Medical Ethics, Law and compliance Chapter 2 © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Learning outcomes: When you finish this chapter you will be able to 2.1 Define medical ethics, bioethics, and etiquette 2.2 Discuss medical law and legal documents, such as advance directives, and give three examples 2.3 Identify and discuss several key components of the HIPAA Administrative Simplification Rule 2.4 State the purpose of a medical compliance plan and explain compliant methods the assistant can use to safeguard against litigation © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Key terms abandonment defensive medicine arbitration deposition assault durable power of attorney authorization ethics battery etiquette bioethics express consent compliance fraud contributory negligence Good Samaritan Act Health Insurance Portability Act (HIPAA) medical practice acts summons implied consent registration informed consent release of information liability settlement licensure statute of limitations litigation subpoena malpractice subpoena duces tecum Teaching Strategies: © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Chapter 2 Key terms abandonment --Unless the patient is discharged in an appropriate way, either because the treatment was completed or because the physician followed the procedure for termination, the patient may sue the physician arbitration --helps both sides resolve the dispute or makes a decision if the two sides cannot agree assault --clear threat of injury to another authorization authorization -- medical office follows a procedure to make sure that the party asking for the data has the right to receive it and that proper authorization to release the information has been granted © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Key terms (continued) battery -- any bodily contact without permission bioethics -- ethical issues involved with medical treatments, procedures, and technology compliance -- adherence to rules and regulations contributory negligence –refusal to have tests, x-rays, or vaccinations or a patient’s failure to follow the physician’s instructions © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Key terms (continued) defensive medicine -- those practices of the physician designed to help him or her to avoid incurring law suits deposition -- sworn statement to the court before any trial begins, and usually made outside of court durable power of attorney -- gives someone else, of the patient’s choosing, the right to make decisions for the patient ethics –the standards of conduct that grow out of one’s understanding of right or wrong © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Key terms (continued) etiquette -- behaviors and customs that are standards for what is considered good manners express consent -- written consent by signing a special consent form before any special procedure is performed fraud -- intentionally dishonest practice that deprives others of their rights Good Samaritan Act -- a law designed to protect the physician from liability for civil damages that may arise as a result of providing emergency care © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Key terms (continued) Health Insurance Portability and Accountability Act (HIPAA) -- regulates how electronic patient information is stored and shared implied consent -- consent given by actions instead of words informed consent -- that the patient has had the illness or problem explained by the physician in simple, understandable language © 2012 The McGraw-Hill Companies, Inc. All rights reserved

key terms (continued) liability -- legal responsibility licensure -- license to practice medicine litigation -- bringing of lawsuits malpractice -- improper care or treatment of a patient by a physician, hospital, or other provider of health care as a result of carelessness, neglect, lack of professional skill, or disregard for the established rules or procedures © 2012 The McGraw-Hill Companies, Inc. All rights reserved

key terms (continued) medical practice acts -- the practice of medicine within its borders through laws registration–permit release of information -- written permission is in the form of an authorization settlement -- reach an agreement and the case does not go to court © 2012 The McGraw-Hill Companies, Inc. All rights reserved

key terms (continued) statute of limitations -- a time limit for initiating litigation subpoena -- an order of the court directing a party to appear and testify subpoena duces tecum -- to appear, to testify, and to bring specified documents or items summons -- a written notice © 2012 The McGraw-Hill Companies, Inc. All rights reserved

2.1 Define medical ethics, bioethics, and etiquette Principles of Medical Ethics Bioethics Etiquette 2.1 Ethics The medical ethics that govern the health care professions are usually found in written policies or codes for each profession. These standards are not laws. A person acting within the law may nevertheless do something that is not ethical. A person may also do something right, or ethical, while breaking the law. Ethics are statements of right and wrong behaviors that hold members of the profession to a high degree of behavior it is an understand of right or wrong; Bioethics The area of bioethics deals with the ethics of medical treatment, technology, and procedure. Advances in the sciences, rapid developments in technology, and new kinds of treatment have dramatically increased the number of bioethical issues and questions. Etiquette is defined as those behaviors and customs that are standards for what is considered good manners. It involves following medical manners and customs, such as using proper form of address for the physician, greeting cheerfully all visitors to the office, and using good telephone techniques. © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Advance directives include: 2.2 Discuss medical law and legal documents, such as advance directives Advance directives include: DNRs (Do Not Resuscitate) living wills medical durable power of attorney (DPA) 2.2 Advance directives are legal documents prepared in advance by the patient, stating the patient’s wishes for receiving or not receiving certain medical care, should the patient be unable to make decisions at that time. Advance directives give the medical team specific directions as to the type of care to render. When a patient does not want to be resuscitated, a DNR (Do Not Resuscitate) should be executed and on file with the medical office. A living will states whether the patient wants medical personnel to administer or sustain life by artificial means, such as life support measures A medical DPA gives another individual the legal right to make decisions relating to a patient’s medical issues such long-term care © 2012 The McGraw-Hill Companies, Inc. All rights reserved

