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Foundations 8

Study guide for foundations 8 final

QuestionAnswer
Explain how you might start reducing and controlling your risk of liability regarding Effective Risk Management. Plans should begin with Identifying Potential Areas of Risk in their Practice and Procedures. Physician Duties imposed by State Laws, Rules, and Professional Codes of Behavior, State Practice Associations
4 things noted that affect “Doctor’s Duties”. Medical Specialty; Marketing, Solicitation and Advertising Activities; Referral Practices and Policies; Public and Legal Opinion
9 major “General Protection Strategies” and explain what each entails. Documentation; Informed Consent; Refer; no Deceptive Advertising; Forms; Insure All Liability; Check Ups on Coverage; Deter: Sexual Harassment; Relationships with/Among Office Staff/Patients; Service Equipment per Manufacturer Guides
Regards to “Reimbursement Policies” explain what is meant by “have one fee schedule”. Certain Pt understands the Proposed Care Plan & expected cost. Insurance Reimbursement Plans and Patient Payment Plans Candidly Discussed, Agreed to by the Pt before Care; Staff knows Fees & Collections Policy
Explain the Doctor’s responsibility regarding Collecting Fees from the patient when there is a third party insurance payer involved. Pt responsibility to pay for service. Insurance: Dr Responsibility to Attempt to Collect Co-Pays/Deductibles; Document Your Staff’s Attempts to Collect all Fees Owed
Explain the usefulness of the Informed consent if it is not an Absolute Protection against malpractice. Establishes the Pt’s Assumption of Risk; mitigates some of Dr’s Exposure to Liability
Explain how the doctor is held to a Standard of Care and how that affects your Risk Management process you attempt to follow Failure to Refer a Pt to Required Medical Specialist may result in a Breach in Standards of Care. Treating Dr is then at Risk for being held to the Same Standard of Care as the Specialist to whom the patient should have been referred.
Explain how your Case Management process affects Risk Management. Failure to Direct or Warn Impaired Pt could create Liability for adverse outcomes and any third party injured by the Pt’s actions.
List the five Red Flags of possible Patient Non-Compliance and how these affect Risk Management outlook. missing appointments; fails to perform therapy/exercise; refuses to modify ADLs; resists advice to take time off work, avoid lifting or avoid driving; simply fails to follow your advice.
Regarding Patient Non-Compliance explain what your ‘best tool’ would be for Risk Management. Documentation: phone calls by staff; Each missed appointment; Every portion of any event that might interfere with the Pt’s progress; Your defense relies on the documentation showing your attempts to deliver appropriate care; Never trust your memory
Explain your liability for other doctors and the staff that work in your office. Owner’s Vicarious Liability not limited to actions of CAs who treat patients under Dr’s supervision, also extends to other DC partners/associates or staff members. A Dr can’t create an independent contractor relationship simply designating as such
Explain how staff training programs help reduce ‘Risk’ in your office. training program for all personnel related to specific duties. train non-DC staff to NOT provide clinical advice either on the telephone or in person. Supervision with initial & annual education throughout employment
Whom do you contact first when you have received notice or summons of a suit being filed against you? The Defendant should immediately contact Professional Liability Insurance Company
Define Subpoena Deuces Tecum regarding the Discovery Process. a formal request for the production of documents, records, files, films, etc. to be brought to a deposition
What are the four things given as General Advise from your attorney regarding a suit filed against you? Speak w/ Attorney; Follow Instruction; Don’t Contact Pt/argue/Volunteer Info not requested.
