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Business In Ethics – Final paper and presentation
Instructor: Lisa Lewin
Interview a professional who has faced an ethical dilemma in
his/her workplace. A professional, for this assignment, is
anyone who has worked full-time, at the same organization for
at least 3 years. You may not interview yourself. Your goal in
this assignment is to analyze the case from an Ethics in
Business perspective. While you may certainly talk to your
interviewee about his/her perspective on the ethics of the case,
the goal is to write your own objective analysis, including your
arguments as to whether or not this individual made the best
decision. HINT: the strongest arguments include anticipating
likely counter-arguments and refuting them. Choose an ethical
situation that is rich enough to provide you with enough content
for a thorough analysis. E.g., a situation in which there is only
one clear ethical option (should I steal from the company?) does
not make for a strong or solid analysis.
Paper Details:
1. Writing counts. A portion of your grade will be based on
your ability to write clearly, language, grammar and spelling. If
this is a problem area for you, consider using The Learning
Center at Rutgers.
2. Length: 3-4 pages, 12 point Times New Roman (or similar)
font, 1 inch margins with double spacing. Because this is a short
paper, use your space efficiently. One mistake students often
make is spending too much time/space describing the details of
the situation, and not enough concentration on the analysis of
the situation. HINT: Remember, this paper is like a “final
exam” – i.e., I expect you to actively demonstrate that you have
mastered the core concepts from the class and can apply some
of the articles and theories we have discussed into your
arguments. Make that your focus.
3. Caution: While this is not a research paper, and you are not
required to use outside sources, you must properly cite any
material you reference, including assigned course readings, any
other material I have provided you, and any information that
you find on your own (e.g., if you look up a definition, a
statistic or a fact online). Failure to cite = plagiarism.
Plagiarism is a violation of the academic integrity policy, and
all violations will be reported to the Dean of Student Affairs.
Consequences for first-time violations can range from a 0 on the
paper to an F for the class.
4. Due: Must be uploaded to BB by 6:00 p.m. on Wed, July 3
Presentation Details:
1. Presentation must be between 5 and 10 minutes in length, and
should approximately follow the written paper in structure.
You may use slides, but they are not required. If you do use
slides, no more than 5 content slides. You may not read directly
from your paper. The goal for this portion of the assignment is
to express your ideas verbally, and therefore the presentation
should contain a brief description of events and a stronger focus
on your analysis and application of course readings and
theories.
Law, Liability, & Ethics
For Medical Office Professionals
Sixth Edition
Chapter 1
The Big Business of Health Care and You
Copyright © 2018 Cengage. All Rights Reserved.
Copyright © 2018 Cengage. All Rights Reserved.
Objectives
Recognize importance of business aspect of health care industry
Recognize importance of your role on frontlines of health care
industry
Identify different types of legal entities
Identify types of managed care delivery systems
Explain benefits of telemedicine
Copyright © 2018 Cengage. All Rights Reserved.
Introduction to the Business of Health Care (1 of 2)
In 2015, the health care industry accounted for almost 18
percent of all U.S. goods and services.
Know risks that can result in lawsuit or other unwanted action
Copyright © 2018 Cengage. All Rights Reserved.
Introduction to the Business of Health Care (2 of 2)
Industry controls health care costs with competition and
regulation
Competition has:
Led employers, governments, and health insurance companies to
control escalating costs through regulation
Given rise to managed care organizations
Copyright © 2018 Cengage. All Rights Reserved.
The Frontline Is You
Frontline professionals communicate most frequently with
patients
What you know and how you conduct yourself can influence
patient’s experience
Copyright © 2018 Cengage. All Rights Reserved.
The Importance of Legal Knowledge (1 of 3 )
Understand legal issues to avoid lawsuits and other risks
Copyright © 2018 Cengage. All Rights Reserved.
The Importance of Legal Knowledge (2 of 3)
Medical office professionals held to higher standard of care
than laypersons
Physicians and nurses held to standard of care established by:
State law
State licensing organizations
Registration boards at national or state level
Copyright © 2018 Cengage. All Rights Reserved.
The Importance of Legal Knowledge (3 of 3)
Know the scope within which you can practice
Most medical office employees:
Are not licensed to practice medicine
Must carry out responsibilities without making medical
decisions or acting outside area of expertise
Copyright © 2018 Cengage. All Rights Reserved.
Personal Protection (1 of 3)
Ignorance of a law/regulation does not excuse violation
Know laws and regulations that govern profession
Understand basic principles of law to protect from:
Needless litigation
Loss of reputation, personal wealth, or earning power
Copyright © 2018 Cengage. All Rights Reserved.
Personal Protection (2 of 3)
Reasonable standard of care is conducting ourselves in a
responsible manner that will not cause harm
Physicians, nurses, and other health care professionals held to
higher standard of care
Violations can lead to:
Medical malpractice lawsuits
Certificate or license revocations
Criminal charges (extreme cases)
For medical assistants, required standard of care is difficult to
predict
Copyright © 2018 Cengage. All Rights Reserved.
Personal Protection (3 of 3)
Medical office professionals are link between patient and
physician
Positive patient interactions minimize nonmedical and nonlegal
variables
May prevent legitimate complaint from developing into lawsuit
Copyright © 2018 Cengage. All Rights Reserved.
Patient Protection (1 of 2)
Patients trust they are being treated by qualified health care
professionals
State licensure laws define education and experience required to
perform certain procedures
A license indicates that holder has basic minimum
qualifications required by state for the occupation
Copyright © 2018 Cengage. All Rights Reserved.
Patient Protection (2 of 2)
Privacy and confidentiality have ethical and legal bases
Requirements of privacy and respect for confidentiality must be
met
Copyright © 2018 Cengage. All Rights Reserved.
HIPAA
Federal law
Requires every health plan and provider maintain “reasonable
and appropriate” safeguards to ensure health information
confidentiality
Copyright © 2018 Cengage. All Rights Reserved.
Patient Bill of Rights (1 of 2)
Patient Bill of Rights:
Conveys patients’ legal and ethical rights
Includes acknowledgment of patient’s right to choose treatment,
to consent to treatment, and to refuse treatment
Not always required by law
Establishes standards, including ethical standards, for patient
care
Copyright © 2018 Cengage. All Rights Reserved.
Patient Bill of Rights (2 of 2)
Some rights that may be included:
To be treated with courtesy and respect in an environment free
from discrimination
To be treated confidentially, with access to your records limited
to those involved in your care or otherwise authorized by you
To be informed by your health care provider about your
diagnosis, scheduled course of treatment, alternative treatment,
risks, and prognosis
To refuse medical treatment, even if your physician
recommends it
To be informed about the outcomes of care, treatment, and
services that have been provided, including unanticipated
outcomes
To be informed if medical treatment is for experimental
research and to give your consent or refusal to participate
Copyright © 2018 Cengage. All Rights Reserved.
Respondeat Superior
Physicians and corporate employers are liable for their own
conduct
Physicians and corporate employers are vicariously liable for
their employees’ conduct while working within scope of
employment
Copyright © 2018 Cengage. All Rights Reserved.
The Business Structure: Legal Entities
A business is a commercial/industrial establishment
Sole Proprietorship: Single physician, therapist, other licensed
health care professional
Partnership: Two or more people who combine their work,
money, and talents
Corporation: Group of people band together and create an
artificial being/entity
Copyright © 2018 Cengage. All Rights Reserved.
Health Care Delivery and Compensation Systems
Health Maintenance Organization (HMO)
With prepaid group practice (PGP) and individual practice
association (IPA)
Preferred Provider Organization (PPO)
Associations of physicians and hospitals (providers) that
contract with employers, insurance companies, or third-party
administrators to provide comprehensive medical services on a
fee-for-service basis to subscribers
Copyright © 2018 Cengage. All Rights Reserved.
Managed Care
Term describes system of integration of financing and delivery
of health care to provide comprehensive services to an
identified segment of the population
Copyright © 2018 Cengage. All Rights Reserved.
Types of Managed Care Organizations
HMO
POS
EPO
PPO
Copyright © 2018 Cengage. All Rights Reserved.
Telemedicine
Patient is in one location and the treating physician is in
another
Use of video and transmission of data to the remote physician
from the patient
Copyright © 2018 Cengage. All Rights Reserved.
