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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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LEGAL AND ETHICAL ISSUESin Medical Practice, Including HIPAA
PowerPoint® presentation to accompany:
Medical AssistingThird Edition
Booth, Whicker, Wyman, Pugh, Thompson
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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3.8 Discuss the impact that HIPAA regulations
have in the medical office.
3.9 Explain how to protect patient confidentiality.
Learning Outcomes
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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Introduction
Reasons to study medical
law and ethics
Function at the highest
professional level
Avoid legal problems
Add clip art
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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Administrative Duties and the Law
Duties related to legal requirements
Insurance billing
Patient consent forms
Documentation in the
medical record
Making appointments
Appointment books are
a legal document
State reporting
requirements
Births
Abuse
Certain diseases
Injuries from violent acts
Deaths
Phone calls
Maintain privacy
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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Documentation
Clear and complete
Referrals
Missed appointments
Dismissals
Patient contact
Medical record correction
Medical records
Property of facility or physician
Retention and storage Based on state law
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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Legal obligation to maintain confidentiality of
patient information
Discuss with patient privately
Share patient information only when appropriate
Do not discuss the case with anyone outside the
medical office
Confidentiality Issues
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HIPAA
Health Insurance Portability and Accountability Act (1996)
Improve efficiency and effectiveness of health-care delivery
Protect and enhance the rights of patients Access to health-care information
Control inappropriate use or disclosure
Improve the quality of health care by restoring trust in the health-care system
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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Title I: Health Care Portability
Increases workers’ ability to get health-care coverage when starting a new job
Reduces workers’ probability of losing existing health-care coverage
Helps workers maintain continuous health-care coverage when changing jobs
Helps workers purchase health insurance on their own if they lose coverage under an employer’s group plan and have no other health-care coverage available
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Title II: Prevention of Health Care Fraud and Abuse, Administrative Simplification and Medical Liability Reform HIPAA privacy rules
Give patients more control over their health information
Set boundaries on the use and release of health-care records
Establish appropriate safeguards to protect the privacy of health information
Hold violators accountable if they violate patients’ privacy rights
Strike a balance when public responsibility supports disclosure of some forms of data
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HIPAA (cont.)
HIPAA allows the provider to use health-care information for:
ayment
perations
reatmentProviders are allowed to share information
to provide care to patients.
Providers are allowed to share information
to receive payment for the treatment
provided.
Providers are allowed to share information
to conduct normal business activities, such
as quality improvement.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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HIPAA (cont.)
Protected health information (PHI) Uses
Movement within an
organization
Disclosure
Transmitted between or
among organizations
Managing and storing
Sharing
Patient notification
Notice of privacy practices
Security measures
HIPAA Security Rule
Computer networks
The Internet
Disks, other storage
media, and extranets
Chart
Reception area and
clinical stations
Fax, copier, and printer
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HIPAA (cont.)
Violations and penalties
Civil
Criminal
For knowing, wrongful misuse of health information
Administrative simplification
Standardizing patient information
Standardized codes
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Apply Your Knowledge
While you are documenting on the computer, you are
called to a patient room for an emergency. What should
you do before leaving the computer?
ANSWER: You should close the patient record and log off the
computer to protect the confidentiality of patient information.
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Confidentiality Issues and Mandatory
Disclosure
Principles for preventing improper release of information
1. When in doubt, do not release information.
2. It is the patient’s right to keep patient information
confidential or disclose it.
3. All patients should be treated with the same degree of
confidentiality.
4. Be aware of all applicable laws and of the regulations.
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Confidentiality Issues and Mandatory
Disclosure (cont.)
Principles for preventing improper release of information
5. When necessary to break confidentiality and when there
is a conflict between ethics and confidentiality:
Discuss it with the patient.
If the law does not dictate what to do in the situation, the attending
physician should make the judgment based on the urgency of the
situation and any danger that might be posed to the patient or others.
6. Get written approval from the patient before releasing
information.
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A police officer enters the physician’s office where you
work and requests information about a patient. May you
release this information? What should you do?
Apply Your Knowledge
ANSWER: No, you should not be the person to release this
information. You should refer the officer to the patient’s
physician, who will make the judgment based on the urgency
of the situation and any danger that might be posed to the
patient or others.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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Code of Ethics
Principles of right and wrong
Laws are based on ethical considerations
Medical professionals are expected to act
ethically
Will have a positive effect
On your reputation
Employer’s practice
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Let no one come to
you without
leaving better and
happier.
—Mother Theresa