org. Ex: reporting wrong DX to Max pmts, billing unprovided svc., altering claims to be paid,taking kickbacks, routine waiver of ded/co-ins
Define Abuse List examples	Incidents/practices of HC workers that, although not consider fraudulent, are inconsistent with accepted practices. Excessive/unwarranted use of tech, pharma or svcs. Abuse of authority, privacy, confidentiality or duty to care, improper billing, etc
What does the False Claims Act do?	Prohibits making a false record or statement to get a false/fraudulent claim paid by the government, submission of false/fraudulent claims and conspiring to have false/fraudulent claims paid by the government.
What are the punishments called for a provider who violates the false claims act? List them.	Administrative Sanctions - denial or revocation of the provider number application. - suspension of provider pmts - civil monetary penalties (CMP’s)
What does TCPA stand for and what is it?	The Telephone Consumer Protection Act Restricts telemarketing and the use of automated phone equipment. Prohibits use express consent and limits use of recordings to convey messages. (Including texts and faxes.
Truth in Lending Act aka: Regulation Z	Requires disclosure of info before credit is extended. Annual % rates and finance charges must be clearly and conspicuously identified. This must also be provided to the consumer in writing.
Fair Credit Billing Act	Protects consumers from inaccurate or unfair practices when issued open-ended credit. Requires creditors to inform debtors of their rights and of the responsibilities of the creditor.
Fair Credit Reporting Act	Created to define what info from consumer reports can be used, by whom, and when. Provides maximum protection of consumer’s right to privacy and confidentiality of credit reports.
FDCPA - what is it and what does it put strict limitations on? (Prohibits will be asked on another card)	Fair Debt Collection Practices Act Imposes strict limitations on: - acquisition of info re: location of the debtor -communications with the debtor or others in collection of a debt.
Fair Debt Collection Practices Act -what does it PROHIBIT?	- harrassment or abuse - using false/misleading info -communicating w/ the consumer: at any unusual time or place (before 8am & after 9pm in debtor’s time zone) -contacting if they are represented by legal counsel unless there is atty consent.
ECOA	Equal Credit Opportunity Act Prohibits discrimination based on any of the usual things as well as b/c they receive public assistance. Can ask the questions but cannot consider them when deciding whether to extend credit or terms of the credit.
What questions does the ECOA prohibit?	Equal Credit Opportunity Act prohibits asking: - ask if widowed or divorced (can ask only: Married, Unmarried, Separated) - ask marital status if applying for a separate, unsecured acct.
EMTALA - what is it and why	Emergency Medical Trtmt and Active Labor Act: aka: Federal Anti-Dumping Statute - is a response to concerns that hospitals were refusing trmt to pts w/o ins and xferring them to other facilities without notification.
EMTALA - what does it require? Applies not just to ER, but to any location on a hospital’s campus and to all patients, not just ER patients.	The Emergency Medical Trtmt and Active Labor Act aka: the Anti-Dumping Act: Requires prior to asking how they intend to pay: - medical screening exam -Necessary stabilizing trtmt -Restricting xfer until stabilized
What is the CLIA and what does it require?	Clinical Laboratory Improvement Ammendment: Requ providers furnishing clinical lab svcs to MC beneficiaries have a CLIA cert, which should be reported on the claim. States can be exempt if state laws are = or more stringent. Currently, only NY and WA.
What is TJC and what does it do?	The Joint Commission Private agy seeking to improve quality & safety of care. CMS allows them to accredit hospitals. Inspect and provides edu on issues of pt care and safety. *not all hospitals use TJC, some are accredited by the state/other agencies.
How often does TJC inspect?	The Joint Commission Conducts audit of a hospital every 39 mos Audits a lab every 2 years -can audit a healthcare facility without notice as early as 9-30 months after it’s initial audit.
What aspects of Patient Access does TJC audit?	The Joint Commission: - distribution and discussion of advance directives - pt rights and responsibilities - organizational ethics - continuum of care - mngmt of environmental care - privacy/confidentiality/security -communication

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