Law, Liability, & Ethics
For Medical Office Professionals
Sixth Edition
Chapter 3
From the Constitution to the Courtroom
Copyright © 2018 Cengage. All Rights Reserved.
Copyright © 2018 Cengage. All Rights Reserved.
Objectives (1 of 2)
Differentiate between federal and state law
Differentiate between origins of statutory, administrative, and
common law
Understand what makes up a federalist government
Identify steps necessary for passage of federal and state
legislation
Distinguish between appellate paths of federal judicial system
and state judicial system
Copyright © 2018 Cengage. All Rights Reserved.
Objectives (2 of 2)
Identify three administrative law agencies involved in
regulation of medical office
Identify parties to a lawsuit
Explain basic trial procedures
Identify stages of an appeal
Demonstrate techniques that aid in being a good witness
Copyright © 2018 Cengage. All Rights Reserved.
It All Starts with the Constitution
Constitution determines if state or federal law is applicable
Constitution is comprised of:
Preamble
The Articles
The Amendments
Amendments 1–10 = The Bill of Rights
Copyright © 2018 Cengage. All Rights Reserved.
The Constitution
Supremacy Clause
Supreme law of the land
Enumerated Powers
Federal government’s powers
The Interstate Commerce Clause
Act of commerce involves more than one state
Copyright © 2018 Cengage. All Rights Reserved.
Three Branches of Government
Executive Branch
President
Congress
435 Representatives
100 Senators
The Judiciary
Copyright © 2018 Cengage. All Rights Reserved.
Health Care: Federal or State Law?
Mix of federal and state law
Federalism and federal government’s role in health care
regulation
Now federal and state law intertwined
Copyright © 2018 Cengage. All Rights Reserved.
Administrative Law
Administrative agencies perform:
Rule making
Adjudication
Prosecution
Advising
Supervision
Investigation
Copyright © 2018 Cengage. All Rights Reserved.
Common Law
Distinguished from statutory law in that it is made up of a body
of principles and rules that are common to entire population
Copyright © 2018 Cengage. All Rights Reserved.
The Distinction Between Criminal and Civil Law
Criminal
State or federal government is plaintiff
Person charged with crime is defendant
Civil
Typically plaintiffs and defendants are private citizens or
companies
Copyright © 2018 Cengage. All Rights Reserved.
Into the Courtroom
What might happen if :
You are named as a party in a lawsuit
Called as a witness at trial
Copyright © 2018 Cengage. All Rights Reserved.
Medical Malpractice Phases
Phase I is the time period when the alleged negligence occurs
Phase II begins when patient seeks advice of an attorney
concerning harm allegedly done
Phase III is a means of settling a dispute between two parties
before a judge or a jury
Phase IV is when either side has right to appeal decision
Copyright © 2018 Cengage. All Rights Reserved.
Medical Malpractice: Phase I
Patient becomes aware of injury or that something is not quite
right and complains to provider
Insurance companies require filing of an incident report
Anger becomes a problem
If physician is unable to smooth over incident, a medical
assistant or other member of office staff may be able to
dissipate anger and head off litigation
Copyright © 2018 Cengage. All Rights Reserved.
Medical Malpractice: Phase II
Attorney will attempt to obtain a copy of medical records
Insurance company, doctor, and attorney for patient may
negotiate a settlement
If negotiations break down, patient’s attorney files a complaint
End of second phase of lawsuit comes when a pretrial
conference is held
Copyright © 2018 Cengage. All Rights Reserved.
Medical Malpractice: Phase III
Plaintiff presents facts
Witnesses are ordinary people interested in telling their story
Members of jury listen and make a fair decision
Bench trials (—) judge serves as both judge and jury
Copyright © 2018 Cengage. All Rights Reserved.
Medical Malpractice: Phase IV
Losing party pursues an appeal
A decision can be appealed only on matters of law
Means that legal principles of lower court’s decision are
challenged, not facts of case
Copyright © 2018 Cengage. All Rights Reserved.
You as a Witness
Pay attention
Behave in a professional manner
Answer question
Cooperate with your attorney
Honesty is the best policy
Copyright © 2018 Cengage. All Rights Reserved.
Art of Examination (1 of 2)
Both plaintiff and defendant try to win case by interviewing
own witnesses and cross-examining witnesses from opposing
side
A witness should be prepared for both direct examination and
cross-examination
Copyright © 2018 Cengage. All Rights Reserved.
Art of Examination (2 of 2)
In direct examination, questions are open-ended and witness is
able to answer freely and in own words
Burden of proof is beyond a reasonable doubt in a criminal
lawsuit
Copyright © 2018 Cengage. All Rights Reserved.
STUDENT’S POST
FROM MY CLASS HAVE POSTED SO FAR. (PLEASE BE
CAREFUL WHICH ONE YOU CHOOSE TO COMPLETE MY
ASSIGNMENT SINCE I WON’T KNOW IF THEY ARE
DOING IT RIGHT OR NOT. PLEASE BASED ON THE
INSTRUCTIONS FROM MY PROFESSOR GO OVER
EVERYTHING AND ALL POSTS AND CHOOSE THE ONE
YOU THINK IT IS BEST AND DONE CORRECTLY)
ORDER FOR YOU TO CHOOSE ONLY ONE AND
COMPLETE
MY POST 2. (As per my professor instructions he is asking to
choose a fellow student’s post and ask to provide
an example along with other things the professor is requesting
me to do. Please read the Discussion Board
Instructions attachment)
Student Name: Yesenia Castro
Post 1: The Patients’ Bill of Rights
For many years different laws in health care have been created
to protect us as patients. The Patient’s Bill of Rights which
sets certain ethical standards and provides proper knowledge to
patients receiving medical care was initially adopted by the
American Hospital Association in 1973 and revised in October
1992. For many it carries diverse expectations of the care that
should
be provided in a respectful and dignified manner.
Setting different guarantees for patients for example: to be
treated in and environment free from discrimination, to be
provided an estimate of charges for medical care, a reasonably
clear itemized bill, and, if needed, an explanation of the charge
(Myrtle and Pardew, 2018), the patient has the right to make
decisions about the plan of care before and during the course of
treatment and to refuse a recommended treatment or plan of care
if it is permitted by law and hospital policy. The patient also
has
the right to be informed of the medical consequences of this
action. In case of such refusal, the patient is still entitled to
appropriate
care and services that the hospital provides or to be transferred
to another hospital (Pecorino 2002).
In conclusion all these rights have given patients the correct
resources to make educated decisions about their health
care needs like designating a health care surrogate or end of life
care choices. Lastly providing accurate information and
explaining
all rights to patients equals better care in healthcare.
References:
Flight, M.R., & Pardew, W. M. (2018). Law, Liability, and
Ethics for Medical Office Professionals. Boston, MA: Cengage
Learning.
Pecorino, P.A. (2002). The Patient’s Bill of Rights AHA.
Retrieved
fromhttp://www.qcc.cuny.edu/SocialSciences/ppecorino/MEDIC
AL_ETHICS_TEXT/Chapter_6_Patient_Rights/Readings_The%
20P
atient_Bill_of_Rights.htm
Student Name: Glenda Betancourt
Post 1: Business of Health Care
The Health Care providers will support their patients and family
too. This place is committed to providing quality healthcare
services
for patients with HIV. The services are provided without
discrimination because, raze, age, religion, nationality, sex,
gender identity
or economic status. When the patients come to Care Resource
strives to expand and help the community. We obtain care from
other clinicians with primary care medical homes to seek a
second opinion and specialty care. The patient gets coordinators
to
assist when are diagnosed with HIV, the doctor and Medical
Case identify treatment supporting goals, skills with assistance,
medical
documentation, provide home visits to locate patient and
treatment. if the patient felling sick he/she has urgent medical
assistance,
sometimes the patients need medicine for HIV/AIDS, Hepatitis
C, or another infectious disease Care Resource helps with health
care services. the most important Health care department is
through education, prevention, research, treatment and support
services and also the patient take a better quality of life.
Student Name: Leyanis Lopez Iglesias
Post 1: Benefits of Telemedicine
When the inevitable happens and someone in your family get
sick, there is probably as aggravating as being forced to sit for
hours
in an emergency room or doctor's office, then you only see
him/her for a few minutes before you are hustled out the door to
deal
with insurance and paper work. Doctor visits are expensive,
time consuming and frustrating. But if you and other colleague
at your
company could have Internet access to a nation-wide network of
licensed doctors any day and save on health insurance costs.
