HS Welcome to Unit 3 by Tami Ford, M.A.

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Instructor Information Tami Ford, M.A. Adjunct Faculty School of Health Sciences Kaplan University AIM: InstructorTami Find me on Facebook via Kaplan at Instructor Tami Ford

Unit 3 Outcomes Differentiate between laws, regulations, rules, requirements, and standards. Understand the roles of governmental entities in healthcare. Describe liability. Explain confidentiality and privacy and their relationship. Discuss the ownership of health information and its disclosure. Define informed consent and explore its relationship to advance directives and living wills. Discuss the differences between a court order for health information and a subpoena. Understand fraud and abuse and the fight to combat it.

Are there any questions so far?

Nongovernmental Entities in Health Care Used to establish standard levels of care; in medical malpractice or licensing hearings. Joint Commission (JC) American Osteopathic Association (AOA) Healthcare Facilities Accreditation Program (HFAP) Approved by Center for Medicare and Medicaid Services (CMS) as deeming authorities. Which others? (McWay, 2008, p. 47)

Role Application “Laws, regulations, and accrediting standards define the content of the patient’s health record” and “Health record content refers to the characteristics essential to constitute an adequate health record” (McWay, 2008, p. 48). “Completeness means to be entire, or lacking in nothing” and “it is measured against the laws, regulations, and standards defining the health record” (McWay, 2008, p. 48). “Record retention policies are the general principles determining the length of time that health records must be maintained by the health care provider” and “statutes, regulations, and standards establish specific time frames” (McWay, 2008, p. 49).

Living Wills & Durable Powers of Attorney “A living will is a written document that provides direction as to medical care in the event that the patient becomes incapacitated or unable to make personal decisions” (McWay, 2008, p. 65). “A durable power of attorney for health care is a written document in which the patient names someone else (the proxy) to make health care decisions on the patient’s behalf if he is later unable to do so” (McWay, 2008, pp ). How are these the same? Different?

Fraud & Abuse “Fraud refers to the intentional deception of another person to that person’s detriment” (McWay, 2008, p. 66). “Abuse refers to a pattern of practices or customs that are unsound or inconsistent with ethical business, fiscal, or health care practices or customs” (McWay, 2008, p. 66). What are of particular importance to the HIM profession? Fraudulent documentation Coding Billing –Upcoding and unbundling (McWay, 2008).

Resources to Combat Fraud & Abuse “Compliance program is a program that ensures the use of effective internal controls that promote adherence to applicable local, state, and federal laws and regulations and the program requirements of federal, state, and private health plans” (McWay, 2008, p. 69). “Corporate integrity agreement (CIA) is a written agreement that specifies the rules of conduct to be followed to remedy the fraud and abuse found, plus any monitoring and reporting requirements” (McWay, 2008, p. 69). How are these two different?

Intentional Torts These refer to civil wrongs committed by persons with the intent to do something: Examples: Assault Battery Defamation Invasion of Privacy Medical Abandonment False Imprisonment (McWay, 2008).

Nonintentional Torts Those that lack the intent to do something wrong; Examples Negligence Malpractice Res ipsa loquitur Respondent superior Corporate negligence Failure to warn (McWay, 2008).

Medical Records Use for legal purpose include: 1.To establish the applicable standard of care 2.As evidence in civil cases 3.As evidence involving the credentialing process 4.For disciplinary proceedings for health care professionals 5.To establish the cause of death 6.To determine blood alcohol content 7.To support an insanity defense 8.As proof of a party’s physical condition (McWay, 2008).

Confidentiality & Privacy “Confidentiality refers to the obligation of the health care provider to maintain patient information in a manner that will not permit dissemination beyond the health care provider” (McWay, 2008, p. 59). “Privacy…the right to be left alone; it is also defined as the right to control personal information” (McWay, 2008, p. 59).

Informed Consent “Defined as the communication of definite knowledge of an event or fact to the patient so that she/he may voluntarily agree to, or forgo treatment” (McWay, 2008, p. 64).

Judicial Process “Subpoena is a command issued by a court or other authorized official to appear or present certain documents and other items” (McWay, 2008, p. 65). Situation: How should a HIM respond to a subpoena regarding the release of requested record or information? Reference: McWay, D.C. (2008). Today’s health information management: An integrated approach. Clifton Park, NY: Delmar Cengage Learning.

Questions? Thank you and good night Questions? Thank you and good night