Health Care Law Flashcards
3 things that limit the right of provider to terminate care
Can’t discriminate
Must provide notice
Can’t abandon patient
Explain patient abandonment
Shall not cease care or to be available to provide care w/o giving sufficient notice or the opportunity to seek treatment else where
3 aspects of the process of terminating the patient relationship
- Evaluate medical status and needs
- Determine if alternative care available
- Consider requirements of contractual relationships with 3rd party payers
Explain the procedure for terminating relationship
- Give notice in person
- Send letter
- Transfer records
- If in ER, then you must still tx pt
- Statute of limitations
It is the patient right to understand what 3 parts of informed consent?
Risks
Purpose, scope, and benefits
Alternatives
What 7 things does informed consent warn the patient?
Complications Sequalla Risks Alternatives Benefits Effects of non-tx Economic interests
Explain consent in writing
Nature, purpose, and known risks
All questions asked
Signed
3 Exceptions for treating against patients will
Public health
Civil commitment
72-hr hold
Explain the 5 steps for Leaving against medical advice
- Patient capacity to understand
- Review chart
- Involve family or friends
- Patient signs AMA
- Aftercare instructions and invite to return
What are the 4 elements to prove for negligence
Duty
Breach
Damages
Causaton
Obligation to conform to a recognized reasonable care under circumstances
Duty
Breached duty by failing to meet standard of care
Breach
Compensatory and intangible losses
Damages
Cause of injuries/damages not occurred any way or for different reason
Causation
Review the slides on examples of medical negligence
Review the slides on examples of medical negligence
Explain an Occurrence Policy
Insured has coverage for claims made and damages awarded as long as liabilities results from an occurrence within the stated time limits
Explain a Claims Made Policy
Coverage is limited to actions which are known during the coverage period because and actual claim is made during that time
Explain Tail Coverage
A reporting endorsement that confers on the policy holder, after nonrenewable or cancellation of the policy the right to purchase coverage for additional claims or disputes. Comes into play when leaving one occurrence policy to a non-occurrence
10 commonly applied safe harbors
Investment interests Lease Personal service and management contracts Physician recruitment Sale of practice Employees Investments in group Warranties Discounts Employees
Categories of fraud and abuse (3)
- bribes or kickbacks
- illegal referrals
- False claims or other fraudulent billing
Anything of value not in exchange for a service/good
Remuneration
Physician self-referral law prohibits…?
A physicians referral of a medicare patient to an entity in which they have financial interests for provision of a certain designated health service.
The request by a physician for a service or item covered by the government health care program, including consulting with another physician and any test or procedure ordered by or to be performed by or under the supervision of another physician
Referral
Exceptions to Stark
- Both ownership and compensation arrangements
- Only to ownership interests
- Only to compensation arrangements
Common PHI
Charts Rx records Billing records Patient profiles Emails/faxes Phone calls Verbal counseling Rounding lists
4 Permitted Disclosures
- Legal representative
- Family and friends involved in care
- Other providers
- Business associates
Is there a time when PHI can be released without authorization?
In an EMERGENCY
3 Rights a patient has in regards to HIPAA
- Notice of privacy practices
- Review and get copies of records
- Request corrections
The privilege of admitting patients to and caring for patients at the hospital
Medical staff membership
The privilege of providing certain treatments and performing certain procedures at the hospital
Clinical privileges
List 5 benefits of Peer Review
Improve Quality of care Protect patients Improve performance Required for compliance Avoid potential legal liability
List 3 protections for peer review
- Involved persons are granted immunity from lawsuits
- Information is deemed confidential
- Work product is privileged and inadmissible
Who appoints practitioners to the medical staff and grants them clinical privileges
The governing board of the hospital
Responsible to assure quality but no clinical expertise
The board
Has no authority but experts responsible for care
Medical staff
3 mechanisms that protect patients from unsafe practitioners
- Hospital credentialing
- Investigation and peer review
- Reporting