Telemedicine is a monthly subscription for medical services
that would not be consistently availably in distant rural
communities, it is
used to save lives in critical care and emergency situations. It is
a monthly subscription for routine health care services, not only
does it save time and frustration waiting for a doctor in an
emergency room or clinic, there is not deductible and no co-
insurance
which saves individuals n business lost income due to
employees being away from work.
Law, Liability, & Ethics
For Medical Office Professionals
Sixth Edition
Chapter 2
Laws and Regulations You Will Encounter
Copyright © 2018 Cengage. All Rights Reserved.
Copyright © 2018 Cengage. All Rights Reserved.
Objectives (1 of 2)
Recognize complexity of government influence on practice and
licensing of medicine
Describe importance of understanding basic employment,
discrimination, and harassment laws when hiring, promoting,
and terminating employees
Identify provisions of Family and Medical Leave Act
Recognize situations affected by Americans with Disabilities
Act (ADA)
Identify four social security benefits
Copyright © 2018 Cengage. All Rights Reserved.
Objectives (2 of 2)
Recognize differences between Medicare and Medicaid
Define Employee Retirement Income Security Act (ERISA)
Recognize importance of Occupational Safety and Health Act
(OSHA) regulations
Define job descriptions, procedures, manuals, and employee
handbooks
Describe basic collection protocol
Copyright © 2018 Cengage. All Rights Reserved.
Introduction to Health Care Laws, Regulations, and Business
Protocols
As a medical office professional, you will want to be aware of:
Medical practice laws and regulations
The nature of your employment
Discrimination
Sexual harassment
Health care laws and regulations
Union membership and collective bargaining.
Copyright © 2018 Cengage. All Rights Reserved.
Government Regulation of Health Care Providers (1 of 2)
Medical practice laws control practice of medicine
State legislatures establish state medical boards with authority
to control health care provider licensing
Copyright © 2018 Cengage. All Rights Reserved.
Government Regulation of Health Care Providers (2 of 2)
Licensing boards grant, renew, and revoke licenses
Physicians to submit reports under certain circumstances.
Child and elder abuse
Controlled substances acts restrict distribution, classification,
sale, and use of certain drugs
Copyright © 2018 Cengage. All Rights Reserved.
Employment Law (1 of 3)
Discrimination law does not allow employers to ask questions
concerning, race, religion, age, or whether a woman is pregnant
Pre employment testing ensures that tests will only measure
skills and abilities necessary to do job
Drug testing is necessary to ensure public’s safety
Equal Opportunity Employment prohibits employment based on
race, color, religion, sex, or national origin
Copyright © 2018 Cengage. All Rights Reserved.
Employment Law (2 of 3)
Drug Testing
Employers allowed to test potential employees as part of hiring
process
EEOC administers and enforces Title VII of the Civil Rights
Act of 1964
Copyright © 2018 Cengage. All Rights Reserved.
Employment Law (3 of 3)
Disparate Treatment does not allow employers to treat
employees differently because of their race, sex, religion, or
national origin
Disparate Impact ensures that employers do not treat employees
differently in an “adverse” manner on a particular protected
group
For example, a minimum height requirement may discriminate
against women
Copyright © 2018 Cengage. All Rights Reserved.
FMLA
The Family and Medical Leave Act of 1993 (FMLA) requires
employers of 50 or more to provide up to 12 weeks of unpaid
leave each year for “serious health condition” of an employee or
member of employee’s immediate family or for birth or
adoption of a child
Copyright © 2018 Cengage. All Rights Reserved.
ADA
The Americans with Disabilities Act (ADA) covers physical as
well as mental disabilities in employment, public services,
public accommodations, and telecommunications
Copyright © 2018 Cengage. All Rights Reserved.
Federal Age Discrimination Act
The Federal Age Discrimination in Employment Act of 1967
(FADA) covers age discrimination and protects rights of older
workers
Copyright © 2018 Cengage. All Rights Reserved.
Equal Pay Act
The Act was passed in 1963 to end the practice of paying
women less than men for the same job
Copyright © 2018 Cengage. All Rights Reserved.
Fair Labor Standards Act
The Fair Labor Standards Act (FLSA) establishes federal
minimum wage, mandates extra pay for overtime work, and
regulates the employment of children
Copyright © 2018 Cengage. All Rights Reserved.
Workers’ Compensation
Workers’ compensation laws are administered by state
governments and create a mandatory insurance system that
reimburses employees for losses sustained because of work-
related injury or disease, regardless of fault.
Copyright © 2018 Cengage. All Rights Reserved.
Social Security (1 of 2)
Social security (Ss) include several different but related
programs:
Retirement
An individual becomes eligible for retirement benefits at the
age 62
Retirement benefits require a total of 40 quarters or 10 years of
work credit from covered employment
Disability
Benefits are paid to individuals who are disabled
Any medical condition that prevents an individual from being
gainfully employed may be considered a disability
Copyright © 2018 Cengage. All Rights Reserved.
Social Security (2 of 2)
Dependent’s/Survivor’s Benefits
Certain dependents of a retired or disabled worker are eligible
for monthly benefits if worker is eligible for retirement or
disability benefits
Surviving family members of a deceased worker may be entitled
to survivor’s benefits
Copyright © 2018 Cengage. All Rights Reserved.
Medicare
Medicare is a federal insurance program for people who are
entitled to Medicare from their social security contributions and
payment of premiums
Copyright © 2018 Cengage. All Rights Reserved.
Medicaid
Medicaid is a program jointly administered by federal
government and state government for low-income individuals
obtainable through social services or welfare departments
Copyright © 2018 Cengage. All Rights Reserved.
Employee Retirement Income Security Act (ERISA)
Protects and regulates pensions
Copyright © 2018 Cengage. All Rights Reserved.
Health Insurance Portability and Accountability Act of 1996
(HIPAA)
Guarantees renewal and transferability of health insurance
coverage to those already with coverage and to their dependents
Copyright © 2018 Cengage. All Rights Reserved.
HITECH Act
The Health Information Technology for Economic and Clinical
Health Act (HITECH) encourages and requires use of various
methods of health care technology with improved health care as
objective
Copyright © 2018 Cengage. All Rights Reserved.
Occupational Safety and Health Act (OSHA)
OSHA rules and regulations are intended to prevent injuries and
promote job safety
OSHA is authorized to enforce standards through:
Complaint
Inspection
Investigation
Copyright © 2018 Cengage. All Rights Reserved.
Unions and Health Care Workers
In 1919, American Federation of Labor organized engine room,
laundry, and dietary employees; nurse’s aides; and orderlies in
three San Francisco hospitals
American Nurses’ Association (ANA) supports collective
bargaining
Copyright © 2018 Cengage. All Rights Reserved.
Working Conditions
Every position in an office should have a job description
divided into two parts:
Responsibilities of each employee
Listing of tasks to be performed by each employee
Copyright © 2018 Cengage. All Rights Reserved.
Procedure Manuals and Handbooks
Procedures Manual describe in detail the manner in which a task
in job description should be carried out
Handbooks provide personnel policies and related instructions
Copyright © 2018 Cengage. All Rights Reserved.
Collections
Steps
Notification
Contact individual
Determine if there is a valid reason for failure to pay
Discuss alternative payment schedule
Copyright © 2018 Cengage. All Rights Reserved.
PLEASE SEE BELOW THE UNIT I OVERVIEW THAT MY
PROFESSOR SENT TO ME.
THIS MAYBE MIGHT BE USEFUL FOR YOU
Chapter 1
Chapter 1 covers a lot of ground and sets the stage for the rest
of the text. The premise of this text is that
the health care industry is a big business and what medical
office professionals do on the frontline
matters. This chapter also features discussion of the standard of
care for medical professionals and
laypersons and what it means to be a medical assistant.
Technical aspects of the law are useful for
medical office professionals so they can understand the business
aspects of working in a medical office.
That is why this chapter includes discussion of the several types
of legal entities, such as corporations,
limited liability companies, and sole proprietorships, among
others. Another foundational issue is
managed care organizations (MCOs), including HMOs, PPOs,
and ACOs. It will be necessary for you to
be familiar with the many facets of MCOs, including the
focused objectives of reducing costs and
delivering quality health care. And, finally, this chapter features
a discussion about telemedicine as an
alternative health care delivery system that has become
increasingly commonplace. The use of
telemedicine is still in its infancy, but it has the potential to
dramatically change the practice of
medicine.
