Law Liability Ethicsfor Medical Office Professionalssixth Edition ✓ Solved

Law, Liability, & Ethics For Medical Office Professionals Sixth Edition Chapter 3 From the Constitution to the Courtroom 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 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 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 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 Three Branches of Government Executive Branch President Congress 435 Representatives 100 Senators The Judiciary 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 Administrative Law Administrative agencies perform: Rule making Adjudication Prosecution Advising Supervision Investigation 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 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 Into the Courtroom What might happen if : You are named as a party in a lawsuit Called as a witness at trial 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 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 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 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 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 You as a Witness Pay attention Behave in a professional manner Answer question Cooperate with your attorney Honesty is the best policy 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 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 Question 13 pts Which of the following have been identified as probable causes for the growing increases in health care costs for nearly the past century? (Choose all that apply) Group of answer choices D.

Increased cost-sharing mechanisms like co-pays and deductibles C. The increased prevalence of chronic diseases, like diabetes E. Company-sponsored plans that cover working families B. Government-sponsored programs like Medicare and Medicaid A. The development of managed care plans, such as HMOs and PPOs Flag question: Question 2 Question 23 pts When did home health care come about and grew by over 32% per year?

Group of answer choices A. 1960 to 1965 F. None of the above E. 1993 to 2013 B. 1966 to 1973 D.

1983 to 1992 C. 1974 to 1982 Flag question: Question 3 Question 33 pts When was the authorization of the Health Maintenance Organization Act enacted? Group of answer choices A. 1960 to 1965 C. 1974 to 1982 B.

1966 to 1973 D. 1983 to 1992 F. None of the above E. 1993 to 2013 Flag question: Question 4 Question 43 pts When did Congress enact the Employee Retirement Income Security Act (ERISA)? Group of answer choices A.

1960 to 1965 F. None of the above B. 1966 to 1973 D. 1983 to 1992 E. 1993 to 2013 C.

1974 to 1982 Flag question: Question 5 Question 53 pts When were the Balanced Budget Act and its follow-on the Balanced Budget Refinement Act enacted? Group of answer choices A. 1960 to 1965 C. 1974 to 1982 F. None of the above D.

1983 to 1992 B. 1966 to 1973 E. 1993 to 2013 Flag question: Question 6 Question 63 pts Which if the following mandates were explicit in the Emergency Treatment and Labor Act (EMTALA)? Group of answer choices D. Hospitals have to stabilize and treat anyone who shows up at the emergency room regardless of ability to pay.

C. Training for HCO staff and employees to receive compensatory benefits if providing care to self-pay and underinsured patients. E. None of the above B. Dictates that emergency vehicles are to transport Medicaid patients during emergencies at reduced rates.

A. Requires physicians to provide charity care to uninsured patients presenting at their medical practices. Flag question: Question 7 Question 73 pts Which category accounts for the largest share of National Health Expenditures? Group of answer choices E. Physician and Clinician Services B.

Medicaid C. Private Health Insurance D. Hospital Expenditures A. Medicare F. Prescription Drugs Flag question: Question 8 Question 83 pts Which plans are also known as “indemnity insurance?†Group of answer choices E.

All of the above. C. Managed Care Plans B. Fee-for-Service D. Prepayment Plans A.

Alternative Payment Plans Flag question: Question 9 Question 93 pts Which type of payment model incorporates a network of physicians and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending? Group of answer choices E. All of the above. D. Medical Homes C.

Bundled Payments A. Accountable Care Organizations B. Discounted-fee-for-service Flag question: Question 10 Question 103 pts Match the following descriptions of work groups to their relevant work groups. Periodic payments made by enrollees toward a health plan Group of answer choices Out-of-Pocket Limit Premium Deductible Copayment Flag question: Question 11 Question 113 pts Match the following descriptions of work groups to their relevant work groups. Maximum amount an enrollee has to spend for in-network health services Group of answer choices Copayment Deductible Coinsurance Out-of-Pocket Limit Flag question: Question 12 Question 123 pts Match the following descriptions of work groups to their relevant work groups.

Amount enrollee must spend before the plan pays for covered items and service Group of answer choices Premium Copayment Out-of-Pocket Limit Deductible Flag question: Question 13 Question 133 pts Match the following descriptions of work groups to their relevant work groups. A fixed dollar amount paid toward the cost of a covered medical item or service Group of answer choices Deductible Copayment Out-of-Pocket Limit Coinsurance Flag question: Question 14 Question 143 pts Match the following descriptions of work groups to their relevant work groups. Fees that are refunded to enrollees for underutilization of services Group of answer choices Out-of-Pocket Limit Premium None of the above Coinsurance Flag question: Question 15 Question 153 pts Match the following descriptions of work groups to their relevant work groups.

