CPHRM Course: Legal and Regulatory (Part 2)

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Overview of CPHRM Course - Legal and Regulatory (Part 2)

• Dr. Sahar Khalil Alhajrassi, a consultant prosthodontist, presents this course which includes SB-Prosth, CPHQ, CPHRM, EFQM, HMP mini-MBA knowledge, as well as strategic planning and KPI practice.

Violations & Penalties

• Failure to report SLA site license authority issues within 72 hours results in a violation.
• Civil penalties for infractions can be 50,000$.
• Civilis monetary penalties for infractions can be 50,000$ per violation.
• Oversight of civil rights is performed by the OCR office.
• The OIG oversees the office of the inspector general.
• CMS governs terminations.

EMTALA Regulations

• Hospitals must report suspected improper transfers (financial "dumps," no prior notice) within 72 hours; failure to report violates EMTALA.
• Sanctions for violations include Medicare provider agreement termination, plus civil penalties up to $50,000 for hospitals and physicians.

EMTALA Regulations

• The Emergency Medical Treatment and Active Labor Act (EMTALA) applies to Medicare/Medicaid hospitals with ER services.
• Requirements include the following:
  • Conduct medical screening for emergency conditions.
  • Stabilize patients to the extent of the facility's capabilities before transfer.
  • Provide medical treatment to all ER patients.
  • Avoid billing patients without insurance.

EMTALA Question Answers

• Mandatory reporting: hospitals are required to report suspected improper transfers (e.g., no prior notice from other hospital, financial “dumps,” etc.) within 72 hours ,and not doing so is a violation of EMTALA.
• Correction: The correct answer between items 1 and 2 only or B. 1 and 4 only, 2. stabilize for the patient and 1 more item then 1 and 3 and 4 ( the correction ) is 1 and 2 only
• The correct answer if you choose a. on call specialist ( that’s wrong ) vs. D. emergency department physician (correct) is b / d.
• Under the EMTALA Nondiscrimination Provision the local regional referral center is obligated to take this patient unless they do not have capacity, the answer is b, not d
• Therefore the answers are a: 1 and 2 is the answer b : answer D is the correct answer, b and d are correct
• B is the correct answer
• D is the correct answer

Emergency Response

• The emergency medical technicians responding to the scene is the correct answer for the question of who has the responsibility to determine initial emergency response level.
• Now shown as correct, The dispatch team at the incident is responsible for identifying the emergency response level vs. that was first thought to be MD who responds is correct.

The Emergency Exception

• Physicians can assume an unconscious patient would consent to emergency procedures when the physician documents the emergency and need for care, given no prior information.

Medicare Long-Term Care (LTC)

• Medicare regulations for long-term care (LTC) facilities are also known as LTC laws.
• The purpose is to set requirements for institutions to qualify for Medicare/Medicaid programs as skilled nursing facilities.
• Details of the LTC include emphasizing residents' rights, promoting dignity, and allowing formal complaints.
• Violations can result in penalties of $10,000 and termination.
• CMS surveys these skilled nursing facilities every 9-15 months.

LTC Requirements

• Initiatives to improve patient care and reduce restraints.
• Reducing pressure ulcers and malnutrition.
• Specific staffing obligations.
• Formal training/certification for nursing assistants.
• Enforcing resident rights.

Resident Rights include but are not limited to

• Information
• Medical Decision
• Informed Consent
• Grievance
• Survey every 9-15 months from CMS
• Violation penalties: 10,000 and can include termination of agreements

Reporting Abuse

• States have adopted their own Child Protective Services laws.
• The Older Americans Act defines elder abuse and funds the National Center for Elder Abuse.
• Adult Protective Services organizations have been implemented by states to address abuse.
• Types of abuse include: Emotional-Sexual-Physical-Neglect-Abduction-Abandonment
• Mandatory reporting laws are in effect.
• Penalties, loss of licensure, and litigation can result.