These resources are provided for additional information about
select topics:
• Legal entities: U.S. Small Business Administration. (n.d.).
Choosing your business structure. In
Starting & managing. Retrieved from
33TUhttps://www.sba.gov/starting-business/choose-your-
business-structureU33T
• Managed care organizations: U.S. Centers for Medicare &
Medicaid Services. (n.d.). Health insurance
plan & network types: HMOs, PPOs, and more. In How to pick a
health insurance plan. Retrieved from
33Thttps://www.healthcare.gov/choose-a-plan/plan-types/33T
American Telemedicine Association. Retrieved from
33Thttp://www.americantelemed.org/home33T
Chapter 2
This chapter also addresses sexual harassment, a serious
problem in the workforce. Other issues
discussed in this chapter are workers’ compensation and social
security, which affect every employer
and employee. The chapter also explains that Medicare and
Medicaid are government-sponsored health
care delivery and compensation systems. And, finally, this
chapter makes clear that procedures manuals,
job descriptions, and employee handbooks are all part of the
business side of a medical practice, as are
laws affecting collection procedures.
These resources are provided for additional information about
select topics:
• Sexual harassment: U.S. Equal Opportunity Employment
Commission. (n.d.). Sexual harassment. In
Laws, rules, & regulations. Retrieved from
33Thttps://www.eeoc.gov/laws/types/sexual_harassment.cfm33T
• ADA Amendments Act of 2008. Retrieved from
33Thttps://www.eeoc.gov/laws/statutes/adaaa.cfm33T
• OSHA. Retrieved from 33Thttps://www.osha.gov/33T
• Social Security. Retrieved from 33Thttps://www.ssa.gov/33T
• Medicare. Retrieved from 33Thttps://www.medicare.gov/
• Medicaid. Retrieved from 33Thttps://www.medicaid.gov/
Chapter 3
All laws in the United States flow from the Constitution. This
chapter explains the basis for a federalist
system of government: the federal government concurrently
existing with state government. The
discussion of the Constitution includes the Supremacy Clause,
which tells us that federal law will govern
if there is a conflict between federal and state law. Also
explained in this chapter is the federal
government’s division into three branches: the executive, the
legislative, and the judiciary. The judicial
branch of law, both in the federal and state governments, is
responsible for settling legal disputes. Each
lawsuit that does go to trial follows certain phases of
development. From the time the alleged negligence
occurs to the time the case goes to trial, both sides are involved
in discovery, which is a form of legal
investigation. You will learn that the outcome of the
investigation may be to decide that there is no case,
to settle, or to take the matter to a judge or a judge and jury.
This chapter discusses that, after a case has
been tried, either side may appeal. And, finally, this chapter
discusses that an individual who is a party
or a witness in a trial undertakes extensive preparation.
These resources are provided for additional information about
select topics:
• Constitution. Retrieved from
33Thttps://www.archives.gov/founding-docs/constitution33T
• Supreme Court. Retrieved from
33Thttps://www.supremecourt.gov/33T
*** PLEASE SEE BELOW EMAIL MY PROFESSOR SENT TO
ALL OF US SPECIFIYING AND WITH MORE
INSTRUCTIONS ON HOW HE WANTS THE DISCUSSIONS
TO BE COMPLETED
*****Please DO NOT post attachments on the discussion
boards. *******
If your posts & papers look like this you are on the way to
success on all assignments. If they don’t that is the reasoning
behind lost
points. SAMPLE PAPER/Discussion POST with CITATIONS
and REFERENCES (3-4 paragraphs recommended for initial
post
and second/follow ups) 1-2 sentence posts would not qualify.
ease DO NOT pchments on the discussion boards.
Post in depth (3-4 paragraph) APA cited posts with in
text/reference list (Quality is key); vs. avoid posting five (5) or
six (6)
one sentence posts without APA format/citing (Quantity is bad)
(APPLY THE BOOK, CITING (IN TEXT AND REFERENCE
LIST) AND PARAPHRASES AS WELL AS THE RESEARCH)
For help
with citing use www.citationmachine.net
AND
http://owl.english.purdue.edu/owl/resource/560/01/
NOTE I ONLY LOOK FOR 4 APA Items with DB's
1) In text citing, 2) Headings, 3) Reference list 4) Indenting
paragraphs and expand in depth
http://www.citationmachine.net/
http://owl.english.purdue.edu/owl/resource/560/01/
EXAMPLE Discussion POST BELOW: (For format and depth)
Criminology
Throughout time, criminologists began to ask complex social
questions about the nature of crime and criminals. Many of
the queries centered around the behavior of criminals, rather
than on the criminality of behavior. There has been interest
generated
which has focused more upon accounting for the factors and
influences which lead to criminal law violations and the
behavior of
offenders rather than it has upon the lawmaking processes
through which criminal prohibitions are produced.
Contemporary views
There is no single theoretical position on crime causation that
can be identified as the liberal perspective. There are many
ways in which contemporary criminological theories can be
classified. Contemporary views regarding deviance represent
distinctive
studies from Emile Durkheim (1858-1917). French sociologist
Emile Durkheim was responsible for two seminal themes on
crime
and deviance. According to Goode (2005), he was one of the
first to insist on the “normality” of criminality. Durkheim
maintained that
the “normal” and “pathological” are not intrinsically different
forms of behavior. Durkheim asserted that it is neither possible
nor
desirable for a society to repress criminality completely. His
second and possibly most important contribution to the study of
deviant
behavior is in the theory of anomie, which was originally
developed as an explanation of suicide (Vold, Bernard and
Snipes, 2002).
When traditional rules have lost their authority over behavior, a
state of deregulation, normalness, or anomie may exist.
Signs of violence
The criminal serves as an identifying sign of the limits of
permissible behavior. If these violations of normative
sentiments
could be repressed, both men and women would become
sensitive to the less marked deviations which are now
overlooked, and
these acts would then be regarded as crimes (Schmalleger,
2007). These increasingly intolerable demands for conformity,
which
would then possibly be imposed on individuals, not thought of
as criminals, would be detrimental to social progress.
References
Goode, E. (2005). Deviant behavior. Upper Saddle River, NJ:
Prentice Hall.
Schmalleger, F. (2007). Criminal justice today: An introductory
text for the 21
st
century. (9
th
Ed.). Upper Saddle River, NJ: Pearson
Prentice Hall.
Vold, G., Bernard, T., & Snipes, J.B. (2002). Theoretical
criminology. New York: Oxford University Press.
EXAMPLE/SAMPLE POST: How should my posts/papers look?
DISCUSSION BOARD INSTRUCTIONS
Discussion Board Posts
Two posts due per week, for a total of FOUR posts per unit.
Very important component of our course and worth 50% of your
final grade. That's right,
HALF of your final grade will come from the discussion board
activity, so do not
disregard the importance of this assignment.
Our units are two weeks long. You must log in and participate
at least twice per week
(i.e. four times per unit). This is how your attendance and
participation will be measured.
Weeks start on Sunday and end on the following Sunday.
Assignment Requirements:
Discuss it thoroughly.
It must be between 150 to 250 words. Do not exceed the word
count, but do not
fall short of the 150 word requirement.This post must be in your
own words. Any
instances of copied material from ANY source will result in an
automatic zero for
the offense and an F in the course for the second one, plus a
permanent notation
in your academic record, which will seriously affect any future
employment
prospects where background checks are conducted (which in
today's job market,
includes every single employer). These posts are due by
Sundays of Weeks I, 3,
5, and 7.
example (i.e. create a
"story" that applies the concept). For example, if a students
discussed the rules
of searching a vehicle trunk, you are to provide an example (i.e.
a little story) of a
police office conducting either an illegal or a legal search of a
vehicle trunk. This
learning process is called "application" and will enhance your
critical thinking
skills. This forces you to "think", not just to memorize and
regurgitate material,
which any circus-trained monkey can do. The goal is to prepare
you for the real
world, which will expect you to think independently. If you are
ready to submit
your second post, but there are insufficient initial posts for you
to choose one,
then you can pick a topic from the reading assignments and
simply provide an
example (i.e. an example/story) for that topic. There is no word
count for these
posts. These posts are due by Sundays of weeks 2, 4, 6, and 8
(Week 8 ends on
a Wednesday, not on Sunday)
assignment and explain
it thoroughly, the same as "Post 1"
Let me further clarify: you will repeat the process twice during
the two-week unit. Posts
1 and 2 are during the first week of the unit and posts three and
four are due during the
second week of the unit. However, I will not be deducting
points for failing to meet these
deadlines during Unit I, as I understand there are textbook
issues and scheduling issues
which can cause delays. As long as you submit four posts by the
end of Unit I, then you
will be fine. However, all deadlines will be strictly enforced for
Units II, III, and IV.