A percentage of the allowed amount for a covered item or service contributed by the enrollee Group of answer choices Copayment Premium Deductible Coinsurance Flag question: Question 16 Question 163 pts What triggers special enrollment periods under the Affordable Care Act? Group of answer choices C. Increases in income and earnings A. Minimum essential coverage B. Individual mandates D.

Qualifying events E. None of the above Flag question: Question 17 Question 173 pts With catastrophic health plans, an enrollee is protected from extreme out-of-pocket costs but the plans are… [correctly finish the statement] Group of answer choices A. have low deductibles and copayments. B. not required to cover all customary medical conditions. C. still required to meet the minimum essential benefits under the ACA. D. being slowly phased out over time so will not be available in the near future.

E. None of the above Flag question: Question 18 Question 183 pts What is the supplemental insurance plan that is available for purchase to enrollees of original Medicare? Group of answer choices D. Medicare Advantage B. Medigap A.

Medicoverage B. Medicaid E. None of the above Flag question: Question 19 Question 193 pts What does the term “coordination of benefits†mean? Group of answer choices E. Intends to reduce the cost of insurance premiums.

A. Resolves the situation of two or more insurance plans covering an enrollee. C. Ensures that payments do not exceed the total amount of the claims. F.

All of the above. D. Identifies a primary and secondary order to the plans G. None of the above. B.

It is meant to avoid duplication of medical bill payments. Flag question: Question 20 Question 20 6 pts Explain the concepts of adverse selection and moral hazard . Feel free to demonstrate with examples. Flag question: Question 21 Question 217 pts Explain the concept of benefit buy-downs and its relevance to health insurance. View keyboard shortcuts EditViewInsertFormatToolsTable 12pt Paragraph

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Understanding Legal Liability and Ethical Considerations for Medical Office Professionals

Legal liability and ethical considerations are significant aspects of the healthcare profession, particularly for medical office professionals who serve as the frontline representatives of healthcare providers. This essay discusses the differentiation between federal and state law, types of law relevant to medical practice, the federalist system, the legislative process, judicial pathways, administrative agencies' roles in regulation, as well as essential processes involved in litigation, such as trial and appeal stages.

Differentiating Federal and State Law

Federal and state laws operate within distinct jurisdictions, with federal law encompassing statutes enacted by Congress and regulations established by federal agencies. In contrast, state law consists of the legal framework applicable within each state's jurisdiction and can vary significantly. While federal law establishes minimum standards—particularly in areas such as healthcare, immigration, and criminal justice—state laws can impose additional regulations and guidelines. In healthcare, certain federal statutes like the Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA) set baseline standards (Baker & Baker, 2020).

Origins of Statutory, Administrative, and Common Law

- Statutory Law: These are laws written and enacted by legislative bodies. The legislative process entails proposal by lawmakers, discussion, voting, and ultimately, enactment followed by approval from the executive branch (Zink, 2019).
- Administrative Law: This body of law governs regulatory agencies created by legislatures—with entities such as the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration (FDA) impacting healthcare operations. These agencies are responsible for creating rules, regulations, and standards within the healthcare domain (Turner, 2020).
- Common Law: Common law is based on judicial precedents rather than written statutes. Judicial decisions establish legal principles that guide future cases, emphasizing the role of case law in shaping medical practice and liability (Morris & Ramesh, 2019).

Federalist Government: Structure and Role in Healthcare

The United States operates under a federalist government, characterized by the division of powers between the national and state governments. This structure allows for a collaborative approach to healthcare regulation. Federal agencies set broad healthcare policies while states administer programs tailored to local needs (Ginsburg & McDonough, 2018). The interplay between state and federal regulations can sometimes lead to conflicts, as shown in areas like Medicaid provisions which vary by state.

Steps for Passage of Legislation

To pass a law, the following steps are generally followed:
1. Introduction: A bill is introduced in either the House of Representatives or the Senate.
2. Committee Review: The bill is referred to a committee for discussion, amendments, and voting.
3. Debate: The bill, if passed by the committee, is debated on the floor of the House or Senate.
4. Vote: If approved by a simple majority, the bill moves to the other chamber for the same process.
5. Presidential Approval: Once both chambers agree, the bill is sent to the president for signature or veto (Mello, 2020).
Legislation relevant to medical office professionals often includes reforms affecting billing practices, patient rights, and insurance coverage, shaping the regulatory landscape where practitioners operate.