Americans with Disabilities Act (ADA) Title III

• AKA ADA is a US law enacted in 1990 to prohibit discrimination based on disability
• Title III specifically addresses nondiscrimination in public accommodations and commercial facilities.
• ADA prohibits private groups from denying goods, services, and programs to individuals based on disabilities.
  • This includes structural accessibility, programmatic access (reasonable modifications to policies/procedures).
• There are limits and they include:
  • Eligibility criteria that screen out individuals with disabilities.
  • Legitimate safety requirements that are essential for safe operation.
  • Surcharges or costs to cover accommodation measures.
• For all qualified disabled
  • Potential employers can not ask about disability or how severe during the job interview
  • Post job offer and acceptance, any medical questions are acceptable

ADA and Hiring

• An employer may decline a disabled job applicant if:
  • if the applicant refuses to describe or explain her disability
  • If the applicant cannot explain or demonstrate how they would handle the job's responsibilities
  • The applicant may present as a safety risk to self or team
  • In other instances the best answer is employment is over
  • C / D are incorrect. B is it

Definition of a Disability per ADA

• A physical/mental disability can substantially limit main daily tasks.
• There are listed restrictions that apply such as restrictions for any impairment, medical condition or organic issues relating to systems.

Legal for an employer to decline to do this

• C If the applicant cannot explain or demonstrate how she would actually perform her job when asked to do so

Emergency Medical Treatment and Active Labor Act (EMTALA)

• The Emergency Medical Treatment and Active Labor Act (EMTALA) allows a Registered Nurse (RN) can perform medical screening, but to perform these duties, they must have both proper designation by medical staff, and proper training, the answer is B not one of the other ones
• EMTALA does not apply to residents answer B is right!
• Under the EMTALA, the Nondiscrimination Provision the local regional referral center is obligated to take this patient unless they do not have capacity, the answer is b, not d
• For A: 1 and 2 only, choose the choice B
• As of November. 2003, All hospitals must have physicians on call 24 hours day and 7 days a week/Physicians must provide healthcare when they are on call for medical emergencies; therefore, the answer is B.

Off campus EMTALA requirements

• A off campus facility that is 1 mile away from a hospital, it must be capable of doing medical screenings. If not, medical staff must approve policies handling emergency medical condition. Then the answer B will be
  • B is the right choice due to the fact that medical screening in such situations are required

Patients Presenting a risk

• If a patient presents with sudden Scrotal pain and testicle irritation, and an ultrasound is inconclusive then the on-site examination by the on-call urologist becomes part of the medical screening examination, the Correct answer is B not one of the other 3

On Call and EMTALA

• Per EMTALA guidelines, the emergency department physician makes the decision about whether the on-call specialist physician must come to the ED to assess the patient the correct answer is D not a/b

Q&A Section 1

• With a known understanding of medical malpractice, with the on-call specialist is in question over patient care, the proper conclusion under EMTLA is to look to the EMTLA department physician to review all the documentation with the surgeon, to determine what the next steps are, therefore the department head must review before bringing in said doctor/specialist.

A 3 year Old Child Scenario

The answer to the question. A 3 year old, after examination, as released with a prescription, but then comes back after symptoms worsen. The exam was adequate; - The answer is B is correct

36 week Pregnant Woman

• If a women shows up to the emergency showing sign of labor, is sent directly to labor rather then the emergency is acceptable if there is consistent history with the hospital for this occurring, if the hospital board is aware this is happening, if other nurses know to give a medical exam, and for further steps to be made is considered law.

EMTALA requirements

• If after being properly discharged through documentation by staff is a high risk, then the answer to document is the “ High ” action must be chosen at all times

Risk Management for Documenting records

The risk manager should do the following to keep quality documentation:

The answer B is the goal

• The risk manager should participate in general orientation.
• They should also involve the Medical Records Department Personnel.
• Incident trends and patterns should also be addressed.

Clinical improvements

With CLI / A, quality is insured by

OVERSIGHT BY CMS CDC AND FDA Reason for enactment

• Misread lab tests
• Proliferation of unregulated laboratories, which the CMS monitors directly with it, the department of quality

Patient Safety and Quality Improvement Act

• The Patient Safety and Quality Improvement Act's main goal: To protect both the hospital, the staff involved and to establish/create what exactly has to happen, for all aspects of the situation, what went wrong, ways to improve with all new policies being out into place, so other groups cannot create lawsuits, but also protect employees so that they don’t avoid work

The following is under the umbrella of “ A P S O “”

These are things the company must have in place.

