Laws and Regulations Flashcards
Accountable care organization
An organization of hospitals, physicians, and other providers who-under a shared governance structure-coordinate patient care, are accountable for the quality and cost of that care, and receive bonuses when they deliver care more efficiently.
Ad valorem tax
A tax imposed in proportion to the value of the property being assessed.
Antikickback statute
The federal law prohibiting the payment of anything of value in return for referring a person for services that will be paid for by Medicare, Medicaid, or another federal program.
Charitable immunity
The venerable principle (now discredited) that a charitable organization is not to be held liable for the wrongful actions of its agents.
Community health needs assessment
A hospital’s systematic evaluation of its community’s health needs, which a tax-exempt hospital must undertake at least once every three years to maintain its tax-exempt status.
Covered entity
As defined by the Health Insurance Portability and Accountability Act, a health plan, healthcare clearinghouse, or healthcare provider that transmits any health information in electronic form.
Designated health services
Certain medical treatments or related work that may not be billed to Medicare or Medicaid if prohibited by the Stark law.
Emergency Medical Treatment and Labor Act
The federal law that prohibits patient “dumping” and establishes a duty to render emergency care to those who need it; often referred to as EMTALA.
False Claims Act
The federal law used most often to prosecute those who present false or fraudulent claims to Medicare and Medicaid claims.
Health Insurance Portability and Accountability Act
Usually referred to as HIPAA, the federal law intended to address the security of electronic health transactions and to protect the privacy of health information.
Hill-Burton Act
Legislation passed in 1946 that established a program of federal grants and loans designed to modernize existing hospitals and construct new ones in underserved areas; formally known as the Hospital Survey and Construction Act.
Informed consent
Agreement to permit a medical procedure after disclosure of all relevant facts needed to make an intelligent decision.
Lobbying
An activity intended to influence the outcome of pending legislation.
Mens rea
Latin for guilty mind, the mental element of a crime in the context of criminal law; one’s awareness that one’s conduct is criminal.
Negligence
Failure to comply with established standards for the protection of others; departure from the conduct expected of a reasonably prudent person acting under the same or similar circumstances.
Never event
A serious, adverse occurrence resulting from failure to follow standard medical practices and generally considered to be negligence per se; an outcome that should never occur.
Not-for-profit
A type of organization in which legal and ethical restrictions prohibit the distribution of profits to owners or shareholders.
Physician Orders for Life-Sustaining Treatment (POLST) forms
Forms that convert patients’ preferences for end-of-life care into enforceable medical orders; similar to advance directives.
Privileging
The process whereby the specific scope and content of patient care (clinical) services are authorized for a healthcare practitioner by a healthcare organization on the basis of evaluation of the individual’s credentials and performance.
Protected health information
Any health-related information that identifies or can be used to identify the individual to whom it pertains.
Stark law
The Ethics in Patient Referrals Act, passed in 1989 and championed by former California Representative Fortney “Pete” Stark, which prohibits a physician from referring Medicare patients to entities with which the physician or an immediate family member has a financial relationship.
Tax Equity and Fiscal Responsibility Act
A federal law passed in 1982 that signaled the end of cost-based reimbursement and the beginning of Medicare’s prospective payment system.
Unrelated business income
Revenue from a line of business that does not further an organization’s charitable purpose and that is therefore subject to taxation.
