Health Care Law

Question 1

3 things that limit the right of provider to terminate care

Answer 1

Can’t discriminate
Must provide notice
Can’t abandon patient

Question 2

Explain patient abandonment

Answer 2

Shall not cease care or to be available to provide care w/o giving sufficient notice or the opportunity to seek treatment else where

Question 3

3 aspects of the process of terminating the patient relationship

Answer 3

• Evaluate medical status and needs
• Determine if alternative care available
• Consider requirements of contractual relationships with 3rd party payers

Question 4

Explain the procedure for terminating relationship

Answer 4

• Give notice in person
• Send letter
• Transfer records
• If in ER, then you must still tx pt
• Statute of limitations

Question 5

It is the patient right to understand what 3 parts of informed consent?

Answer 5

Risks
Purpose, scope, and benefits
Alternatives

Question 6

What 7 things does informed consent warn the patient?

Answer 6

Complications
Sequalla
Risks
Alternatives
Benefits
Effects of non-tx
Economic interests

Question 7

Explain consent in writing

Answer 7

Nature, purpose, and known risks

All questions asked

Signed

Question 8

3 Exceptions for treating against patients will

Answer 8

Public health
Civil commitment
72-hr hold

Question 9

Explain the 5 steps for Leaving against medical advice

Answer 9

1. Patient capacity to understand
2. Review chart
3. Involve family or friends
4. Patient signs AMA
5. Aftercare instructions and invite to return

Question 10

What are the 4 elements to prove for negligence

Answer 10

Duty
Breach
Damages
Causaton

Question 11

Obligation to conform to a recognized reasonable care under circumstances

Answer 11

Duty

Question 12

Breached duty by failing to meet standard of care

Answer 12

Breach

Question 13

Compensatory and intangible losses

Answer 13

Damages

Question 14

Cause of injuries/damages not occurred any way or for different reason

Answer 14

Causation

Question 15

Review the slides on examples of medical negligence

Answer 15

Review the slides on examples of medical negligence

Question 16

Explain an Occurrence Policy

Answer 16

Insured has coverage for claims made and damages awarded as long as liabilities results from an occurrence within the stated time limits

Question 17

Explain a Claims Made Policy

Answer 17

Coverage is limited to actions which are known during the coverage period because and actual claim is made during that time

Question 18

Explain Tail Coverage

Answer 18

A reporting endorsement that confers on the policy holder, after nonrenewable or cancellation of the policy the right to purchase coverage for additional claims or disputes. Comes into play when leaving one occurrence policy to a non-occurrence

Question 19

10 commonly applied safe harbors

Answer 19

Investment interests
Lease
Personal service and management contracts
Physician recruitment
Sale of practice
Employees
Investments in group
Warranties
Discounts
Employees

Question 20

Categories of fraud and abuse (3)

Answer 20

1. bribes or kickbacks
2. illegal referrals
3. False claims or other fraudulent billing

Question 21

Anything of value not in exchange for a service/good

Answer 21

Remuneration

Question 22

Physician self-referral law prohibits…?

Answer 22

A physicians referral of a medicare patient to an entity in which they have financial interests for provision of a certain designated health service.

Question 23

The request by a physician for a service or item covered by the government health care program, including consulting with another physician and any test or procedure ordered by or to be performed by or under the supervision of another physician

Answer 23

Referral

Question 24

Exceptions to Stark

Answer 24

• Both ownership and compensation arrangements
• Only to ownership interests
• Only to compensation arrangements

Question 25

Common PHI

Answer 25

``` Charts Rx records Billing records Patient profiles Emails/faxes Phone calls Verbal counseling Rounding lists ```

Question 26

4 Permitted Disclosures

Answer 26

- Legal representative - Family and friends involved in care - Other providers - Business associates

Question 27

Is there a time when PHI can be released without authorization?

Answer 27

In an EMERGENCY

Question 28

3 Rights a patient has in regards to HIPAA

Answer 28

- Notice of privacy practices - Review and get copies of records - Request corrections

Question 29

The privilege of admitting patients to and caring for patients at the hospital

Answer 29

Medical staff membership

Question 30

The privilege of providing certain treatments and performing certain procedures at the hospital

Answer 30

Clinical privileges

Question 31

List 5 benefits of Peer Review

Answer 31

``` Improve Quality of care Protect patients Improve performance Required for compliance Avoid potential legal liability ```

Question 32

List 3 protections for peer review

Answer 32

1. Involved persons are granted immunity from lawsuits 2. Information is deemed confidential 3. Work product is privileged and inadmissible

Question 33

Who appoints practitioners to the medical staff and grants them clinical privileges

Answer 33

The governing board of the hospital

Question 34

Responsible to assure quality but no clinical expertise

Answer 34

The board

Question 35

Has no authority but experts responsible for care

Answer 35

Medical staff

Question 36

3 mechanisms that protect patients from unsafe practitioners

Answer 36

- Hospital credentialing - Investigation and peer review - Reporting