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1. Describe how local, state, and federal legislation and regulations affect patient care.
Federal and state laws aim at safeguarding patients’ rights and protecting them from fraud. There are confidentiality compliance and privacy laws (45 CFR, parts 160 and 164) that give patients the right to privacy, obtain or amend information in their medical records where legally possible and know what information has been collected about them. Patients in long term care, such as elderly patients, can exercise their right to information through 42 CFR, Part 483, section 483.10(b)(2) where they can get all their medical records from past 24 hours. However, situations where disclosure of such information are required by any federal or state rule, the privacy rule is overridden. Every patient has the right to know the treatment plans and their side effects, if any. They also have the rights to know all the treatment options even if they are not covered by their health plans. Frauds pertaining to insurance are prevented by Health Insurance Portability and Accountability Act of 1996 (HIPAA). Mentally ill patients are entitled to same level of care as normal patients according to the Mental Health Parity Act (MHPA). The Newborns’ and Mothers’ Health Protection Act (NMHPA) benefits women availing maternity leave and assured hospital stay for 48 hours for normal delivery and 96 hours for cesarean section. Medical laws help create competent healthcare sector. They also help the medical professionals to be compassionate towards patients and work within legit frameworks to avoid lawsuits (Hughes, 2002).
2. Describe how Fair Debt Collection Practices Act and the Bankruptcy Act affect the billing in the medical office.
Medical billing involves sending bills via email or post and verifying over the phone. However, sometimes not all patients pay bills on time. During such situation it is advisable to follow certain polite protocols before taking drastic steps. Debtors are protected by Fair Debt Collection Practices Act (FDCPA – 15 USC 1692 et seq.) which states that no debtor shall be subjected to unfair debt collection that violates their dignity. This means that the debt collector shall not threaten or abuse or use deception for collection of the debt. A telephonic call to the insurance agency regarding the bill followed by collection letters should suffice in most cases. However, if there are discrepancies, the medical office should make follow up calls and send ‘overdue’ marked envelopes for reminding the payment. They may use outside collection agencies after thoroughly examining their collection procedures (French, Fordney, & Follis, 2012).
When the patient files for bankruptcy then the billing circumstances change. If the patient files bankruptcy under Chapter 7, the patient is allowed a fresh financial start and the debt collectors are repaid through liquidation of whatever assets are left of the patient, in order of priority. The medical office should produce a claim proof and file it in the court. However, services such as physicians’ are the last on the list to be paid. If the patient files for bankruptcy under Chapter 13, the court allows the debtors to repay their loans and debts over a period of time (which may go up to 5 years or more). Here again, healthcare provider’s fee is the last to be paid (French, Fordney, & Follis, 2012)
3. Describe why it is important to report required diseases and conditions to the proper authorities for the protection of the public.
Every state has a law mandating healthcare authorities and schools to report communicable and infectious diseases to the Center for Disease Control and Prevention’s (CDC) branch, National Notifiable Diseases Surveillance System (NNDSS). The NNDSS analyzes disease trends, updates the list of reportable diseases frequently and separately for each region, maintains statistical data on all such diseases and protects the public from communicable diseases by curbing the spread of the disease, determining the extent of spread of the disease in a community, and assessing the risk imposed by the disease. Diseases such as AIDS, Polio, Tetanus, Measles, Lyme’s disease, STDs, Botulism, etc are some of the notifiable diseases and conditions (CDC, 2012).
4. Describe implied contract between the patient and the physician and his employees.
The term ‘contract’ refers to an agreement between two parties. In this case, the contract is between the patient and the physician and his staff. There are two types of contract i) implied contract and ii) expressed contract.
