Law, Ethics, and HIPAA

Question 1

licensure

Answer 1

strongest form of administrative regulation; needed to practice medicine

• granted by state board
• verifies that person holding license has met minimum standards
• must be periodically renewed
• granted by examination, endorsement, reciprocity

Question 2

Clinical Laboratory Improvement Act of 1988 (CLIA 1988)

Answer 2

identifies standards for laboratory testing; any facility performing lab testing subject to CLIA 1988

Question 3

Certificate of Need (CON)

Answer 3

certificate needed to expand service and get approval to expand service (based on need to community)

Question 4

The Joint Commission (TJC)

Answer 4

accreditation of healthcare facilities

Question 5

OSHA (Occupational Safety and Health Administration)

Answer 5

regulates safety in workplace

Question 6

ADA (Americans with Disabilities Act)

Answer 6

sets up rules protecting people with physical or mental disabilities from discrimination

Question 7

Title VII (7) of Civil Rights Act

Answer 7

protects employees from sexual harassment and hostile work environment; employer is liable

Question 8

Federal Discrimination Act

Answer 8

employers with 15+ employees cannot discriminate on basis of age, gender, sexual orientation, race, creed, marital status, color, national origin, disabilities

Question 9

Regulation Z of the Consumer Protection Act

Answer 9

• Truth in Lending Act
• requires pt and provider to agree if payment of bills is to be made in more than 4 installments; agreement must be in writing

Question 10

Controlled Substances Act

Answer 10

• administered by DEA (Drug Enforcement Administration)

- regulates any individual who prescribes, administers, or dispenses controlled substances

Question 11

FMLA (Family Medical Leave Act)

Answer 11

employers with 50+ employees must provide up to 12 weeks of unpaid, job-protected leave each year

• for care of employees own health
• care of immediately family member with serious health condition
• birth or adoption of child

Question 12

HIPAA (Health Insurance Portability and Accountability Act)

Answer 12

requires privacy and security standards to protect patient’s identifiable health information

• sets stds for privacy of individually identifiable health info
• allows flow of health info while protecting pt’s privacy
• failure to comply –> sanctions and fines

Question 13

risk management

Answer 13

techniques that keep practice, environment, and procedures as safe for pt as possible
- proper risk management decreases chance of negligence/lawsuits

Question 14

techniques of risk management

Answer 14

1. only perform within scope of practice
2. follow federal and state statutes
3. keep office and clinic areas safe
4. keep all pt info confidential
5. follow all established office policies
6. document completely
7. log telephone calls and return calls in reasonable amt of time
8. follow up on canceled/missed appts
9. never guarantee cure or diagnosis; never advise without provider order
10. secure informed consent
11. explain apptment delays
12. be aware of pt’s w/ special needs
13. report any error to employer

Question 15

consent

Answer 15

voluntary permission given by capable person to receive medical care

Question 16

types of consent

Answer 16

1. express (oral or written)

2. implied (actions or behavior that can be understood as consent)

Question 17

informed consent consists of

Answer 17

allows pt to adequately evaluate medical care; understanding of
- what procedure is, why, risks, benefits, alternative treatments, risks of alternative treatments

Question 18

National Labor Relations Act of 1935 (NLRA)

Answer 18

defines unfair labor practices

- provides hearing or mediation of complaints

Question 19

FLSA (Fair Labor Standards Act of 1938)

Answer 19

defines minimum wage, equal pay for equal work, child labor restrictions
- req all employee records of hours worked to be continuously maintained

Question 20

Equal Pay Act of 1963 (EPA)

Answer 20

amendment of FLSA; addresses wage disparities based on sex

Question 21

Equal Employment Opportunities Act of 1972 (EEOA)

Answer 21

prohibits employment discrimination based on age, race, sex, color, religion, national origin

Question 22

ADEA (Age Discrimination in Employment Act of 1967)

Answer 22

prohibits discrimination based on age

Question 23

worker’s compensation law

Answer 23

state-mandated programs to provide wage continuation and medication treatment compensation for work-related injuries + illnesses

Question 24

two provisions of HIPAA

Answer 24

1. Health Insurance Reform

2. Administrative Simplification

Question 25

Department of Health and Human Services (HHS)

Answer 25

establishes and implements standards

Question 26

CMS (Centers for Medicare and Medicaid)

Answer 26

enforces insurance portability and code set reqs of HIPAA

Question 27

OCR (Office of Civil Rights)

Answer 27

enforces privacy standards

Question 28

covered entity

Answer 28

can be healthcare plan (e.g. Blue Shield/Blue Cross), health care provider, healthcare clearinghouse

Question 29

transaction

Answer 29

transmission of information btwn 2 parties - health care claims - health care payments - coordination of benefits - claim status - enrollment and disenrollment in health care plan - eligibility for health plan - premium payments - referral certification or authorization - first report of injury

Question 30

privacy

Answer 30

being secluded from view or presence of others

Question 31

confidentiality

Answer 31

use of discretion in keeping info private

Question 32

disclosure

Answer 32

release, transfer, access to, or divulgence of info

Question 33

IIHI (individually identifiable health info)

Answer 33

any part of someone' health information collected (e.g. DOB, demographic info)

Question 34

PHI (protected health info)

Answer 34

IIHI that is transmitted or maintained in any form or medium (electronic or otherwise) - all pt info is protected regardless of way it is maintained - includes paper records, billing system, spoken words, x-ray

Question 35

use of IIHI

Answer 35

sharing, application, use, examination, analysis of IIHI

Question 36

use of PHI

Answer 36

PHI protected both inside and outside of org unless use is specifically required or permitted

Question 37

pt rights under HIPAA

Answer 37

1. right to notice of privacy practices 2. request restrictions on certain uses/disclosures of PHI 3. request confidential info 4. access PHI 5. request amendment of PHI 6. receive accounting of disclosures of PHI 7. organization and staff responsibilities 8. code set regulations 9. guidelines for HIPAA privacy compliance

Question 38

HITECH Act (Health Information Technology for Economic and Clinical Health Act)

Answer 38

contains specific incentives to speed up adoption of EHR systems - widens scope of privacy and security under HIPAA - increases potential for legal liability for noncompliance - provides for greater enforcement - pt of 2009 american recovery act

Question 39

3 main components of EHR

Answer 39

1. use of EHR in meaningful manner (e.g. e-prescribing) 2. use of EHR technology for electronic exchange of health info (therefore improving quality of care) 3. use of EHR to submit clinical quality reports, diagnosis, procedure codes, etc.

Question 40

what does meaningful use of EHR mean?

Answer 40

using EHR tech in ways that can be measured in quality and quantity - if meet requirements, can qualify for incentive payments