Part II: The Legal Environment Key Concepts & Practice Question Flashcards
What are the reasons that a physician’s license may be revoked?
(1) conviction of a crime,
(2) unprofessional conduct,
(3) personal or professional incapacity.
To order a non-narcotic prescription, what must a provider have?
(1) a state license
(2) a NPI
In what year did electronic prescribing methods begin appearing in clinics?
2004
The passage of which act led to an increase push for providers to adopt EMR’s
American Recovery and Reinvestment Act of 2009
Which part of medicare requires drug plans participating in the new prescription benefit to support electronic prescribing?
Medicare Part D
What type of drugs are on Schedule I of The Controlled Substances Act?
drugs of high potential for abuse and that have no currently accepted
medical use
drugs used by physicians only for purposes of research
What type of drugs are on Schedule II of The Controlled Substances Act?
drugs that have current accepted medical use in the United States, but with severe restrictions;
drugs that have a high potential of abuse that may lead to severe psychological or physical
dependence
drugs that require physicians to use a special order form
What type of drugs are on Schedule III of The Controlled Substances Act?
drugs that have less potential for abuse than substances in schedules I and II
drugs that have accepted medical use for treatment in the United States, but abuse may lead
to moderate or low physical dependence or high psychological dependence
What type of drugs are on Schedule IV of The Controlled Substances Act?
drugs that have a lower potential for abuse than those in schedule III
drugs that have accepted medical use in the United States, but their abuse still may lead to limited physical or
psychological dependence
What type of drugs are on Schedule V of The Controlled Substances Act?
drugs that have less potential for abuse than drugs in schedule IV and their abuse may be
limited to physical or psychological dependence
What is a script doctor?
A doctor who freely and excessively prescribes potentially dangerous drugs.
When was HIPAA passed by congress and when did it become effective?
Passed by congress (1996)
Effective (2003)
What are the 3 things that HIPAA requires?
(1) standardization of electronic client health data, administrative data, and financial data
(2) unique health identifiers for employees (NPIs);
(3) security standards to protect individually identifiable health information, past, present, or future
What does the “Privacy Rule” protect?
all individually identifiable health information, which is called protected health information (PHI).
Providers must provide clients with a notice of their privacy practices, which must include the right to:
- Restrict use of PHI
- Request confidential communication
- Inspect and obtain a copy of the PHI
- Request any amendment to the PHI
- Receive an accounting of PHI disclosures
When were Medicare and Medicaid both established?
1965
What is the purpose of The Healthcare Reform Act of 2010?
to make health care available to as many Americans as possible
What did the Affordable Care Act of 2010 require the Department of Health and Human Services to do?
issue new regulations to implement a new Patient Bill of Rights
What are the protections The Affordable Care Act and the new Patient Bill of Rights offer for consumers?
(1) No preexisting condition exclusions for children under age 19 years
(2) No arbitrary rescissions (cancellations) of insurance coverage
(3) No lifetime limits on coverage
(4) Restricted annual dollar limits on coverage
(5) Protection of the client’s choice of doctors
(6) Removal of insurance company barriers to emergency department services
What does “no pre existing conditions exclusions” mean?
health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition”
What is a lifetime limit?
the maximum dollar benefit an individual may receive under a health insurance policy or plan
What are annual dollar limits?
a dollar limit on their yearly spending for your covered benefits
What are the most common contracts in health-care?
Implied
What is an example of an implied contract?
a client complains of a sore throat and the provider does a throat culture to diagnose and treat the ailment
What are the 4 D’s of professional negligence?
Duty, Derelict, Direct cause, Damages
What does the Duty in professional negligence mean?
Duty exists when the provider–client relationship has been established.
What does the Derelict in professional negligence mean?
The client must prove that the provider failed to comply with the standards required and dictated by the profession
What does the Direct cause in professional negligence mean?
implies that any damage or injuries that resulted from the provider’s breach of duty were directly related to that breach and no other acts or circumstances could have caused the problem
What does the Damage cause in professional negligence mean?
compensation provided for injuries suffered by the client
What type of compensation is most common in medical professional liability cases?
monetary