Expressed contracts are tangible written contracts that have list of rules, regulations, bylaws and clauses. An implied contract is not a written legal document, but rather a mutual unuttered contract formed on basis of behavior and trust. For example, the act of a patient visiting the doctor for receiving treatment means that the patient trusts the doctor, displaying agreement. Meanwhile, the doctor treating the patient by administering or prescribing medicine means that the doctor has mutually agreed to take responsibility of the patient’s health. Both the acts involve agreement, though not in a spoken or written form, thus forming implied contract (French, Fordney, & Follis, 2012). The same extends to a patient and the staff working under the doctor.
5. Describe the guidelines that will prevent lawsuits.
Physicians and hospitals are highly liable for lawsuits. Studying medical ethics and being familiar with certain laws will help healthcare professionals to avoid lawsuits. There are 2 kinds of lawsuits that could be filed against a physician. Malpractice: When a doctor and his/her staff fail to provide proper treatment or diagnose a problem incorrectly leading to further health problems, a patient may claim malpractice. Negligence: When the doctor and his/her staff fail to perform their duty, cause direct harm, provide low standards of care expected of the profession thereby leading to injury and discomfort, a patient can claim negligence on part of the doctor and his/her staff.
- Avoiding negligence by clearly spelling out duties of physician and his/her staff
- Having good listening skills for proper diagnosis (to avoid malpractice claims) and allocating every patient the time they need
- Communicating the pros and cons of all the treatment options available for the patient along with the fees that would be charged
- Following all legal protocols before, during and after providing treatment. Example: maintaining confidentiality, maintaining proper paperwork, etc.
- Following all medical protocols devised by the medical associations during routine treatments such as vaccination as well as technical treatments such as surgery or chemotherapy.
- Using tactful patient-handling techniques and using careful neutral language to describe the outcome.
- If the patient is found to be not following physician’s advice, then the physician should terminate treatment by formally withdrawing giving sufficient time for the patient to find a new doctor. (Lindh, Pooler, Tamparo & Dahl, 2009)
6. Discuss how OSHA is important to the personnel in a medical facility. List the safety devices and documents that are needed by the medical assistant.
Occupational Safety and Health Administration (OSHA) guidelines were created to prevent workplace injuries, provide ergonomically optimal workplace settings and protect the health of workers of various sectors. It gives the employees the right to information about their workplace and the right-to a safe workplace. The general regulations include restriction of eating, smoking and other such non-work related activities inside the work premises. Title 29 of the Code of Federal Regulations (29 CFR) discusses at length about OSHA regulations.
Personal protective equipments and important documents
A medical assistant needs personal safety devices such as latex gloves, goggles, mask-cum-eye shield, non-absorbent face masks, plastic face masks, non-absorbent gown, plastic gown, face shield, caps, shoe covers, etc.
Keeping records is one of the most important parts of OSHA guidelines. All the important standards such as blood borne pathogen, exposure control plans, hazard communication, exit route, electrical, etc must be kept handy at an accessible location. Employee’s training records, exposure to harmful substances reports, occupational injuries and medical records must be well-recorded and preserved for 30 years even after employment ceases. If employer has retired, the same documents must be sent to the director of OSHA (Ramutkowski, Booth, Pugh, Thomson & Whicker, 2004).
References
Center for Disease Control and Prevention. (2012). National notifiable diseases surveillance system. Public Health Surveillance and Informatics Program Office. Retrieved from website: http://wwwn.cdc.gov/nndss/
French, L. L., Fordney, M. T., & Follis, J. J. (2012). Administrative Medical Assisting. 7th edition. Cengage Learning.
Hughes, Gwen. (2002). Laws and Regulations Governing the Disclosure of Health Information. AHIMA Practice Brief.
Lindh, W. Q., Pooler, M. S., Tamparo, C. D., & Dahl, B. M. (2009). Delmar's comprehensive medical assisting: administrative and clinical competencies. Cengage Learning.
Ramutkowski, B., Booth, K. A., Pugh, D. J., Thomson, S., & Whicker, L. (2004). Administrative Procedures for Medical Assisting. McGraw-Hill Science/Engineering/Math