• The database of that organization is in place
• Safety protocols
• Department is set for for health / Human services

With the Emergency rule, medical staff do not do

To force a physician to continue with an operation

For A offsite campus that is 1 miles away, the campus.. Needs to have a medical screening as per the A of ADA with the EMTALA requirements.

• There is limited on what can do: what is under local regional is required

HIPAA

• Goal is to keep peoples` personal information, from abuse and to keep it safe from the workforce not just people.

HIPAA RULES state what is allowed to be said/ done.

These rules dictate how to ensure to have a process for the following:

• Who is authorize
• Covered entity

The RN as an EMTALA

• An RN can can administer medical if proper authorization. They must have the authorization in place with staff approval

Risk Management role for HIPAA

Risk management is a lot about security for HIPAA

With HIPAA

You require access to the following to not make a data breach.

    - Education records and employment records

For NPP: A officer has to report to the OCR during the session and in court to state the law

• A covered entity may disclose PHI without authorisation for business needs for the organization

A certified PT / consultant is NOT allowed under HIPAA rules to share data with another consultant

• Ethical you can’t share if told so

HITECH law helps with breach notification rule

• Thereis this notification rule states only for “ covers only PHI with out autorisation

Data breach to have is needed

• If the breach effects more than 500 residents of a state or jurisdiction, notice must be provided to prominent media, and also posting on an HHS website.

What happens if data is breached, the notification requirements apply to both providers and their business associates.

What is the definition of a medical record and what is used For.

• All patient related data
  • Is to manage / plan / operate any action that is happening to the The Medical Chart

What is used for (Medical records

All the what where when why for proper use of documentation is to be accurate with a written procedure and or list of events,

Must be secured and with a code

Who what how and what is being done must be written with what that person is doing, in the correct way.

ADA law says

- One can not ask in interviews what medical  conditions/ health issues

Is having someone from outside the organization help the process a HIPAA breech ?

- Yes if that staff from another company is not trained in HIPAA

If Patient is taken from Telemetry to x-ray one should look at in these orders with HIPAA

  - Accessibility
 - Patient allergies
 - Need for people to escort

The correct law to help staff. What process you are looking at for healthcare is:

• Is a medical order correct as signed from a Doctor

The goal is to find out how staff functions properly, one should look

HIPAA in a medical way:

• All of the above to follow

Neglecting is the # 1 cause code to the government as medical negligence by law in malpractice claims.

What is needed or has to happen, is

• Medical Review
• The report is not discoverable

The chair from ethics board, after going to the ethics board goes to you as risk

• He should inform the doctor that’s on staff and they are in charge. The department is
  • 514 fax machine to ensure patient’s state , they’ll look to see where the state the fax was sent and report from the location

Risk in order to protect from people (the main goal) is

• “E” all answers and areas Medical staff as they are needed, as those should exist in.
  • It is not for treatment It Is following through on the patient’s health for legal help and issues, that effect the patient when not dealing with them at this moment on going

HIPAA

Not all information is safe to share, and one must know

• C is not all. They do not have to state everything during to to proper safety, with one of the statements saying that

“all” it would state that, one must do just that.

• D : all must apply

The nurse has the correct orders, but is being sued by another department

HIPAA cannot take hold in situation with all the evidence from board and other parties is correct actions in law and HIPAA is no able to assist with any law suits that arise

For a malpractice claims is

A / C Both Are Incorrect - The best practice for that situation will say / is the steps of review with that staff, is in place the correct paperwork as stated by staff at the time of care C is what needs to be said, for the final act

Then. Under what was there code that said by the test - there is, one is a and what one

• With a legal team reviewing A, A is the to final choice.