Regarding the General Advice from your attorney, what are the 9 things to do when answering questions at a deposition or during a trial? Take Time; Listen Entire Question. Expect tricks; Repeat to self; brief, factual, concise, Consistent; Composed/Professional/ Assured/Clear/Confident; Never Volunteer Information not requested
Explain some of the causes of legal proceedings brought against a DC. Mad Plaintiff, owes the Dr significant money; The Dr/Staff Derelict in Duties; Pt Erred in Judging Behavior/Actions/failure to act; The Plaintiff Attorney erred in advancing Case; In a Multi-Doctor Case Scenario, other Dr Erred
Explain what you should do to prepare for a defense when being sued. Review Subpoena for Notice of Complaint; Review your File; Identify any potential Errors/Omissions; Review Documentation Dx/Tx; If Staff had Input on the Forms; Verify Who Staff Member was; What their Job was; What was Writte ; Do Not Alter File Entries
Explain what you should do to prepare for a Deposition. Educate Attorney: Chiropractic; how you define/practice; Details of Specific Case; Recall Unique Events; Review Dx Imaging, Physician Consult, Lab Reports; Review Communications; Deposition Logistics: Polite Composed; Take time; offer to respond later
What are your rights regarding when a Deposition takes place? to request Time/Location of deposition; You Should Review all Expert Witness Reports and Depositions before you testify at your deposition
What can you do if you perceive the questions become hostile toward you? Inform attorney you believe question not relevant to issues. Statement could be You Refuse to Offer an Answer at This Time.” The Plaintiff Attorney can accept that or ask Judge to compel answer
What is expected of you regarding Consultations & Referrals? Ethical Responsibility to Assure Pt receive Appropriate Care. Medical Consultations by Specialists safest. Treating Dr maintain control gathering info about Dx/alt Tx. Refer When Chiro Inappropriate/Contraindicated. Failure to Refer Dereliction of Duty
Explain the expectation of maintaining a license to practice. Formal edu; State Vary Stature of Institution/Applicant Level of Edu; CEUs minimum renewal requirement, Standard of Care require more. Moral responsibility to remain educated in Current Technology and Methodology
List and or explain the varying rules and pitfalls of Advertising & Marketing. Pre-Approved by the State Board. Disclosures: License Specialty; Value Free Offer; Contact Info; Restrictions, Implied Guarantees. Illegal: Kickback, bait Switch; phone; Misrepresentation; Violate Insurance; Solicit Accident Victims/other DCs Pt
Explain the Insurances Company’s expectation regarding the patient’s deductable or co-payments. plans that involve 3rd Party Payers to share Pt’s Responsibility to reimburse the Dr for services provided
Explain Health Insurance Plan as it relates to the Doctor, the Patient and the obligation inferred between them & the Insurance Company. Dr Accepts Assignment, Pt Assigns the Benefits to Dr. involves Deductibles/Co-Pays. based on Fee for Service or Managed Care. The Dr s Obliged to Follow terms of Plan when Accept Assignment
What are ‘No Out of Pocket Expense Plans’ and why they are illegal? violate private/govt insurance. fees created may be considered as new lower fee. Reimbursement is then based on Lower Fee, Insurance pays a % of new Lower Fee
Explain why ‘Financial Hardship Agreement Plans’ are considered legal. offer Individually, written within rules of state. Document reasons/terms in a formal written agreement. Avoid Insurance Viewing Agreement: Keep Documentation Current; intent to assist the Pt to get required/recommended care; Do Not Advertise as policy
Define ‘Miscoding’. if you do not match the right Diagnostic Code and Procedure Code you will not get paid
Define ‘Abuse’ regarding coding. Mistakenly using Wrong Codes to describe what services you are providing
Explain how a D.C. as an office owner might get involved in a Multidisciplinary Practice. Drs are Equity Partners/Stock Owners employees salary/percentage. DC refer for co-management, files stay in DC clinic.
Explain the General Guidelines of any Multidisciplinary Practice DC services w/in scope of practice. disclose specialty of provider. tell Pt multi-specialty services provided. Consultation on medical necessity. Who Employee/Independent. rules regarding Coding and Compliance followed vary by Insurer/state.
Regarding Multidisciplinary Practices does the State Law place you as a Chiropractor in a different status than other Chiropractors? States limit specialties that join and define the scope of practice of a Multi-Specialist provider. DC services w/in scope of practice. Co-Management is DC providing Chiro while the other specialist manages Dz. remain current on state law
What are the four Problem Areas pointed out in the notes regarding the Anticipation of Potential Problems? Records:use Legend. Records used: available, preferred, proper use. Pt Tx Plans: Associate to make decision, level of exams, policy on labs, imaging, consults, protocols. Chiro Technique: Associate can do techniques, agrees w/ procedure/schedule
How does a multiple DC office situation affect the patient files? staff understand office forms, HIPAA, Laws, Rules on Record Use/File Storage, support New or Temporary DCs w/ forms to use, assuring records reviewed for: Completeness; Conciseness; Continuity; Capture; Clarity
What are the issues surrounding the multiple DC office when patients are seen by more than one D.C.? (blank)
How does a multiple DC office situation alter Staff interaction and expectations? (blank)
Created by: stigmatamarty