Grading Criteria:
Detail of discussion.
Accuracy of content. Label the subject line of your post: Post 1
or Post 3
content application.
Label the subject line of your post: Post 2 or Post 4.
Due Dates:
3, 5, and 7
Posts 2 and 4: Sundays of Weeks 2, 4, 6, and 8

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Business In Ethics – Final paper and presentation Instructor Li.docx

  • 1. Business In Ethics – Final paper and presentation Instructor: Lisa Lewin Interview a professional who has faced an ethical dilemma in his/her workplace. A professional, for this assignment, is anyone who has worked full-time, at the same organization for at least 3 years. You may not interview yourself. Your goal in this assignment is to analyze the case from an Ethics in Business perspective. While you may certainly talk to your interviewee about his/her perspective on the ethics of the case, the goal is to write your own objective analysis, including your arguments as to whether or not this individual made the best decision. HINT: the strongest arguments include anticipating likely counter-arguments and refuting them. Choose an ethical situation that is rich enough to provide you with enough content for a thorough analysis. E.g., a situation in which there is only one clear ethical option (should I steal from the company?) does not make for a strong or solid analysis. Paper Details: 1. Writing counts. A portion of your grade will be based on your ability to write clearly, language, grammar and spelling. If this is a problem area for you, consider using The Learning Center at Rutgers. 2. Length: 3-4 pages, 12 point Times New Roman (or similar) font, 1 inch margins with double spacing. Because this is a short paper, use your space efficiently. One mistake students often make is spending too much time/space describing the details of the situation, and not enough concentration on the analysis of the situation. HINT: Remember, this paper is like a “final exam” – i.e., I expect you to actively demonstrate that you have mastered the core concepts from the class and can apply some of the articles and theories we have discussed into your arguments. Make that your focus.
  • 2. 3. Caution: While this is not a research paper, and you are not required to use outside sources, you must properly cite any material you reference, including assigned course readings, any other material I have provided you, and any information that you find on your own (e.g., if you look up a definition, a statistic or a fact online). Failure to cite = plagiarism. Plagiarism is a violation of the academic integrity policy, and all violations will be reported to the Dean of Student Affairs. Consequences for first-time violations can range from a 0 on the paper to an F for the class. 4. Due: Must be uploaded to BB by 6:00 p.m. on Wed, July 3 Presentation Details: 1. Presentation must be between 5 and 10 minutes in length, and should approximately follow the written paper in structure. You may use slides, but they are not required. If you do use slides, no more than 5 content slides. You may not read directly from your paper. The goal for this portion of the assignment is to express your ideas verbally, and therefore the presentation should contain a brief description of events and a stronger focus on your analysis and application of course readings and theories. Law, Liability, & Ethics For Medical Office Professionals Sixth Edition Chapter 1 The Big Business of Health Care and You Copyright © 2018 Cengage. All Rights Reserved.
  • 3. Copyright © 2018 Cengage. All Rights Reserved. Objectives Recognize importance of business aspect of health care industry Recognize importance of your role on frontlines of health care industry Identify different types of legal entities Identify types of managed care delivery systems Explain benefits of telemedicine Copyright © 2018 Cengage. All Rights Reserved. Introduction to the Business of Health Care (1 of 2) In 2015, the health care industry accounted for almost 18 percent of all U.S. goods and services. Know risks that can result in lawsuit or other unwanted action Copyright © 2018 Cengage. All Rights Reserved. Introduction to the Business of Health Care (2 of 2) Industry controls health care costs with competition and regulation Competition has: Led employers, governments, and health insurance companies to control escalating costs through regulation Given rise to managed care organizations
  • 4. Copyright © 2018 Cengage. All Rights Reserved. The Frontline Is You Frontline professionals communicate most frequently with patients What you know and how you conduct yourself can influence patient’s experience Copyright © 2018 Cengage. All Rights Reserved. The Importance of Legal Knowledge (1 of 3 ) Understand legal issues to avoid lawsuits and other risks Copyright © 2018 Cengage. All Rights Reserved. The Importance of Legal Knowledge (2 of 3) Medical office professionals held to higher standard of care than laypersons Physicians and nurses held to standard of care established by: State law State licensing organizations Registration boards at national or state level Copyright © 2018 Cengage. All Rights Reserved. The Importance of Legal Knowledge (3 of 3) Know the scope within which you can practice Most medical office employees: Are not licensed to practice medicine Must carry out responsibilities without making medical
  • 5. decisions or acting outside area of expertise Copyright © 2018 Cengage. All Rights Reserved. Personal Protection (1 of 3) Ignorance of a law/regulation does not excuse violation Know laws and regulations that govern profession Understand basic principles of law to protect from: Needless litigation Loss of reputation, personal wealth, or earning power Copyright © 2018 Cengage. All Rights Reserved. Personal Protection (2 of 3) Reasonable standard of care is conducting ourselves in a responsible manner that will not cause harm Physicians, nurses, and other health care professionals held to higher standard of care Violations can lead to: Medical malpractice lawsuits Certificate or license revocations Criminal charges (extreme cases) For medical assistants, required standard of care is difficult to predict Copyright © 2018 Cengage. All Rights Reserved. Personal Protection (3 of 3) Medical office professionals are link between patient and physician
  • 6. Positive patient interactions minimize nonmedical and nonlegal variables May prevent legitimate complaint from developing into lawsuit Copyright © 2018 Cengage. All Rights Reserved. Patient Protection (1 of 2) Patients trust they are being treated by qualified health care professionals State licensure laws define education and experience required to perform certain procedures A license indicates that holder has basic minimum qualifications required by state for the occupation Copyright © 2018 Cengage. All Rights Reserved. Patient Protection (2 of 2) Privacy and confidentiality have ethical and legal bases Requirements of privacy and respect for confidentiality must be met Copyright © 2018 Cengage. All Rights Reserved. HIPAA Federal law Requires every health plan and provider maintain “reasonable and appropriate” safeguards to ensure health information confidentiality
  • 7. Copyright © 2018 Cengage. All Rights Reserved. Patient Bill of Rights (1 of 2) Patient Bill of Rights: Conveys patients’ legal and ethical rights Includes acknowledgment of patient’s right to choose treatment, to consent to treatment, and to refuse treatment Not always required by law Establishes standards, including ethical standards, for patient care Copyright © 2018 Cengage. All Rights Reserved. Patient Bill of Rights (2 of 2) Some rights that may be included: To be treated with courtesy and respect in an environment free from discrimination To be treated confidentially, with access to your records limited to those involved in your care or otherwise authorized by you To be informed by your health care provider about your diagnosis, scheduled course of treatment, alternative treatment, risks, and prognosis To refuse medical treatment, even if your physician recommends it To be informed about the outcomes of care, treatment, and services that have been provided, including unanticipated outcomes To be informed if medical treatment is for experimental research and to give your consent or refusal to participate Copyright © 2018 Cengage. All Rights Reserved.
