FINAL Added Info Flashcards
A legal entity that requires no state filing to create it
Sole proprietorship
Simply one person operating a business for profit
Sole proprietorship
Person has unlimited personal liability for the business
Can have employees
Sole proprietorship
Simplest and most basic business structure and appeals to a person who wants to be independent and free from the laws that govern other legal entities
Individual ownership - sole proprietorship
Two or more people who combine their work, money, and talents to achieve a common goal
Partnership
Many states require a document or registration that serves as notice to the public that the partnership members are doing business together
Partnership
All partners are bound by
Acts of others
Legal entitiy, created by one or more individuals or other legal entities, to further a common goal and to create ground rules for matters such as ownership, profit distribution, liability, taxes, and control
LLC - limited liability company
Individuals who have an interest in an LLC are usually referred to as
Members
Most states have laws that govern LLC. T/f
True
Protection from being held personally reliable
LLC
Physicians, lawyers, architects, and accountants
Professional limited liability company - PLLC
Limits of liability may only be applied to certain aspects of the business, such as creditors
PLLC
One of the most desirable features of a corporation is the protection given to
Investors
Only the capital of the corporation is available for
The payment of debts
Management responsibility is in th ehands of the corporation’s
Board of directors
Directors answer to
Stockholders, who elect and can terminate them
Officers of a corporation include
President Vice president Treasurer Secretary Any other officers in board of directors appoints
Profits of a corporation are distributed to stockhoolders as
Dividends
persons holding formal positions of trust in an organization, especially those involved in high levels of management
Officers
Those elected and terminated by stockholders to manage a corporation
Directors
Those who hold an interest (stock) in a corporation
Stockholders
Units of stock giving the possessor part ownership in a corporation investment expenditure of resources (money, effort, etc) to secure income or profit
Shares
Regulations adopted by a corporation or association to govern its internal affairs dividends distributed profits of a corporation
Bylaws
Managed care contracts with
Doctors
Hospitals
Clinics
Other health care providers to create provider networks
An in-network physician or health care facility is part of a MCO’s network if there is a preexisting agreement between the MCO and the
Health care provider
The agreement dictates the protocols for patient care and the compensation system
Managed care organizations
A physician or health care facility that does not have an agreement with the MCO
An out-of-network provider
To discourage the use of out-of-network providers, a patients reimbursement for services provided is not compensated at the same level as
An in-network provider
Managed care focuses on varous aspects of health care and can include characteristics such as
Networks of health care providers or facilities
Who have agreed to predetermined protocols and compensation
PCPs
Coordiante all patient’s health care
Preauthorizaiton for specific tx
Limited reimbursement for out-of-network providers
Claim filing assigned to the provider rather than the patient
And tiered coverage of prescription drugs
Employment law
Interviewing
Pre-employment testing
Civil rights act of 1964q
Employers are not allowed to ask interview questions involving
Race
Religion
Age
Whether a woman is pregnant
Employers are allowed to test potential employees as part of the hiring process but such tests must be carefully constructed usually by experts to ensure
That they only measure the skills and abilities necessary to do the job
The opportunity to do so cannot be denied employees on the basis of race, color, religion, sex, or national origin
Civil rights act of 1964
Unwanted sexual attention from anyone the victim may interact with on the job in which the victim’s response may be restrained by fear of reprisals
Sexual harassment
Harassment occurs against
The victim’s wishes
Sexual harassments can include
Peers Subordinates Supervisors Customers Clients
Sexual harassment range of behavior
Verbal comments Subtle pressure for sexual activity Leering Pinching Patting Other forms of unwanted touching as well as rape and attempted rape
Requires employers of 50 or more people to provide up to 12 weeks of unpaid leave each year for the serious health condition of an employee or member of the employee’s immediate family or for the birth or adoption of a child
Family and medical leave act of 1993 (FMLA)
FMLA covers
All public employers
Private employers who have 50 or more employees on the payroll during each of 20 or more calendar workweeks in either the current or preceding calendar year
Employees who have been employed for at least 12 months and who have worked at least 1250 hours in the 12 months preceding commencement of the FMLA leave
A physical or mental impairment that substantially limits one or more of hte major life activities of an individual or a record of such impairment or being regarded as having such an impairment
Disability
