Prentice Ch. 3 - Legal Concerns and Insurance Issues

Question 1

Liability

Answer 1

the state of being legally responsible for the harm one causes another person

Question 2

negligence

Answer 2

the failure to use ordinary or reasonable care

Question 3

The standard of reasonable care

Answer 3

assumes that an individual is neither exceptionally skillful nor extraordinarily cautious but is a person of reasonable and ordinary prudence
- common sense approach

Question 4

duty of care

Answer 4

part of an official job description

Question 5

to est. negligence you need 4 things

Answer 5

1. duty of care existed between person injured and person responsible for injury
2. conduct of the defendant fell short of the standard of care
3. the defendant caused the injury to occur
4. personal, property, or punitive damages occured

Question 6

Torts

Answer 6

legal wrongs committed against the person or property of another

Question 7

nonfeasance

Answer 7

when an individual fails to perform a legal duty

- ATC fails to refer a seriously injured pt. for proper medical attention

Question 8

malfeasance

Answer 8

an individual commits an act that is not legally his or hers to perform
- ATC may perform a therapeutic treatment that violates the practice of another licensed health care professional

Question 9

misfeasance

Answer 9

an individual improperly does something he or she has the legal right to do
- ATC may incorrectly administer a treatment technique procedure he or she has been trained to perform

Question 10

a successful negligence case against an ATC needs

Answer 10

1. ATC had a duty to exercise reasonable care
2. ATC breached that duty by failing to use reasonable care
3. that there is a reasonable connection between the failure to use reasonable care and the injury the individual suffered or that the ATCs actions made the injury worse

Question 11

Sovereign immunity

Answer 11

neither the government nor any individual who is employed by the government can be held liable for negligence
- once the ATC assumes the duty of caring for a patient the ATC has an obligation to make sure that appropriate care is given

Question 12

Good samaritan law

Answer 12

provides limited protection against legal liability to any person who chooses to provide first aid. however, it does not apply to someone who has a duty to act as dictated by the nature of his or her job

Question 13

Statues of Limitation

Answer 13

sets a specific length of time that individuals may sue for damages from negligence

• between 1 and 5 years to file suit
• some states permit an injured minor to file suit up to three years after the minor reaches the age of 18

Question 14

Assumption of risk

Answer 14

The individual through express or implied agreement assumes that some risk or danger is involved in the particular undertaking. In other words a person takes his or her own chances

Question 15

How to reduce litigation

Answer 15

• est. good personal relationships
• specific policies and guidelines
• record keeping

Question 16

Product liability

Answer 16

if the product is not used correctly by the consumer, the manufacturer cannot be held liable
- does not excuse ATC who misuses the equipment, only equipment that is faulty

Question 17

General health insurance

Answer 17

policy that covers illness, hospitalization, and emergency care

Question 18

Primary insurance

Answer 18

all medical expenses are paid for by the institution

- institutions pay an extremely high premium for this

Question 19

Secondary insurance

Answer 19

pays the remaining medical bills once the personal insurance company has made its payment
- always includes a deductible that is not covered by plan

Question 20

Health maintenance organizations (HMOs)

Answer 20

• provide preventive measures and limit where the individual can receive care
• generally pay 100% of the medical costs as long as care is at one of the HMO facilities
• most use capitation systems

Question 21

Preferred Provider organizations (PPOs)

Answer 21

• discount health care but also limit where a person can go for treatment of an illness
• pay for fee service basis
• can provide PT etc. more easily and cheaper

Question 22

Point of service plan

Answer 22

• combination of HMO and PPO plans.
• based on an HMO structure yet allows members to go outside the HMO to obtain services but only under certain conditions and circumstances

Question 23

Exclusive Provider Organizations (EPOs)

Answer 23

• combo of HMO and PPO
• restrictive of the number and types of providers the have
• will most likely not pay anything if you use out of network providers

Question 24

Physician Hospital organization (PHOs)

Answer 24

involve a major hospital or hospital chain

- contacts directly with employers to provide services

Question 25

Third-Party Administrators

Answer 25

• used to administer services and to pay claims for self-insured group plans and thus function as pseudo insurance companies

Question 26

Medicare

Answer 26

federal health insurance program for the aged and disabled

Question 27

Medicare parts

Answer 27

Part A: Hospital. normally premium-free and retirement to beneficiary
Part B: Physician. mostly premium charge to the beneficiary
Part C: allows person to choose among several types of health care plans
Part D: federal program to subsidize the costs of prescription drugs for medicare beneficiaries

Question 28

Medicaid

Answer 28

health insurance program for people with low incomes and limited resources
- funded by both the federal government and individual states

Question 29

Workers comp

Answer 29

• employers pay premiums

Question 30

indemnity plans

Answer 30

-fee for service plan that allows the insured party to seek medical care without restriction on utilization or cost

Question 31

Capitation

Answer 31

form of reimbursement used by managed care providers in which members make a standard payment each month regardless of how much service is rendered to the meter by the provider

Question 32

National Provider Identifier (NPI)

Answer 32

government issued identification number for individual health care providers and provider organizations