If medical orders are called/texted: and a patient suffers and needs aid to the emergency and the chart is gone what has now Happened

• Spoliation Tampering to record = loss the case, in addition additionaly is this case which is covered due to HIPPA as fire walls. So low level wall fire

It is not all of these if asked about HIPAA:

The right to get a of there Souse as a primary patient or spouse / relative as the core patient To properly file an incident statement

A person should report there mistake as the first action

• With as much aid the patient can

As the patient, has the right to ask all of the following except What records their relative is going through

Medicare-MEDCAID +

• requires self service from Medicare and insurance companies with
  • In case of breach the government considers, this part of 2nd pay

What should it be called

• The 10 step program

Title 324 / 434 are also code titles as well as numbers that can come into play during testing for this aspect

As the Risk Manager you should look to the chart for

• the proper format for the case as well as making it secure to only those who are viewing the chart

All those who provide service at this time or those needing records are protected under PHI law, for this reason the best practices a medical facility should have is (1634)

• is“ d “as well. ( to show when did this happen )

Medical malpractice code names

There Title three one section 39 Section code 3 / 9 are both needed in legal

• The most accurate is A
• The best medical act you’re being sued. You should use the legal team first
  • And then to follow up on the next steps

Askhof medical chart/ info to those not allowed under HIPAA

• Is not appropriate with the patient

What is need/ done to ensure a patients correct medical record

  - Should be with the Dr with an signed copy in the file

Medical terms regarding what is/ is not in records is The correct order of steps. To look, A is in proper order or procedure for the following steps

• The process should be as D, to contact Then one of the options was medical orders first, B
• To prove is signed by the Medical team is right

B is what can you do to get aid as part of a medical team The process. Is looking at the signed orders and then the Medical information

The point of HIPAA IS TO ask all questions correctly, the answer is C

• C or B ( to find with this process for A “ the chart information “ is a step. And so is the follow to action

It is d or c since you need the. Dr first

Is C, under what is not aloud. All. But really none of information is to follow for That reason at that moment. Which gives proper claim In order

• 1 / with code and all

Not D all those with medical staff. And that this person in such situation is A

One and the correct and the others on that code

“ c “ is not the correct answer if we all the all those what

• And follow at “ B “
• The answer is if not with signed it's false D/ but A is more core

There is an ethical breach due, also

• 18.“ B “ must be documented at all times when to file claims

It is, never what the individual says. It what is followed per documents

• all of C

Is the code and is needed if it is with patient rights! And “ D “ It has to be asked at all times!!

Under the safety list and the OSHA: safety list is that’s is in. “ OSHA can’t be reported “. is incorrect

-Is correct

All the Following: For Medicare has its correct function for its duties

• The answer is “ A report “. Under the 10 steps and is correct There was the correct information as well

Medicare rules to assist it what they

Under health care requirements by a nurse who sees or has info that’s can be seen as an ethical issue

• The answer would be: ( A is also the last one but that’s incorrect ). She must let the proper entity, the Department
  • What they have documented
• To the proper ethical and all the steps as part
• What has also take a place with the patient “ also with there own documentation
  • what what needs to happen under those requirements
• A and 4/ 3/ 1 ( and then review the statement that had in store the
• A and C

OSHA

These are code to look at, for testing

455 / 357 must also be taken into account 1.1007 To review for documentation and 1.1077 for a list to the point

As safety for both OSHA and the patient what is to look

• One must not get hurt, as there correct, there is correct steps
• To fallow

The process is to ensure that there is good practice in place

• To show what the safety has in place to protect
• To show how it happened and the steps to avoid

You are all trained per.

• This statement
• To have all safe for employees that are working . “ B “ as we are looking at. Why is happened. What was put into place

As a team, OSHA and patient “ safely there as to know”. For a right answer

Is b as it tells - Why and how the hazored was done

The goal, is that those 5 points must have

The OSHA or code and policy for a safe worker and so must follow those and also under safety has the those points Those are - B and C

Then under HIPAA: The test that it is

• C, as is said in that statement and follow properly with proper action with A is needed

• For these reasons is why we need as D

• for these 2 proper steps proper and or -C is under proper claim In such order code/with. all: Not it under

• • Corporate Compliance A a is not always the is has too Proper proper team and what action was put with it. “c, as follow with is the and this is why is correct what is not the

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• B and what is be at for and and is
• With. The is and for then to To to A Medical then D

" A Is the. “ but has for then or

Code it D and as that too

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• It there in that a is those “ all “ but to, must then know is not those Proper all the to and but know in place that the and with is

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• *As must do to see , those too at “34 is said “ to look for action
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