  • 8. Respondeat Superior Physicians and corporate employers are liable for their own conduct Physicians and corporate employers are vicariously liable for their employees’ conduct while working within scope of employment Copyright © 2018 Cengage. All Rights Reserved. The Business Structure: Legal Entities A business is a commercial/industrial establishment Sole Proprietorship: Single physician, therapist, other licensed health care professional Partnership: Two or more people who combine their work, money, and talents Corporation: Group of people band together and create an artificial being/entity Copyright © 2018 Cengage. All Rights Reserved. Health Care Delivery and Compensation Systems Health Maintenance Organization (HMO) With prepaid group practice (PGP) and individual practice association (IPA) Preferred Provider Organization (PPO) Associations of physicians and hospitals (providers) that contract with employers, insurance companies, or third-party administrators to provide comprehensive medical services on a fee-for-service basis to subscribers
  • 9. Copyright © 2018 Cengage. All Rights Reserved. Managed Care Term describes system of integration of financing and delivery of health care to provide comprehensive services to an identified segment of the population Copyright © 2018 Cengage. All Rights Reserved. Types of Managed Care Organizations HMO POS EPO PPO Copyright © 2018 Cengage. All Rights Reserved. Telemedicine Patient is in one location and the treating physician is in another Use of video and transmission of data to the remote physician from the patient Copyright © 2018 Cengage. All Rights Reserved. Law, Liability, & Ethics For Medical Office Professionals
  • 10. Sixth Edition Chapter 3 From the Constitution to the Courtroom Copyright © 2018 Cengage. All Rights Reserved. Copyright © 2018 Cengage. All Rights Reserved. Objectives (1 of 2) Differentiate between federal and state law Differentiate between origins of statutory, administrative, and common law Understand what makes up a federalist government Identify steps necessary for passage of federal and state legislation Distinguish between appellate paths of federal judicial system and state judicial system Copyright © 2018 Cengage. All Rights Reserved. Objectives (2 of 2) Identify three administrative law agencies involved in regulation of medical office Identify parties to a lawsuit Explain basic trial procedures Identify stages of an appeal Demonstrate techniques that aid in being a good witness
  • 11. Copyright © 2018 Cengage. All Rights Reserved. It All Starts with the Constitution Constitution determines if state or federal law is applicable Constitution is comprised of: Preamble The Articles The Amendments Amendments 1–10 = The Bill of Rights Copyright © 2018 Cengage. All Rights Reserved. The Constitution Supremacy Clause Supreme law of the land Enumerated Powers Federal government’s powers The Interstate Commerce Clause Act of commerce involves more than one state Copyright © 2018 Cengage. All Rights Reserved. Three Branches of Government Executive Branch President Congress 435 Representatives 100 Senators The Judiciary
  • 12. Copyright © 2018 Cengage. All Rights Reserved. Health Care: Federal or State Law? Mix of federal and state law Federalism and federal government’s role in health care regulation Now federal and state law intertwined Copyright © 2018 Cengage. All Rights Reserved. Administrative Law Administrative agencies perform: Rule making Adjudication Prosecution Advising Supervision Investigation Copyright © 2018 Cengage. All Rights Reserved. Common Law Distinguished from statutory law in that it is made up of a body of principles and rules that are common to entire population Copyright © 2018 Cengage. All Rights Reserved. The Distinction Between Criminal and Civil Law Criminal
  • 13. State or federal government is plaintiff Person charged with crime is defendant Civil Typically plaintiffs and defendants are private citizens or companies Copyright © 2018 Cengage. All Rights Reserved. Into the Courtroom What might happen if : You are named as a party in a lawsuit Called as a witness at trial Copyright © 2018 Cengage. All Rights Reserved. Medical Malpractice Phases Phase I is the time period when the alleged negligence occurs Phase II begins when patient seeks advice of an attorney concerning harm allegedly done Phase III is a means of settling a dispute between two parties before a judge or a jury Phase IV is when either side has right to appeal decision Copyright © 2018 Cengage. All Rights Reserved. Medical Malpractice: Phase I Patient becomes aware of injury or that something is not quite right and complains to provider Insurance companies require filing of an incident report Anger becomes a problem
  • 14. If physician is unable to smooth over incident, a medical assistant or other member of office staff may be able to dissipate anger and head off litigation Copyright © 2018 Cengage. All Rights Reserved. Medical Malpractice: Phase II Attorney will attempt to obtain a copy of medical records Insurance company, doctor, and attorney for patient may negotiate a settlement If negotiations break down, patient’s attorney files a complaint End of second phase of lawsuit comes when a pretrial conference is held Copyright © 2018 Cengage. All Rights Reserved. Medical Malpractice: Phase III Plaintiff presents facts Witnesses are ordinary people interested in telling their story Members of jury listen and make a fair decision Bench trials (—) judge serves as both judge and jury Copyright © 2018 Cengage. All Rights Reserved. Medical Malpractice: Phase IV Losing party pursues an appeal A decision can be appealed only on matters of law Means that legal principles of lower court’s decision are challenged, not facts of case
  • 15. Copyright © 2018 Cengage. All Rights Reserved. You as a Witness Pay attention Behave in a professional manner Answer question Cooperate with your attorney Honesty is the best policy Copyright © 2018 Cengage. All Rights Reserved. Art of Examination (1 of 2) Both plaintiff and defendant try to win case by interviewing own witnesses and cross-examining witnesses from opposing side A witness should be prepared for both direct examination and cross-examination Copyright © 2018 Cengage. All Rights Reserved. Art of Examination (2 of 2) In direct examination, questions are open-ended and witness is able to answer freely and in own words Burden of proof is beyond a reasonable doubt in a criminal lawsuit Copyright © 2018 Cengage. All Rights Reserved.
  • 16. STUDENT’S POST FROM MY CLASS HAVE POSTED SO FAR. (PLEASE BE CAREFUL WHICH ONE YOU CHOOSE TO COMPLETE MY ASSIGNMENT SINCE I WON’T KNOW IF THEY ARE DOING IT RIGHT OR NOT. PLEASE BASED ON THE INSTRUCTIONS FROM MY PROFESSOR GO OVER EVERYTHING AND ALL POSTS AND CHOOSE THE ONE YOU THINK IT IS BEST AND DONE CORRECTLY) ORDER FOR YOU TO CHOOSE ONLY ONE AND COMPLETE MY POST 2. (As per my professor instructions he is asking to choose a fellow student’s post and ask to provide an example along with other things the professor is requesting me to do. Please read the Discussion Board Instructions attachment) Student Name: Yesenia Castro Post 1: The Patients’ Bill of Rights
  • 17. For many years different laws in health care have been created to protect us as patients. The Patient’s Bill of Rights which sets certain ethical standards and provides proper knowledge to patients receiving medical care was initially adopted by the American Hospital Association in 1973 and revised in October 1992. For many it carries diverse expectations of the care that should be provided in a respectful and dignified manner. Setting different guarantees for patients for example: to be treated in and environment free from discrimination, to be provided an estimate of charges for medical care, a reasonably clear itemized bill, and, if needed, an explanation of the charge (Myrtle and Pardew, 2018), the patient has the right to make decisions about the plan of care before and during the course of treatment and to refuse a recommended treatment or plan of care if it is permitted by law and hospital policy. The patient also has the right to be informed of the medical consequences of this action. In case of such refusal, the patient is still entitled to appropriate care and services that the hospital provides or to be transferred to another hospital (Pecorino 2002). In conclusion all these rights have given patients the correct resources to make educated decisions about their health care needs like designating a health care surrogate or end of life
  • 18. care choices. Lastly providing accurate information and explaining all rights to patients equals better care in healthcare. References: Flight, M.R., & Pardew, W. M. (2018). Law, Liability, and Ethics for Medical Office Professionals. Boston, MA: Cengage Learning. Pecorino, P.A. (2002). The Patient’s Bill of Rights AHA. Retrieved fromhttp://www.qcc.cuny.edu/SocialSciences/ppecorino/MEDIC AL_ETHICS_TEXT/Chapter_6_Patient_Rights/Readings_The% 20P atient_Bill_of_Rights.htm Student Name: Glenda Betancourt Post 1: Business of Health Care
  • 19. The Health Care providers will support their patients and family too. This place is committed to providing quality healthcare services for patients with HIV. The services are provided without discrimination because, raze, age, religion, nationality, sex, gender identity or economic status. When the patients come to Care Resource strives to expand and help the community. We obtain care from other clinicians with primary care medical homes to seek a second opinion and specialty care. The patient gets coordinators to assist when are diagnosed with HIV, the doctor and Medical Case identify treatment supporting goals, skills with assistance, medical documentation, provide home visits to locate patient and treatment. if the patient felling sick he/she has urgent medical assistance, sometimes the patients need medicine for HIV/AIDS, Hepatitis C, or another infectious disease Care Resource helps with health care services. the most important Health care department is through education, prevention, research, treatment and support services and also the patient take a better quality of life. Student Name: Leyanis Lopez Iglesias Post 1: Benefits of Telemedicine When the inevitable happens and someone in your family get sick, there is probably as aggravating as being forced to sit for hours in an emergency room or doctor's office, then you only see him/her for a few minutes before you are hustled out the door to deal with insurance and paper work. Doctor visits are expensive, time consuming and frustrating. But if you and other colleague
  • 20. at your company could have Internet access to a nation-wide network of licensed doctors any day and save on health insurance costs. Telemedicine is a monthly subscription for medical services that would not be consistently availably in distant rural communities, it is used to save lives in critical care and emergency situations. It is a monthly subscription for routine health care services, not only does it save time and frustration waiting for a doctor in an emergency room or clinic, there is not deductible and no co- insurance which saves individuals n business lost income due to employees being away from work. Law, Liability, & Ethics For Medical Office Professionals Sixth Edition Chapter 2 Laws and Regulations You Will Encounter Copyright © 2018 Cengage. All Rights Reserved. Copyright © 2018 Cengage. All Rights Reserved. Objectives (1 of 2) Recognize complexity of government influence on practice and licensing of medicine
  • 21. Describe importance of understanding basic employment, discrimination, and harassment laws when hiring, promoting, and terminating employees Identify provisions of Family and Medical Leave Act Recognize situations affected by Americans with Disabilities Act (ADA) Identify four social security benefits Copyright © 2018 Cengage. All Rights Reserved. Objectives (2 of 2) Recognize differences between Medicare and Medicaid Define Employee Retirement Income Security Act (ERISA) Recognize importance of Occupational Safety and Health Act (OSHA) regulations Define job descriptions, procedures, manuals, and employee handbooks Describe basic collection protocol Copyright © 2018 Cengage. All Rights Reserved. Introduction to Health Care Laws, Regulations, and Business Protocols As a medical office professional, you will want to be aware of: Medical practice laws and regulations The nature of your employment Discrimination Sexual harassment Health care laws and regulations Union membership and collective bargaining.
