Podcast
Questions and Answers
What is one of the primary obligations of the anesthesiologist?
What is one of the primary obligations of the anesthesiologist?
To protect the health and welfare of the public
Which of the following is an example of civil litigation? (Select all that apply)
Which of the following is an example of civil litigation? (Select all that apply)
- Involve federal property
- Lawsuits between citizens and states
- Negligence of intentional infliction of injury (correct)
- Actions brought under federal statutes
Which anesthesia service is being provided when care is being provided by the anesthesiologist to more than 5 cases at one time?
Which anesthesia service is being provided when care is being provided by the anesthesiologist to more than 5 cases at one time?
- Medical Supervision (correct)
- Medical Direction
- Personally Performed
- Nonmedically Directed CRNA
Which of the following statements regarding the Medical Direction Model is false?
Which of the following statements regarding the Medical Direction Model is false?
What is a correct action by a CRNA giving a deposition?
What is a correct action by a CRNA giving a deposition?
Which of the following is not an activity that the anesthesiologist must perform for payment for medically directed anesthesia services?
Which of the following is not an activity that the anesthesiologist must perform for payment for medically directed anesthesia services?
Which of the following will not help the CRNA avoid litigation?
Which of the following will not help the CRNA avoid litigation?
In a legal case where the doctrine of res ipsa loquitur is used, the burden of proof lies with whom?
In a legal case where the doctrine of res ipsa loquitur is used, the burden of proof lies with whom?
What is the most cost-effective anesthesia delivery model?
What is the most cost-effective anesthesia delivery model?
What model does not allow for any reimbursement to an anesthesiologist?
What model does not allow for any reimbursement to an anesthesiologist?
Which statement about the doctrine of res ipsa loquitur is incorrect?
Which statement about the doctrine of res ipsa loquitur is incorrect?
If a statute or law established by legislation is breached, the practitioner and facility are held accountable under what consideration?
If a statute or law established by legislation is breached, the practitioner and facility are held accountable under what consideration?
The pass-through funding process is currently used to facilitate funding of whom?
The pass-through funding process is currently used to facilitate funding of whom?
The doctrine of ______________ states that when federal legislation is enforced in an area, state laws may no longer be enforced in that area unless specifically designated by the federal government.
The doctrine of ______________ states that when federal legislation is enforced in an area, state laws may no longer be enforced in that area unless specifically designated by the federal government.
Which variable is NOT taken into consideration by Medicare when factoring a dollar amount for anesthesia services provided?
Which variable is NOT taken into consideration by Medicare when factoring a dollar amount for anesthesia services provided?
_______ describes care provided by an anesthesiologist to more than four concurrent cases, each involving a CRNA.
_______ describes care provided by an anesthesiologist to more than four concurrent cases, each involving a CRNA.
When damage to a patient is caused by an employee, the employer should be held responsible. This is known as the doctrine of:
When damage to a patient is caused by an employee, the employer should be held responsible. This is known as the doctrine of:
Which is NOT a variable used by Medicare when establishing conversion factors? (Select all that apply)
Which is NOT a variable used by Medicare when establishing conversion factors? (Select all that apply)
Which statement best defines the legal doctrine of res ipsa loquitur?
Which statement best defines the legal doctrine of res ipsa loquitur?
Which ACT model is most cost effective?
Which ACT model is most cost effective?
Which answer is not a factor for a true case of res ipsa loquitur?
Which answer is not a factor for a true case of res ipsa loquitur?
The most cost effective model of anesthesia delivery is thought to be:
The most cost effective model of anesthesia delivery is thought to be:
Which of the following is not an acceptable way to avoid litigation in your anesthetic practice?
Which of the following is not an acceptable way to avoid litigation in your anesthetic practice?
By which processes can Certified Registered Nurse Anesthetists (CRNAs) be reimbursed for their services?
By which processes can Certified Registered Nurse Anesthetists (CRNAs) be reimbursed for their services?
Which of the following is false regarding nurse anesthesia practice?
Which of the following is false regarding nurse anesthesia practice?
Which of the following actions is outside the jurisdictional limits of the federal courts?
Which of the following actions is outside the jurisdictional limits of the federal courts?
Which anesthesia care model is the most expensive?
Which anesthesia care model is the most expensive?
