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MAS 115 Review of Chapters 1 through 3

MAS 115 Review of Chapters 1 through 3

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  • 1. MAS 115 Medical Office Administration Chapters 1 ~ 3 Review for Exam
  • 2. Some advantages of Managed Care include:
    • 100% coverage of approved treatment with very little out-of-pocket expense
    • People are more likely to get preventative care since their insurance is pre-paid
  • 3. Capitation is:
    • A fee ‘per head,’ usually per month, paid to the physician by a managed care insurance company
  • 4. Which type of medical practice has the advantage of shared liability?
    • Solo practice
    • Associate practice
    • Group practice
  • 5. They are two types of “permission” from patients to share PHI
    • Consent ~ for routine transactions
    • Authorization ~ for special transactions
  • 6. Examples of bioethical issues today include:
    • IVF and other reproductive technologies, stem cell research, cloning, surrogacy, euthanasia
  • 7. What’s malpractice?
    • Literally “bad practice”
    • It means carelessness or negligence of a professional
  • 8. Bonding is
    • Insurance against embezzlement
  • 9. Can you name six ways an administrative medical assistant can protect their patient’s PHI?
  • 10. Name some good characteristics that demonstrate a professional attitude:
    • Initiative
    • Honesty
    • Respectful
    • Dependable
    • Decisive
    • Accurate
    • Confidential
    • Ethical
  • 11. Credentialing is
    • Review of the physician’s curriculum vitae (resume); checking up on hospital, practice history and peer references; and often includes an oral interview
  • 12. Some examples of Managed Care Organizations include:
    • HMO
    • PPO
    • IPA
    • EPO
    • POS
  • 13. HIPAA is
    • The Health Insurance Portability & Accountability Act
    • Regulates the rules regarding privacy of protected health information (PHI)
  • 14. Medical Practice Acts are
    • State acts that regulate the requirements for obtaining a medical license
    • Designed to protect the public from “quackery”
  • 15. Tort is
    • A tort is when one person causes injury to another person
  • 16. Important interpersonal skills to have are:
    • Observing
    • Showing interest, concern
    • Watching your tone of voice
    • Empathy
    • Initiative
    • Teamwork
  • 17. Three steps in coping with stress include:
    • 1) Identify the cause of stress
    • 2) Evaluate the situation ~ what can you do about it?
    • 3) Confront the problem ~ Make a decision and do it!
  • 18. Five stages of dying (in order) are:
    • Denial
    • Anger
    • Bargaining
    • Depression
    • Acceptance
  • 19. Hospice is
    • Medical care and support for patients and families during terminal illness
  • 20. HIPAA’s security rule covers:
    • Physical and technical safeguards
    • Policies, procedures, documentation requirements
    • Risk analysis and management
    • Administrative safeguards
  • 21. Who “owns” the medical record?
    • The physician (or the health care organization itself)
  • 22. Respondeat Superior means:
    • Literally “let the master answer”
    • Figuratively it means that an employer can be held liable for the actions of its employees
  • 23. You do NOT need authorization to share PHI under these conditions:
    • In emergencies
    • When mandated by the State to report communicable diseases or concerning conditions
    • When subpoenaed by a court of law
    • Federally-funded programs automatically have authorization to receive certain PHI
  • 24. An authorization is
    • “Special” permission from a patient to share certain PHI with certain people regarding a certain timeframe
  • 25. A Consent is:
    • “Routine” permission from a patient to share information regarding treatment, payment or other routine health care operations
  • 26. What’s a Compliance Officer?
    • A person who oversees and monitors an organization’s HIPAA compliance plan
  • 27. Misfeasance means
    • Lawful or proper treatment but done incorrectly
  • 28. Who oversees the Medical Practice Act?
    • Each State Board of Medical Examiners oversees its own State Medical Practice Act
  • 29. HIPAA’s privacy rule defines patient’s rights which include:
    • Patient’s have a right to receive notice about how an organization is sharing their PHI
    • They have a right to access their own records
    • They have a right to ask for amendment to their own records
    • They have a right to ask a health care organization for an “accounting” – when and to whom were their records released?
    • They have a right to restrict disclosures of information
  • 30. What’s the Good Samaritan Law?
    • State laws (they vary) which protect off-duty health care workers and others from liability when responding to emergencies
    • It’s intended to ENcourage health care workers to help…without fear of being sued
    • No duty = no contract and no 4D’s of negligence
    • HOWEVER ~ actions must be considered “prudent,” not reckless; nor can doctor “charge a fee” for service
  • 31. Nonfeasance means
    • Failure to treat when there was a duty to do so
  • 32. Types of Contracts:
    • Expressed Contract ~ Written or verbal agreement
    • Implied Contract ~ An agreement deduced from the situation (emergencies) or from the patient’s behavior
    • NOTE: No Contract exists during a “Good Samaritan” action (p. 79)
  • 33. What are some alternatives to litigation?
    • Screening panel
      • A physician review panel; advisory but cannot bar litigation
    • Arbitration
      • Agreed upon before treatment; in some States this can be a binding decision
    • No-fault insurance
      • “Injured person is compensated without regard to fault” (p. 78)
  • 34. What are some “defenses” the physician may use if sued?
    • Contributory negligence ~ the patient was in some way responsible for his or her own injuries (fully or partially)
    • Assumption of risk ~ the patient was informed of the risks of treatment but chose to consent anyway
    • Statute of Limitations ~ the time limit to take legal actions has passed/expired
  • 35. Malfeasance means
    • Improper or unlawful treatment
  • 36. The 4D’s
    • Are:
      • Duty
      • Dereliction (of duty)
      • Direct Cause
      • Damages
    • All four are necessary to prove negligence
  • 37. Some ways you can reduce litigation for your office/employer:
    • Obey the LAW!