  • 22. Copyright © 2018 Cengage. All Rights Reserved. Government Regulation of Health Care Providers (1 of 2) Medical practice laws control practice of medicine State legislatures establish state medical boards with authority to control health care provider licensing Copyright © 2018 Cengage. All Rights Reserved. Government Regulation of Health Care Providers (2 of 2) Licensing boards grant, renew, and revoke licenses Physicians to submit reports under certain circumstances. Child and elder abuse Controlled substances acts restrict distribution, classification, sale, and use of certain drugs Copyright © 2018 Cengage. All Rights Reserved. Employment Law (1 of 3) Discrimination law does not allow employers to ask questions concerning, race, religion, age, or whether a woman is pregnant Pre employment testing ensures that tests will only measure skills and abilities necessary to do job Drug testing is necessary to ensure public’s safety Equal Opportunity Employment prohibits employment based on race, color, religion, sex, or national origin Copyright © 2018 Cengage. All Rights Reserved.
  • 23. Employment Law (2 of 3) Drug Testing Employers allowed to test potential employees as part of hiring process EEOC administers and enforces Title VII of the Civil Rights Act of 1964 Copyright © 2018 Cengage. All Rights Reserved. Employment Law (3 of 3) Disparate Treatment does not allow employers to treat employees differently because of their race, sex, religion, or national origin Disparate Impact ensures that employers do not treat employees differently in an “adverse” manner on a particular protected group For example, a minimum height requirement may discriminate against women Copyright © 2018 Cengage. All Rights Reserved. FMLA The Family and Medical Leave Act of 1993 (FMLA) requires employers of 50 or more to provide up to 12 weeks of unpaid leave each year for “serious health condition” of an employee or member of employee’s immediate family or for birth or adoption of a child Copyright © 2018 Cengage. All Rights Reserved.
  • 24. ADA The Americans with Disabilities Act (ADA) covers physical as well as mental disabilities in employment, public services, public accommodations, and telecommunications Copyright © 2018 Cengage. All Rights Reserved. Federal Age Discrimination Act The Federal Age Discrimination in Employment Act of 1967 (FADA) covers age discrimination and protects rights of older workers Copyright © 2018 Cengage. All Rights Reserved. Equal Pay Act The Act was passed in 1963 to end the practice of paying women less than men for the same job Copyright © 2018 Cengage. All Rights Reserved. Fair Labor Standards Act The Fair Labor Standards Act (FLSA) establishes federal minimum wage, mandates extra pay for overtime work, and regulates the employment of children Copyright © 2018 Cengage. All Rights Reserved. Workers’ Compensation
  • 25. Workers’ compensation laws are administered by state governments and create a mandatory insurance system that reimburses employees for losses sustained because of work- related injury or disease, regardless of fault. Copyright © 2018 Cengage. All Rights Reserved. Social Security (1 of 2) Social security (Ss) include several different but related programs: Retirement An individual becomes eligible for retirement benefits at the age 62 Retirement benefits require a total of 40 quarters or 10 years of work credit from covered employment Disability Benefits are paid to individuals who are disabled Any medical condition that prevents an individual from being gainfully employed may be considered a disability Copyright © 2018 Cengage. All Rights Reserved. Social Security (2 of 2) Dependent’s/Survivor’s Benefits Certain dependents of a retired or disabled worker are eligible for monthly benefits if worker is eligible for retirement or disability benefits Surviving family members of a deceased worker may be entitled to survivor’s benefits
  • 26. Copyright © 2018 Cengage. All Rights Reserved. Medicare Medicare is a federal insurance program for people who are entitled to Medicare from their social security contributions and payment of premiums Copyright © 2018 Cengage. All Rights Reserved. Medicaid Medicaid is a program jointly administered by federal government and state government for low-income individuals obtainable through social services or welfare departments Copyright © 2018 Cengage. All Rights Reserved. Employee Retirement Income Security Act (ERISA) Protects and regulates pensions Copyright © 2018 Cengage. All Rights Reserved. Health Insurance Portability and Accountability Act of 1996 (HIPAA) Guarantees renewal and transferability of health insurance coverage to those already with coverage and to their dependents Copyright © 2018 Cengage. All Rights Reserved.
  • 27. HITECH Act The Health Information Technology for Economic and Clinical Health Act (HITECH) encourages and requires use of various methods of health care technology with improved health care as objective Copyright © 2018 Cengage. All Rights Reserved. Occupational Safety and Health Act (OSHA) OSHA rules and regulations are intended to prevent injuries and promote job safety OSHA is authorized to enforce standards through: Complaint Inspection Investigation Copyright © 2018 Cengage. All Rights Reserved. Unions and Health Care Workers In 1919, American Federation of Labor organized engine room, laundry, and dietary employees; nurse’s aides; and orderlies in three San Francisco hospitals American Nurses’ Association (ANA) supports collective bargaining Copyright © 2018 Cengage. All Rights Reserved. Working Conditions Every position in an office should have a job description divided into two parts:
  • 28. Responsibilities of each employee Listing of tasks to be performed by each employee Copyright © 2018 Cengage. All Rights Reserved. Procedure Manuals and Handbooks Procedures Manual describe in detail the manner in which a task in job description should be carried out Handbooks provide personnel policies and related instructions Copyright © 2018 Cengage. All Rights Reserved. Collections Steps Notification Contact individual Determine if there is a valid reason for failure to pay Discuss alternative payment schedule Copyright © 2018 Cengage. All Rights Reserved. PLEASE SEE BELOW THE UNIT I OVERVIEW THAT MY PROFESSOR SENT TO ME. THIS MAYBE MIGHT BE USEFUL FOR YOU
  • 29. Chapter 1 Chapter 1 covers a lot of ground and sets the stage for the rest of the text. The premise of this text is that the health care industry is a big business and what medical office professionals do on the frontline matters. This chapter also features discussion of the standard of care for medical professionals and laypersons and what it means to be a medical assistant. Technical aspects of the law are useful for medical office professionals so they can understand the business aspects of working in a medical office. That is why this chapter includes discussion of the several types of legal entities, such as corporations, limited liability companies, and sole proprietorships, among others. Another foundational issue is managed care organizations (MCOs), including HMOs, PPOs, and ACOs. It will be necessary for you to be familiar with the many facets of MCOs, including the focused objectives of reducing costs and delivering quality health care. And, finally, this chapter features a discussion about telemedicine as an alternative health care delivery system that has become increasingly commonplace. The use of
  • 30. telemedicine is still in its infancy, but it has the potential to dramatically change the practice of medicine. These resources are provided for additional information about select topics: • Legal entities: U.S. Small Business Administration. (n.d.). Choosing your business structure. In Starting & managing. Retrieved from 33TUhttps://www.sba.gov/starting-business/choose-your- business-structureU33T • Managed care organizations: U.S. Centers for Medicare & Medicaid Services. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more. In How to pick a health insurance plan. Retrieved from 33Thttps://www.healthcare.gov/choose-a-plan/plan-types/33T American Telemedicine Association. Retrieved from 33Thttp://www.americantelemed.org/home33T Chapter 2 This chapter also addresses sexual harassment, a serious problem in the workforce. Other issues discussed in this chapter are workers’ compensation and social security, which affect every employer and employee. The chapter also explains that Medicare and
  • 31. Medicaid are government-sponsored health care delivery and compensation systems. And, finally, this chapter makes clear that procedures manuals, job descriptions, and employee handbooks are all part of the business side of a medical practice, as are laws affecting collection procedures. These resources are provided for additional information about select topics: • Sexual harassment: U.S. Equal Opportunity Employment Commission. (n.d.). Sexual harassment. In Laws, rules, & regulations. Retrieved from 33Thttps://www.eeoc.gov/laws/types/sexual_harassment.cfm33T • ADA Amendments Act of 2008. Retrieved from 33Thttps://www.eeoc.gov/laws/statutes/adaaa.cfm33T • OSHA. Retrieved from 33Thttps://www.osha.gov/33T • Social Security. Retrieved from 33Thttps://www.ssa.gov/33T • Medicare. Retrieved from 33Thttps://www.medicare.gov/ • Medicaid. Retrieved from 33Thttps://www.medicaid.gov/
  • 32. Chapter 3 All laws in the United States flow from the Constitution. This chapter explains the basis for a federalist system of government: the federal government concurrently existing with state government. The discussion of the Constitution includes the Supremacy Clause, which tells us that federal law will govern if there is a conflict between federal and state law. Also explained in this chapter is the federal government’s division into three branches: the executive, the legislative, and the judiciary. The judicial branch of law, both in the federal and state governments, is responsible for settling legal disputes. Each lawsuit that does go to trial follows certain phases of development. From the time the alleged negligence occurs to the time the case goes to trial, both sides are involved in discovery, which is a form of legal investigation. You will learn that the outcome of the investigation may be to decide that there is no case, to settle, or to take the matter to a judge or a judge and jury. This chapter discusses that, after a case has been tried, either side may appeal. And, finally, this chapter discusses that an individual who is a party or a witness in a trial undertakes extensive preparation.