2.3 Identify and discuss several key components of the HIPAA Administrative Rule. HIPAA Electronic Transaction and Code Set Standards Requirements HIPAA Privacy Requirements HIPAA Security Requirements 2.3 To ensure that health information is protected from misuse, a federal law, the Health Insurance Portability and Accountability Act , or HIPAA (pronounced hip-uh), regulates how electronic patient information is stored and shared. National standards for electronic formats and data content are the foundation of this requirement. HIPAA requires every provider who does business electronically to use the same health care transactions, code sets, and identifiers. The privacy requirements limit the release of patient protected health information without the patient’s knowledge and consent beyond that required for patient care The security regulations outline the maximum administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information. The security standards help safeguard confidential health information during the electronic interchange of health care transactions. © 2012 The McGraw-Hill Companies, Inc. All rights reserved

Health care clearinghouses Business associates 2.3 HIPAA (continued) Who Must Comply Health care providers Health plans Health care clearinghouses Business associates 2.3 Covered Entities. There are three categories of what are termed “covered entities”—health providers, health plans, and health care clearinghouses—that must comply with HIPAA “Health care provider” includes any person or organization who furnishes, bills, or is paid for health care in the normal course of business. Providers include, among many others, physicians, hospitals, pharmacies, nursing homes, durable medical equipment suppliers, dentists, optometrists, and chiropractors. A health plan is an individual or a group plan that provides or pays for the cost of medical care. Health care clearinghouses are companies that “translate” or “facilitate” translation of electronic transactions between the providers of health care and the health care plans. In other words, they are a “go between,” electronically formatting the provider’s claim and billing information in the HIPAA-approved electronic standards needed by the health care plan and transmitting the information to the health care plan. Business associates must also provide the covered entity satisfactory assurances that it will appropriately guard information as required by HIPAA. Examples of business associates include software vendors, lawyers, transcriptionist services, and accounting firms. © 2012 The McGraw-Hill Companies, Inc. All rights reserved

2.4 State the purpose of a medical compliance plan and explain compliant methods the assistant can use to safeguard against litigation Scope of service To prevent the submission of erroneous claims or unlawful conduct involving federal programs. 2.4 The administrative medical assistant can contribute to compliance in several ways: Entering data accurately, and documenting thoroughly Maintaining the flow of records, especially if the provider is using hardcopy patient records Reporting errors or the instances of fraudulent/abusive situations promptly © 2012 The McGraw-Hill Companies, Inc. All rights reserved

The Administrative Medical Assistant’s Role in Compliance: 2.4 State the purpose of a medical compliance plan and explain compliant methods the assistant can use to safeguard against litigation (continued) The Administrative Medical Assistant’s Role in Compliance: Accurate data entry Accurate documentation Timely filing and storing of records Prompt reporting of errors or instances of fraudulent conduct 2.4 The Administrative Medical Assistant’s Role in Compliance The potential for accusations of fraud is always present in the complex areas of patient care, billing and coding, and documentation. If fraud is detected and not reported or corrected, the reputation and legal standing of the practice are put at grave risk. The assistant has job responsibilities related to all of these areas and plays a central role in helping to ensure that the practice is in compliance. Accurate data entry. Accurate work speeds the correct payment of claims and lessens the chances of federal audit. • Accurate documentation. Good documentation reduces the chances for mistakes and provides an excellent trail if proof of corrective action is required. In addition to protecting the practice, accurate documentation contributes to improved patient care. • Timely filing and storing of records. Keeping records in good order and for an appropriate length of time can show the physician’s good faith efforts to apply the principles of compliance. • Prompt reporting of errors or instances of fraudulent conduct. The assistant has the ethical and professional responsibility to help the physician correct mistakes and investigate instances of unlawful behavior. © 2012 The McGraw-Hill Companies, Inc. All rights reserved