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LEGAL AND ETHICAL ISSUESin Medical Practice, Including HIPAA

PowerPoint® presentation to accompany:

Medical AssistingThird Edition

Booth, Whicker, Wyman, Pugh, Thompson

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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

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Introduction

Reasons to study medical

law and ethics

Function at the highest

professional level

Avoid legal problems

Add clip art

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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

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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

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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

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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.

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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.

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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