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Health Care Systems > Health Care Law > Flashcards

Health Care Law Flashcards

1
Q

3 things that limit the right of provider to terminate care

A

Can’t discriminate
Must provide notice
Can’t abandon patient

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2
Q

Explain patient abandonment

A

Shall not cease care or to be available to provide care w/o giving sufficient notice or the opportunity to seek treatment else where

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3
Q

3 aspects of the process of terminating the patient relationship

A
  • Evaluate medical status and needs
  • Determine if alternative care available
  • Consider requirements of contractual relationships with 3rd party payers
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4
Q

Explain the procedure for terminating relationship

A
  • Give notice in person
  • Send letter
  • Transfer records
  • If in ER, then you must still tx pt
  • Statute of limitations
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5
Q

It is the patient right to understand what 3 parts of informed consent?

A

Risks
Purpose, scope, and benefits
Alternatives

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6
Q

What 7 things does informed consent warn the patient?

A 
Complications
Sequalla
Risks
Alternatives
Benefits
Effects of non-tx
Economic interests
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7
Q

Explain consent in writing

A

Nature, purpose, and known risks

All questions asked

Signed

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8
Q

3 Exceptions for treating against patients will

A

Public health
Civil commitment
72-hr hold

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9
Q

Explain the 5 steps for Leaving against medical advice

A
  1. Patient capacity to understand
  2. Review chart
  3. Involve family or friends
  4. Patient signs AMA
  5. Aftercare instructions and invite to return
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10
Q

What are the 4 elements to prove for negligence

A

Duty
Breach
Damages
Causaton

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11
Q

Obligation to conform to a recognized reasonable care under circumstances

A

Duty

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12
Q

Breached duty by failing to meet standard of care

A

Breach

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13
Q

Compensatory and intangible losses

A

Damages

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14
Q

Cause of injuries/damages not occurred any way or for different reason

A

Causation

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15
Q

Review the slides on examples of medical negligence

A

Review the slides on examples of medical negligence

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16
Q

Explain an Occurrence Policy

A

Insured has coverage for claims made and damages awarded as long as liabilities results from an occurrence within the stated time limits

17
Q

Explain a Claims Made Policy

A

Coverage is limited to actions which are known during the coverage period because and actual claim is made during that time

18
Q

Explain Tail Coverage

A

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

19
Q

10 commonly applied safe harbors

A 
Investment interests
Lease
Personal service and management contracts
Physician recruitment
Sale of practice
Employees
Investments in group
Warranties
Discounts
Employees
20
Q

Categories of fraud and abuse (3)

A
  1. bribes or kickbacks
  2. illegal referrals
  3. False claims or other fraudulent billing
21
Q

Anything of value not in exchange for a service/good

A

Remuneration

22
Q

Physician self-referral law prohibits…?

A

A physicians referral of a medicare patient to an entity in which they have financial interests for provision of a certain designated health service.

23
Q

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

A

Referral

24
Q

Exceptions to Stark

A
  • Both ownership and compensation arrangements
  • Only to ownership interests
  • Only to compensation arrangements
25
Q

Common PHI

A 
Charts
Rx records
Billing records
Patient profiles
Emails/faxes
Phone calls
Verbal counseling
Rounding lists
26
Q

4 Permitted Disclosures

A
  • Legal representative
  • Family and friends involved in care
  • Other providers
  • Business associates
27
Q

Is there a time when PHI can be released without authorization?

A

In an EMERGENCY

28
Q

3 Rights a patient has in regards to HIPAA

A
  • Notice of privacy practices
  • Review and get copies of records
  • Request corrections
29
Q

The privilege of admitting patients to and caring for patients at the hospital

A

Medical staff membership

30
Q

The privilege of providing certain treatments and performing certain procedures at the hospital

A

Clinical privileges

31
Q

List 5 benefits of Peer Review

A 
Improve Quality of care
Protect patients
Improve performance
Required for compliance
Avoid potential legal liability
32
Q

List 3 protections for peer review

A
  1. Involved persons are granted immunity from lawsuits
  2. Information is deemed confidential
  3. Work product is privileged and inadmissible
33
Q

Who appoints practitioners to the medical staff and grants them clinical privileges

A

The governing board of the hospital

34
Q

Responsible to assure quality but no clinical expertise

A

The board

35
Q

Has no authority but experts responsible for care

A

Medical staff

36
Q

3 mechanisms that protect patients from unsafe practitioners

A
  • Hospital credentialing
  • Investigation and peer review
  • Reporting

Health Care Systems (9 decks)

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