Prohibits employment discrimination and places the burden on an employer to prove that the requirements of a specific job could not be changed to accomodate a disabled applicant
Title 1 of americans with disabilities act
Guarantee the disabled access to teh workplace. Professional offices of health care providers are in the public sector and as such require an employer to make reasonable modificaitons for hte disabled to gain access
Titles 2 and 3 of americans with disabilities act
Conditions that are not impairments - americans with disabilites act
Pregnancy
Physical characteristics like hair or eye color
Common personality traits
Nomal deviations in height or weight
In defining undue hardship, the ADA requires consideration of
The nature and cost of accommodation needed
The overall finances of the facility
The overall resources of the covered entity
The type of operation or operations of the covered entity
Provides that workers over the age of 40 cannot arbitrarily be discriminated against because of age in any employment decisions
Federal age discrimination in employment act
Federal minimum wage, mandates extra pay for overtime work, regulates employment of children and is administered by the department of labor
Fair labor standards act (FLSA)
Guaranteeing renewal and transferability of health insurance coverage to those who already have coverage adn to their dependents
HIPAA
Health insurance portability and accountability act of 1996
HIPAA nondiscrimination provision generally prohibits group health plans and group health insurance issuers from
Discriminating against participants or beneficiaries based on any health factor
Written standard office procedures help maintain
High standards of patient care
Protect against omission of important steps
Ensure compliance with government adn third party regulations
Decrease the possibility of a malpractice aciton
Aid in achieving the risk managment goals for the office as well as maintaining quality assurance
Procedures manual
Usually provides personnel policies and related instructions. It includes information about work hours, sick leave, pension benefits, evaluation procedures, and so on
Employee handbook
Voluntary agreement between two or more parites that establishes a legally enforeable obligation
Oral
Written
Contract
Parties enter into a contractual relationship by mutual agreement, also referred to as assent or meeting of the minds
Contract
A clear, definitive agreement between two or more parties
Express contract
An actual agreement between the parties, the terms of which are openly stated in distinct and explicit language either orally or in writing
Express contract
An agreement not indicated by direct words but evident from the conduct of the parties
Implied contract
Gives rise to contractual obligations by some action or inaction without specifically stating the terms orally or in writing
Implied contract
Foundation of medical practice
Patient-physician relationship
Elements of a contract
Offer
Acceptance
Consideration
A proposal to perform or refrain from a certain action
Offer
An agreement to the terms of an offer
Acceptance
Something promised that results in making an agreement a lawful, enforceable contract
Consideration
By entering into a relationship with a health care provider, the patient makes the offer of
His or her person for treatment
By opening office doors or scheduling a patient’s appointment the health care facility
Accepts patient’s offer
In a patient-physician contract, the patient promises to pay a fee for the medical care received ant eh physician promises to provide
The agreed—upon treatment
Consideration
To form a contract, there must be
A clear understanding between parties, known as mutual agreement, assent or meeting of the minds
Legal duties and obligations exist once a patient-physician relationship exists so it is important to understand when the relationship begins and ends
Mutual agreement
St. John v Pope
Mutual agreement
Wax v Johnson
Mutual agreement
Lack of legal capacity for mutual agreement
Legal disability
Persons who are under the age of majority as set forth by state law
Minors
In most states the age of majority is
18 years but a few are 19 and 21
Those who lack necessary qualifications to perform a duty
Incompetent persons
Being influenced by threat to do something one would not ordinarily do
Duress
A physicians terminations of a patient should be with a written notice sent by certified mail, return receipt requested, and filed in patient’s chart and it should explain the patient’s medical problems
Termination of contracts
One the parties does not keep a promise - by not performing not paying for services not keeping to scheudle, or not doing the procedure as had been agreed
Breach of contract
Occurs when one party prevents the other party from performing
Breach of contract
Patient does not pay bill
When physicial makes a warranty that the physician will cure the patient but fails to do so
Examples of breach
An agreed-upon addition signed by all parties to the original contract
Amendment
Details specific terms, clauses, sections and definitions to be changed in the original contract but otherwise leaves it in full force adn effect
Changes to written contract
The goal when writing a contract amendment is to only change
The parts that all parties want to change while not creating any loopholes or unintended consequences in the agreement as it stands in writing
Including an additional document in the already existing one
Addendum
