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MEDICAL ETHICS, LAW, AND COMPLIANCE Chapter 2. 2 Medical Ethics, Law, and Compliance Learning Objectives Define medical ethics, bioethics, and etiquette.

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Presentation on theme: "MEDICAL ETHICS, LAW, AND COMPLIANCE Chapter 2. 2 Medical Ethics, Law, and Compliance Learning Objectives Define medical ethics, bioethics, and etiquette."— Presentation transcript:


2 2 Medical Ethics, Law, and Compliance Learning Objectives Define medical ethics, bioethics, and etiquette. State three functions of medical practice acts. Discuss the legal responsibilities of physicians. Describe the ways to ensure the proper transfer of information. State the purpose of a medical compliance plan and three ways the assistant can help the practice be compliant. List the safeguards against litigation.

3 Chapter 23 Key Terms Abandonment Arbitration Assault Authorization Battery Bioethics Compliance Contributory negligence Defensive medicine Deposition Ethics Etiquette Express consent Fraud Good Samaritan act Health Insurance Portability and Accountability Act (HIPAA) Implied consent

4 Chapter 24 Key Terms (contd) Informed consent Liability Licensure Litigation Malpractice Medical practice acts Registration Release of information Settlement Statute of limitations Subpoena Summons

5 Chapter 25 Medical Ethics Ethics are the standards of conduct that grow out of ones understanding of right and wrong Each profession usually has written policies or codes These statements of right or wrong hold members of the profession to a high degree of competency

6 Chapter 26 Medical Ethics (contd) Hippocratic Oath First statement governing the conduct of physicians AMA Code of Ethics requires physicians to Practice high standards of patient care Respect patients rights Treat patients with compassion Safeguard patient confidences

7 Chapter 27 Medical Assistants Ethical Responsibility AAMA Code of Ethics and Creed Based on AMA code Medical assistant acts as agent of physician

8 Chapter 28 Bioethics Ethics of treatment, medical technology, and procedures Spurred by advances in science, rapid development in technology, and new treatments Issues Abortion, moment of death, patients rights, genetic engineering Living will

9 Chapter 29 Moral Values Concepts of what is good Terms such as compassion, honesty, and responsibility Physician must put benefit of patient first Moral values are often contained within state laws Violence to children must be reported in many states

10 Chapter 210 Etiquette Behavior and customs that are standards for what is considered good manners or mark the courteous treatment of others Dressing appropriately Using proper forms of address Greeting visitors cheerfully Using good telephone techniques Observing the use of polite phrases Basis for good communication

11 Chapter 211 The Right to Practice States govern the practice of medicine with medical practice acts These acts Define medical practice Explain who must be licensed Set rules for obtaining a license State the duties imposed by the license State grounds for revocation List statutory reports to be sent to government These acts also protect users of health care services

12 Chapter 212 Medical Law Licensure granted by each state Educational requirements Examinations Reciprocity Endorsement through National Board of Medical Examiners Relicensure (annually or every other year) Continuing education requirements

13 Chapter 213 Medical Law (contd) Certified Specialization American Board of Specialties Board Certified Additional academic in-hospital training as a resident Comprehensive certification examination

14 Chapter 214 Medical Law (contd) Narcotics Registration Enables physicians to write drug prescriptions DEA permit Renewed annually

15 Chapter 215 The Physicians Practice Contractual relationship Implied or express contract Physician is legally required to Possess the skill/learning held by a reputable physician Act for the benefit of the patient Preserve confidentiality Act in good faith Perform to the best of his/her ability Advise against unwise or unnecessary treatment Advise when condition is beyond scope of his/her competency

16 Chapter 216 The Physicians Practice (contd) Physician is not legally required to Accept all who seek his/her services Restore patients to condition prior to illness Obtain recovery for all patients Guarantee successful results Know all possible reactions of patients to various medicines Be free from errors in complex cases Possess the maximum amount of education Continue care after patient discharges him/herself

17 Chapter 217 Patients Responsibilities Give necessary information to allow for correct diagnosis Follow the physicians instructions and treatment Generally cooperate with physician Pay for all services rendered

18 Chapter 218 Consent Implied consent Not stated outright Routine treatment only Express consent Oral or written Persons incapable of giving consent may be treated in an emergency

19 Chapter 219 Consent (contd) Informed consent Illness or problem has been explained in understandable language Options for treatment, along with their benefits and risks, have been explained Physicians prognosis is clearly stated

20 Chapter 220 Consent (contd) Competent to give consent Legal age and of sound mind Parents give consent for children Some minors (for example, in military service or if married or divorced) may give consent in certain cases Pregnancy tests and prenatal care Diagnosis and treatment of sexually transmitted diseases Diagnosis and treatment of alcohol or drug abuse

