Exam II Lecture 4 and 5, 7,8,9 Flashcards
What must be done when declining treatment to a patient?
30 day notice
Ensure alternative care
Transfer the records.
What is the EMTALA
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.
When is it ok to transfer a patient under the EMTALA rule?
Only if the patient is stabilized and it is appropriate.
What must be done to protect patients that are leaving against medical advice?
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.
What does informed consent cover?
Potential risks
Purpose, scope and benefits
Alternatives
Competency vs capacity
Competency is legal judgment
Capacity is the clinical decision making ability.
What are the exceptions to parental consent for minors under 18?
Emergencies Emancipated minors substance abuse HIV/AIDS tests positive Sexual health Abortion
What are the four elements to prove negligence?
Duty
Breach in duty
Damages
Causation: Cause of injuries.
Describe occurence insurance policies
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.
Describe claims made by policy
Coverage is limited to when the claim was made
unlike the occurrence policy which is when the negligence occurs
Tail coverage
Coverage for additional claims or disputes in between coverage periods.
What is battery?
Application of force that is unwaranted or results in harmful/offensive contact.
Apology Statute
Professional saying sorry is not admissible in court.
Example: Iowas Condor Law
If state law is not as strict as HIPPA law
Hippa takes presidence.
If state law is Stricter than HipAA you follow the state law.
Incedental disclosures
Overheard by another person when counseling a patient or talking to another healthcare professional.
Is it acceptable to release PHI in emergency situations?
Yes even without authorization.
Starks law
Stops illegal referrals
such as, self referrals or family referrals .
Anti-Kickback statute
Stops paying or receiving of remuneration in exchange for referral of patients or business.
What is the general definition of remuneration?
Anything of value not in exchange for a service/good.
Safe harbors for kickback
Lease of space Personal services and management contracts Physician recruitment Sale of practice Employees
Phantom billing
Claims for services not rendered or provides medically unnecessary services.
Unbundling false claim
Bill for treatment not corresponding to treatment actually provided.
Upcoding
Provider uses CPT codes to bill a payer for higher paying service.
What is the goal of nonprofit corporations?
Purpose is not profit but to benefit the community.
What is the goal of for profit corporations?
To make money for the company.
what are the three most effective mechanisms to protect patients from unsafe practitioners?
Hospital credentialing
Investigation and peer review
Reporting
What is credentialing?
The decision making process for determining whether a physician will be permitted to joint a medical staff.