  • 33. These resources are provided for additional information about select topics: • Constitution. Retrieved from 33Thttps://www.archives.gov/founding-docs/constitution33T • Supreme Court. Retrieved from 33Thttps://www.supremecourt.gov/33T *** PLEASE SEE BELOW EMAIL MY PROFESSOR SENT TO ALL OF US SPECIFIYING AND WITH MORE INSTRUCTIONS ON HOW HE WANTS THE DISCUSSIONS TO BE COMPLETED *****Please DO NOT post attachments on the discussion boards. ******* If your posts & papers look like this you are on the way to success on all assignments. If they don’t that is the reasoning behind lost points. SAMPLE PAPER/Discussion POST with CITATIONS and REFERENCES (3-4 paragraphs recommended for initial post and second/follow ups) 1-2 sentence posts would not qualify. ease DO NOT pchments on the discussion boards.
  • 34. Post in depth (3-4 paragraph) APA cited posts with in text/reference list (Quality is key); vs. avoid posting five (5) or six (6) one sentence posts without APA format/citing (Quantity is bad) (APPLY THE BOOK, CITING (IN TEXT AND REFERENCE LIST) AND PARAPHRASES AS WELL AS THE RESEARCH) For help with citing use www.citationmachine.net AND http://owl.english.purdue.edu/owl/resource/560/01/ NOTE I ONLY LOOK FOR 4 APA Items with DB's 1) In text citing, 2) Headings, 3) Reference list 4) Indenting paragraphs and expand in depth http://www.citationmachine.net/ http://owl.english.purdue.edu/owl/resource/560/01/ EXAMPLE Discussion POST BELOW: (For format and depth) Criminology Throughout time, criminologists began to ask complex social questions about the nature of crime and criminals. Many of
  • 35. the queries centered around the behavior of criminals, rather than on the criminality of behavior. There has been interest generated which has focused more upon accounting for the factors and influences which lead to criminal law violations and the behavior of offenders rather than it has upon the lawmaking processes through which criminal prohibitions are produced. Contemporary views There is no single theoretical position on crime causation that can be identified as the liberal perspective. There are many ways in which contemporary criminological theories can be classified. Contemporary views regarding deviance represent distinctive studies from Emile Durkheim (1858-1917). French sociologist Emile Durkheim was responsible for two seminal themes on crime and deviance. According to Goode (2005), he was one of the first to insist on the “normality” of criminality. Durkheim maintained that the “normal” and “pathological” are not intrinsically different forms of behavior. Durkheim asserted that it is neither possible nor desirable for a society to repress criminality completely. His second and possibly most important contribution to the study of deviant
  • 36. behavior is in the theory of anomie, which was originally developed as an explanation of suicide (Vold, Bernard and Snipes, 2002). When traditional rules have lost their authority over behavior, a state of deregulation, normalness, or anomie may exist. Signs of violence The criminal serves as an identifying sign of the limits of permissible behavior. If these violations of normative sentiments could be repressed, both men and women would become sensitive to the less marked deviations which are now overlooked, and these acts would then be regarded as crimes (Schmalleger, 2007). These increasingly intolerable demands for conformity, which would then possibly be imposed on individuals, not thought of as criminals, would be detrimental to social progress. References Goode, E. (2005). Deviant behavior. Upper Saddle River, NJ: Prentice Hall. Schmalleger, F. (2007). Criminal justice today: An introductory text for the 21
  • 37. st century. (9 th Ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Vold, G., Bernard, T., & Snipes, J.B. (2002). Theoretical criminology. New York: Oxford University Press. EXAMPLE/SAMPLE POST: How should my posts/papers look? DISCUSSION BOARD INSTRUCTIONS Discussion Board Posts Two posts due per week, for a total of FOUR posts per unit. Very important component of our course and worth 50% of your final grade. That's right, HALF of your final grade will come from the discussion board activity, so do not disregard the importance of this assignment. Our units are two weeks long. You must log in and participate at least twice per week (i.e. four times per unit). This is how your attendance and participation will be measured.
  • 38. Weeks start on Sunday and end on the following Sunday. Assignment Requirements: Discuss it thoroughly. It must be between 150 to 250 words. Do not exceed the word count, but do not fall short of the 150 word requirement.This post must be in your own words. Any instances of copied material from ANY source will result in an automatic zero for the offense and an F in the course for the second one, plus a permanent notation in your academic record, which will seriously affect any future employment prospects where background checks are conducted (which in today's job market, includes every single employer). These posts are due by Sundays of Weeks I, 3, 5, and 7. example (i.e. create a "story" that applies the concept). For example, if a students discussed the rules of searching a vehicle trunk, you are to provide an example (i.e. a little story) of a police office conducting either an illegal or a legal search of a vehicle trunk. This learning process is called "application" and will enhance your critical thinking skills. This forces you to "think", not just to memorize and regurgitate material, which any circus-trained monkey can do. The goal is to prepare you for the real
  • 39. world, which will expect you to think independently. If you are ready to submit your second post, but there are insufficient initial posts for you to choose one, then you can pick a topic from the reading assignments and simply provide an example (i.e. an example/story) for that topic. There is no word count for these posts. These posts are due by Sundays of weeks 2, 4, 6, and 8 (Week 8 ends on a Wednesday, not on Sunday) assignment and explain it thoroughly, the same as "Post 1" Let me further clarify: you will repeat the process twice during the two-week unit. Posts 1 and 2 are during the first week of the unit and posts three and four are due during the second week of the unit. However, I will not be deducting points for failing to meet these deadlines during Unit I, as I understand there are textbook issues and scheduling issues which can cause delays. As long as you submit four posts by the end of Unit I, then you will be fine. However, all deadlines will be strictly enforced for Units II, III, and IV. Grading Criteria:
  • 40. Detail of discussion. Accuracy of content. Label the subject line of your post: Post 1 or Post 3 content application. Label the subject line of your post: Post 2 or Post 4. Due Dates: 3, 5, and 7 Posts 2 and 4: Sundays of Weeks 2, 4, 6, and 8