Prentice Ch. 3 - Legal Concerns and Insurance Issues Flashcards Preview

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Flashcards in Prentice Ch. 3 - Legal Concerns and Insurance Issues Deck (32):
1

Liability

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

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negligence

the failure to use ordinary or reasonable care

3

The standard of reasonable care

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

4

duty of care

part of an official job description

5

to est. negligence you need 4 things

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

6

Torts

legal wrongs committed against the person or property of another

7

nonfeasance

when an individual fails to perform a legal duty
- ATC fails to refer a seriously injured pt. for proper medical attention

8

malfeasance

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

9

misfeasance

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

10

a successful negligence case against an ATC needs

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

11

Sovereign immunity

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

12

Good samaritan law

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

13

Statues of Limitation

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

14

Assumption of risk

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

15

How to reduce litigation

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

16

Product liability

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

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General health insurance

policy that covers illness, hospitalization, and emergency care

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Primary insurance

all medical expenses are paid for by the institution
- institutions pay an extremely high premium for this

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Secondary insurance

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

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Health maintenance organizations (HMOs)

- 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

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Preferred Provider organizations (PPOs)

- 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

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Point of service plan

- 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

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Exclusive Provider Organizations (EPOs)

- 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

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Physician Hospital organization (PHOs)

involve a major hospital or hospital chain
- contacts directly with employers to provide services

25

Third-Party Administrators

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

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Medicare

federal health insurance program for the aged and disabled

27

Medicare parts

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

28

Medicaid

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

29

Workers comp

- employers pay premiums

30

indemnity plans

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

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Capitation

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

32

National Provider Identifier (NPI)

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