Exam II Lecture 4 and 5, 7,8,9

Question 1

What must be done when declining treatment to a patient?

Answer 1

30 day notice

Ensure alternative care

Transfer the records.

Question 2

What is the EMTALA

Answer 2

Emergency Medical Treatment and Labor Act

Put into place by medicare requires emergency care to persons in the ED regardless of ability to pay or citizenship.

Question 3

When is it ok to transfer a patient under the EMTALA rule?

Answer 3

Only if the patient is stabilized and it is appropriate.

Question 4

What must be done to protect patients that are leaving against medical advice?

Answer 4

Is patient able to understand medical conditions?

Explain the risks of leaving and alternatives.

Involve the family and friends.

Have th patient sign an against medical advice form.

Send aftercare instructions and invite to return.

Question 5

What does informed consent cover?

Answer 5

Potential risks
Purpose, scope and benefits
Alternatives

Question 6

Competency vs capacity

Answer 6

Competency is legal judgment

Capacity is the clinical decision making ability.

Question 7

What are the exceptions to parental consent for minors under 18?

Answer 7

Emergencies
Emancipated minors
substance abuse
HIV/AIDS tests positive
Sexual health
Abortion

Question 8

What are the four elements to prove negligence?

Answer 8

Duty
Breach in duty
Damages
Causation: Cause of injuries.

Question 9

Describe occurence insurance policies

Answer 9

Coverage for claims made resulting from an occurence WITHIN THE STATED TIME LIMITS.

focus is on the time of the incident/negligence and not the time of the losses/verdicts.

Question 10

Describe claims made by policy

Answer 10

Coverage is limited to when the claim was made

unlike the occurrence policy which is when the negligence occurs

Question 11

Tail coverage

Answer 11

Coverage for additional claims or disputes in between coverage periods.

Question 12

What is battery?

Answer 12

Application of force that is unwaranted or results in harmful/offensive contact.

Question 13

Apology Statute

Answer 13

Professional saying sorry is not admissible in court.

Example: Iowas Condor Law

Question 14

If state law is not as strict as HIPPA law

Answer 14

Hippa takes presidence.

If state law is Stricter than HipAA you follow the state law.

Question 15

Incedental disclosures

Answer 15

Overheard by another person when counseling a patient or talking to another healthcare professional.

Question 16

Is it acceptable to release PHI in emergency situations?

Answer 16

Yes even without authorization.

Question 17

Starks law

Answer 17

Stops illegal referrals

such as, self referrals or family referrals .

Question 18

Anti-Kickback statute

Answer 18

Stops paying or receiving of remuneration in exchange for referral of patients or business.

Question 19

What is the general definition of remuneration?

Answer 19

Anything of value not in exchange for a service/good.

Question 20

Safe harbors for kickback

Answer 20

Lease of space 
Personal services and management contracts
Physician recruitment
Sale of practice
Employees

Question 21

Phantom billing

Answer 21

Claims for services not rendered or provides medically unnecessary services.

Question 22

Unbundling false claim

Answer 22

Bill for treatment not corresponding to treatment actually provided.

Question 23

Upcoding

Answer 23

Provider uses CPT codes to bill a payer for higher paying service.

Question 24

What is the goal of nonprofit corporations?

Answer 24

Purpose is not profit but to benefit the community.

Question 25

What is the goal of for profit corporations?

Answer 25

To make money for the company.

Question 26

what are the three most effective mechanisms to protect patients from unsafe practitioners?

Answer 26

Hospital credentialing
Investigation and peer review
Reporting

Question 27

What is credentialing?

Answer 27

The decision making process for determining whether a physician will be permitted to joint a medical staff.