Ch 3: Review Test Flashcards

The Legal and Ethical Side of Medical Insurance

1
Q

A breach of medical care can result in what?

A

A malpractice lawsuit

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2
Q

Loosely translated, the Latin term “respondeat superior” means what?

A

The employer is ultimately responsible for employee actions

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3
Q

Failure to exercise a reasonable degree of care is referred to as what?

A

Negligence

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4
Q

A health insurance policy and the relationship between a healthcare provider and a patient are considered what?

A

Legal contracts

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5
Q

In terms of contract law, when an individual completes an application for health insurance, he or she is doing what?

A

Making an offer

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6
Q

When the insurance company agrees to grant health insurance coverage to an individual, this is called what?

A

Completing an acceptance

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7
Q

The binding force in any contract that gives it legal status - the thing of value that each party gives to the other - is the ____?

A

Consideration

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8
Q

For a contract to be enforceable, it must be what?

A

Legal

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9
Q

The parties to a legal contractual agreement must be what?

A

Mentally competent

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10
Q

Individuals younger than 18 years of age who are independent and living away from home are called ____?

A

Emancipated minors

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11
Q

The contract between a healthcare provider and a patient is referred to as a(n) ____?

A

Implied contract

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12
Q

Ceasing to provide care to a patient without taking prudent steps is a breach of the physician-patient contract referred to as what?

A

Abandonment

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13
Q

What act regulates disclosure of Social Security numbers or other confidential information?

A

Federal Privacy Act of 1974

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14
Q

What act allows current or former employees or dependents younger than age 65 to become eligible for Medicare because of end-stage renal disease?

A

Federal Omnibus Budget Reconciliation Act (OBRA) of 1987

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15
Q

The Patient Protection and Affordable Care Act (PPACA) along with the Health Care and Education Reconciliation Act make up what?

A

Healthcare Reform Act

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16
Q

What are standards of human conduct - sometimes called morals - of a particular group or culture known as?

A

Ethics

17
Q

Adhering to the rules and conventions governing correct or polite behavior in society is called what?

A

Etiquette

18
Q

Timeliness, according to The Joint Commission, is within ____ hours of the encounter.

A

24 hours

19
Q

What is a chronological account of a patient’s medical assessment, investigation, and course of treatment called?

A

Medical record

20
Q

A medical record is considered privileged communication; information in it should not be divulged to anyone without a patient’s ___?

A

Written consent

21
Q

If additional information needs to be added to a patient’s record, it should be in the form of a(n) ____.

A

Appropriate addendum

22
Q

Adequate and complete documentation of medical records helps to do what?

A
  • Determine the level of service
  • Establish medical necessity
  • Justify the fees charged
23
Q

Lack of proper documentation of medical records often results in what?

A
  • Denied claims

- Reduced claim payments

24
Q

HIPAA’s objective stating that employees cannot be denied health insurance coverage when moving from one group health plan to another is called what?

A

Portability

25
Q

If medical personnel in a reception room call a patient by name, HIPAA refers to the exposure as ____?

A

Incidental disclosure

26
Q

Situations that do not come under the umbrella of patient confidentiality include what?

A
  • Communicable diseases
  • Abuse of a child (or an adult)
  • Wounds inflicted by firearms
27
Q

Under what circumstances may a signed release of information not be required?

A
  • The patient is a Medicaid recipient

- The patient is being treated as a result of an on-the-job injury

28
Q

A legal document the requires an individual to appear in court with a piece of evidence that can be used or inspected by the court is called a(n) ____?

A

Subpoena duces tecum