21 Chapter 221 Medical Liability Legal responsibility for actions or nonactions and their consequences Responsible for patients Responsible for Safety of employees Safety of premises Defensive medicine

22 Chapter 222 Malpractice Improper care or treatment of a patient Despite vigilance on part of physician Accidents can happen during treatment Patients can become dissatisfied with care Patient may file lawsuit to prove injury

23 Chapter 223 Termination by Physician End of the physician/patient relationship Usually due to patients stated intention to go to another physician, OR Patient does not follow treatment instructions Patient fails to pay for services rendered Physician must notify patient in writing Allow enough time for patient to obtain a new provider

24 Chapter 224 Abandonment Opposite of termination Physician does not continue to treat or follow up with patient Good documentation Essential to prove that the physician did not abandon the patient

25 Chapter 225 Assault and Battery Assault is the clear threat of injury Battery is bodily contact without permission Procedures done without consent Procedures beyond the scope of consent Physician acting in a grave emergency

26 Chapter 226 Fraud Intentionally dishonest practice that deprives others of their rights Falsifying qualifications or licensure False statement about the benefits of a drug or treatment Filing false insurance claims Penalties vary by state License can be revoked

27 Chapter 227 Litigation Bringing of lawsuits against the physician Steps in litigation Summons is sent to person being sued (defendant) Subpoena orders all documentation relevant to case be delivered to the courts Deposition (sworn statement) is made outside of court

28 Chapter 228 Response to Litigation Accurate documentation is critical Contributory negligence by patient Documentation to show that patient refused tests, did not follow treatment, etc. Alternatives to trial Settlement between plaintiff (patient) and physicians insurance company Arbitration by a neutral third party Statute of limitations Sets time limit for initiating a lawsuit Varies by state

29 Chapter 229 Good Samaritan Act Protects physician from liability for civil damages resulting from providing emergency care Minor variations by state

30 Chapter 230 Medical Communications Final privacy rule Federal law that requires patients to give consent to share information needed to carry out treatment or to submit insurance claims Patients must also provide authorization for specific items not covered by general consent

31 Chapter 231 Medical Communications (contd) Release of Information Form Written form Must contain Name of facility releasing information Name of facility requesting information Patients name, address, and date of birth Specific dates of treatment Description of information to be released Signature of patient (or parent/guardian) Date signed

32 Chapter 232 Confidentiality To help ensure confidentiality Avoid speaking about patients treatments, records, finances, etc. Never leave messages, other than requests for call backs, on answering machines Keep documents from view; shred documents Keep computerized documents secure

33 Chapter 233 Confidentiality (contd) Exceptions Physicians must file statutory reports for Births Deaths Abuse Wounds resulting from violence Occupational illnesses Communicable diseases Food poisoning

34 Chapter 234 Electronic Transmission of Information Fax Confirm receipt of fax Do not use for confidential information Health Insurance Portability and Accountability Act (HIPAA) Regulates how electronic patient information is stored and shared

35 Chapter 235 Medical Compliance Plans Voluntary plan to reduce risk of accusations of fraud/abuse in submitting insurance claims OIG/HHS Compliance Program Guidance for Individual and Small Group Physician Practices Documentation Improper inducements, kickbacks, self-referrals Risk areas Coding and billing Reasonable and necessary services

36 Chapter 236 Medical Compliance Plans (contd) Aim to prevent submission of erroneous claims or unlawful conduct involving federal health care programs Seven basic elements Written policies and procedures Designation of a chief compliance officer Training and education programs Effective line of communication Auditing and monitoring Well-publicized disciplinary directives Prompt corrective action

37 Chapter 237 Medical Assistants Role in Compliance Central role in ensuring compliance Accurate data entry Increased accuracy of documentation Timely filing and storing of records Prompt reporting of errors or instances of fraudulent conduct

38 Chapter 238 Safeguards Against Litigation Maintain confidentiality Promote effective communication between medical assistant and physician, patient, employees Keep complete and accurate records Be safety conscious

39 Chapter 239 Quiz Matching Implied consent Fraud Malpractice Assault Bioethics Improper care or treatment of a patient. Clear threat of injury. Intentional commission of dishonest act. Ethics of treatment, technology, and procedures. Permission that is not stated outright.

40 Chapter 240 Critical Thinking Explain the items covered by medical practice acts. Each states medical practice acts define medical practice, explain who must be licensed, set rules for obtaining a license, state the duties imposed by the license, state the grounds for revocation, and list statutory reports that must be sent to governmental agencies.

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