American Health Information Management Association (AHIMA) Certification Practice Exam

What standards must a skilled nursing facility meet to become certified for federal government reimbursement programs such as Medicare?

1. Joint Commission Accreditation Standards

2. Accreditation Association for Ambulatory Healthcare Standards

3. Conditions of Participation

4. Outcomes and Assessment Information Set

The correct answer is: Conditions of Participation

A skilled nursing facility must meet the Conditions of Participation to become certified for federal government reimbursement programs, including Medicare. These Conditions of Participation are a set of federal regulations outlined by the Centers for Medicare & Medicaid Services (CMS) that establish the minimum requirements for healthcare providers to receive Medicare and Medicaid funding. These requirements cover various aspects of facility operations, including patient care, quality assurance, and staff qualifications, ensuring that the facility provides safe and effective care to its residents. While Joint Commission Accreditation Standards and Accreditation Association for Ambulatory Healthcare Standards are important for quality assurance and may enhance a facility’s reputation, they are not prerequisites for federal certification or reimbursement under Medicare. Additionally, the Outcomes and Assessment Information Set (OASIS) is a data collection tool used for assessing patient outcomes in home health care rather than skilled nursing facilities specifically. Thus, the Conditions of Participation is the specific set of criteria required for certification that directly impacts a skilled nursing facility's ability to participate in federal government reimbursement programs.