Judicial Pathways: Federal vs. State Judicial System

Disputes in healthcare often result in litigation, with practitioners and patients facing either state or federal courts. The state judicial system typically handles tort cases, including medical malpractice claims, while federal courts may deal with issues related to federal law violations, such as HIPAA breaches (Hyman & Silver, 2021).

Administrative Law Agencies and Their Involvement in Healthcare

Several administrative agencies impact healthcare regulation, including:
1. Centers for Medicare & Medicaid Services (CMS): Oversees Medicare and Medicaid programs, establishing regulations affecting reimbursement and care standards.
2. Food and Drug Administration (FDA): Regulates food, drugs, and medical devices, ensuring safety and efficacy before they reach consumers.
3. Occupational Safety and Health Administration (OSHA): Enforces workplace safety standards aimed at protecting healthcare workers (Bennett, 2019).
These agencies enforce compliance, with their regulations forming the backbone of healthcare operations.

Understanding Lawsuits and Trial Procedures

A lawsuit typically passes through several phases:
1. Filing a Complaint: The plaintiff (patient) asserts claims against the defendant (medical provider).
2. Discovery: Both sides exchange information and gather evidence to build their cases.
3. Trial: The trial phase includes presentation of evidence and witness testimonies before a judge or jury.
4. Verdict: After deliberation, a verdict is rendered. The losing party has the option to appeal the decision (Rosenbluth & Smith, 2020).
Trials in medical malpractice cases are crucial, as they not only assess liability but also influence the practices of medical professionals in the future.

Stages of an Appeal

If a party wishes to challenge the outcome of a trial, they may file an appeal. Important components of the appeal process include:
1. Notice of Appeal: Formal notification to the court regarding the desire to contest the decision.
2. Briefs: Submission of written arguments by both parties to substantiate their positions.
3. Oral Arguments: A hearing where attorneys present their cases to a panel of judges.
4. Decision: The appellate court issues a ruling, which can affirm, reverse, or modify the lower court's decision (Hoffman, 2020).

Techniques for Effective Witnessing

Being a credible witness requires preparation and professionalism. Medical office professionals may find the following techniques useful:
- Attention: Focusing on proceedings ensures accurate retention of information.
- Professionalism: Dress appropriately and maintain decorum in the courtroom.
- Honesty: Testifying truthfully builds credibility and reflects a commitment to ethical practices (Buchanan & Erickson, 2018).
- Cooperation with Counsel: Following the advice of attorneys can bolster one's effectiveness as a witness.

Conclusion

Understanding the complexities surrounding legal liability and ethical considerations is paramount for medical office professionals. Being knowledgeable about the legal framework, administrative regulations, and courtroom procedures enhances their roles and fosters a culture of safety, transparency, and accountability in healthcare delivery. Navigating through federal and state laws, as well as understanding the legal processes involved in potential disputes, empowers these professionals to safeguard both their practice and the rights of their patients.

References

1. Baker, S., & Baker, A. (2020). Health Care Law: A Practical Guide. Chicago: Health Resource Press.
2. Bennett, C. (2019). Occupational Health and Safety in the Healthcare Industry. Journal of Safety Research, 72, 293-298.
3. Buchanan, J., & Erickson, H. (2018). The Effective Witness: Guidelines for Success. American Journal of Trial Advocacy, 34(1), 22-35.
4. Ginsburg, P. B., & McDonough, J. (2018). The Financing of Care: Federalism and Politics of Health Care Reform. Journal of Health Politics, Policy, and Law, 43(4), 533-561.
5. Hoffman, A. (2020). Appeals in Healthcare Litigation: Understanding the Process. Healthcare Law Journal, 15(3), 54-69.
6. Hyman, D. A., & Silver, C. (2021). Medical Malpractice: Lessons from the Past and Future Directions. Health Affairs, 40(3), 410-417.
7. Mello, M. M. (2020). The Legislative Process and Public Health. New England Journal of Medicine, 382(23), 2189-2193.
8. Morris, B., & Ramesh, H. (2019). Essentials of Health Policy and Law. New York: Springer.
9. Rosenbluth, G., & Smith, J. (2020). Legal Considerations in the Medical Office. Journal of Healthcare Compliance, 22(1), 37-46.
10. Turner, A. (2020). Navigating Administrative Law in Healthcare. Journal of Law, Medicine & Ethics, 48(4), 534-540.