    • Work within the scope of your training and be careful
    • Don’t ( assume and then ) admit fault
    • Don’t make promises
    • Don’t practice medicine without a license!
    • Keep timely, accurate records
  • 38. Examples of intentional torts include:
    • Assault & Battery*
    • Invasion of Privacy*
    • Defamation of Character
    • Libel or Slander
    • False Imprisonment*
    • Fraud
    • *MY NOTE: Some of these can be “negligent” torts as well – depends on “intent” of the accused
  • 39. Examples of negligent (or UNintentional) torts might include:
    • Accidentally administering incorrect dose
    • Accidentally faxing PHI to wrong number
    • Accidentally documenting information in the wrong chart…
    • Negligence occurs when we do not “behave in the way a prudent person who is similarly educated and trained would behave under comparable circumstances.” (p. 75)
    • MY NOTE: In health care, most lawsuits are regarding UNintentional torts
  • 40. What’s “Criminal Negligence?”
    • Reckless disregard for, or indifference to, the welfare of a patient
  • 41. What kind of comments could be perceived as “Promise to cure?”
    • “You’ll be just fine…”
    • “Dr. Smith will fix you right up…”
  • 42. What is “stress?”
    • Physical and psychological tension, caused by both “good” and “bad” events in our lives
  • 43. It’s when a physician is not available when the patient seeks help
    • Abandonment
    • Today, doctors must be careful to communicate with patients – terminate the contract properly, have ‘coverage’ available for patients when they are ill or on vacation, etc.
  • 44. Reasons a physician might terminate a contract with patient:
    • Failure to pay for appointments
    • Failure to appear for appointments
    • Failure to follow medical advice
  • 45. How should a patient be informed their contract with physician is terminated?
    • In writing
    • Mailed certified with return receipt
    • Letter should state reason, and allow enough time for patient to find new doc
    • Copy of letter and signed receipt should be filed in patient’s chart as “proof” of proper termination
    • PURPOSE: To avoid charge of abandonment
  • 46. What’s an advance directive?
    • Legal form detailing the desires of the patient for procedures to either be performed or withheld when death is imminent
  • 47. Examples of advance directives:
    • Living Will
    • Health Care Power of Attorney
    • Medical Directive
    • Values History Form
    • Health Care Proxy
    • DNR (Do Not Resuscitate)
    • Donor/Anatomical Gift Form
  • 48. Some “advantages” for the patient with Traditional Care insurance (versus Managed Care):
    • Patients feel they have more choice – they can see any doctor, any time, as often as they want (no ‘network’)
    • No pre-authorization is required so there are no delays in treatment, referrals, getting medications
  • 49. What is “Informed Consent”
    • Remember it has two parts – “Informed” and “Consent”
    • Informed ~ doctor explains risks, benefits, alternatives of recommended treatment and answers any questions
    • Consent ~ patient agrees to treatment after being informed, often “signing” a formal consent agreement
  • 50. Special rules about “Minors”
    • States have varying laws about minors
    • Emancipated Minors can personally consent to treatment (p. 80)
    • “Mature minor” is usually over 14 years of age and can often consent to medical/surgical treatment without parental consent
    • Reproductive Health issues: Abortion, pregnant unmarried minors – rules vary by State
  • 51. Sources of stress include:
    • Good
      • Marriage
      • Birth of a baby
      • Better Job
      • Moving
    • Bad
      • Divorce
      • Death
      • Loss of job
      • Health issues
  • 52. What’s a gatekeeper?
    • A primary care doctor who oversees the patient’s plan of care
    • This position is designed to help Managed Care control costs by scrutinizing referrals, pre-authorizing tests or drugs, etc.
  • 53. Subpoena is
    • Court order to appear
    • Subpoena duces tecum is
      • Court order to appear with records
  • 54. PHI stands for
    • Protected Health Information
    • It includes personal identification and patient’s health information
  • 55. Some reasons doctors are more likely to be sued today:
    • Well educated public expects the best care regardless of ability to pay; when they don’t get it, they may sue
    • Different “relationship” with doctors today; not held on a pedestal; more like “equal partners” in health care. Patients more like to question, compare (and sue) doctor
    • Bioethical issues generate lawsuits – new, untested legal ground = lawsuits
    • Managed care can cause delays in approvals, testing, diagnosis = lawsuits
  • 56. What’s the difference between an “authorization” and a “pre-authorization?
    • An authorization is special patient permission to share certain PHI
    • A pre-authorization is a request sent to managed care insurance for the purpose of gaining their agreement to pay for certain services, testing, drugs, etc. If they “approve” they will pay; if they do not approve, they will not pay.
  • 57. What’s the difference between a consent and an informed consent?
    • Consent is permission from a patient to share routine health care information with insurance companies, other people involved in their care
    • Informed consent is when a provider ‘informs’ patient of risks, benefits, alternatives to treatment, and then the patient gives (usually written) consent for the treatment as described
  • 58. Some reasons for the rise in health care costs today include:
    • Increased cost of a medical education
    • Increased lawsuits cause increase in medical malpractice insurance
    • Longer life expectancy = more people with chronic health issues = increased costs
    • Increased technology = increased specialization = higher cost for personnel
    • Docs over-prescribing, over-testing to reduce liability = wasteful = higher costs
  • 59. “ Think with empathy, act through ___________________”?
    • SERVICE!