Regarding reimbursement, the method used to quantitatively measure the intensity of anesthesia services provided is:
Regarding reimbursement, the method used to quantitatively measure the intensity of anesthesia services provided is:
To prove negligence in a lawsuit, standards of care can be established by the following except:
To prove negligence in a lawsuit, standards of care can be established by the following except:
Third-party payers view chronic pain management services as what type of services?
Third-party payers view chronic pain management services as what type of services?
Communication between attorneys and their clients is protected because of the need to have ______ discussions.
Communication between attorneys and their clients is protected because of the need to have ______ discussions.
When did CRNAs become eligible for Medicare reimbursement?
When did CRNAs become eligible for Medicare reimbursement?
What is the definition of Tort's Law?
What is the definition of Tort's Law?
What is the billing modifier used in the Medicare Part B Reimbursement Model for care delivered by a CRNA without medical direction?
What is the billing modifier used in the Medicare Part B Reimbursement Model for care delivered by a CRNA without medical direction?
Which of the following is the most commonly considered evidence used in trials of whether an appropriate standard of care was upheld?
Which of the following is the most commonly considered evidence used in trials of whether an appropriate standard of care was upheld?
What is the least cost-effective model for providing anesthesia?
What is the least cost-effective model for providing anesthesia?
Why is the principle of 'negligence per se' helpful to the plaintiff?
Why is the principle of 'negligence per se' helpful to the plaintiff?
Which of the following is/are considered methods of establishing a measurement intensity for a particular anesthesia service?
Which of the following is/are considered methods of establishing a measurement intensity for a particular anesthesia service?
Damages based on the value of the injury caused are called:
Damages based on the value of the injury caused are called:
CRNAs can receive direct reimbursement from:
CRNAs can receive direct reimbursement from:
Who can testify to a CRNA's standard of care in anesthesia administration?
Who can testify to a CRNA's standard of care in anesthesia administration?
The Medicare RVS (relative value scale) measures the ____ of a particular anesthesia service and combines with anesthesia time to determine a charge for services.
The Medicare RVS (relative value scale) measures the ____ of a particular anesthesia service and combines with anesthesia time to determine a charge for services.
What situation is most likely to prevent the filing of a lawsuit against a CRNA?
What situation is most likely to prevent the filing of a lawsuit against a CRNA?
The sum of what anesthesia-related 'units' equal the total 'procedure units'?
The sum of what anesthesia-related 'units' equal the total 'procedure units'?
Which court system is most likely to handle this lawsuit?
Which court system is most likely to handle this lawsuit?
Pain management services provided by CRNAs:
Pain management services provided by CRNAs:
In the tort justice system:
In the tort justice system:
Tort liability utilizes the standard of care for Nurse Anesthetists. This standard is:
Tort liability utilizes the standard of care for Nurse Anesthetists. This standard is:
Which of the following is true regarding the medical direction reimbursement model?
Which of the following is true regarding the medical direction reimbursement model?
CRNAs providing services in a designated critical access hospital (CAH) can be reimbursed through Medicare Part B. All of the following are criteria that must be met to be designated as a CAH EXCEPT:
CRNAs providing services in a designated critical access hospital (CAH) can be reimbursed through Medicare Part B. All of the following are criteria that must be met to be designated as a CAH EXCEPT:
A key element of the law of negligence is fault. Many cases involving malpractice of anesthetists are decided under the legal doctrine of res ipsa loquitur. 3 aspects of this doctrine include all of the following EXCEPT:
A key element of the law of negligence is fault. Many cases involving malpractice of anesthetists are decided under the legal doctrine of res ipsa loquitur. 3 aspects of this doctrine include all of the following EXCEPT:
Under the anesthesia care team (ACT) model using both anesthesiologists and CRNAs, which method of reimbursement is most often used?
Under the anesthesia care team (ACT) model using both anesthesiologists and CRNAs, which method of reimbursement is most often used?
Damages based on the value of the injury caused, are called ___________.
Damages based on the value of the injury caused, are called ___________.
An anesthetic delivery model that would utilize the QX billing modifier and allow the CRNA to receive 50% reimbursement of the anesthesia fee for service could be considered:
An anesthetic delivery model that would utilize the QX billing modifier and allow the CRNA to receive 50% reimbursement of the anesthesia fee for service could be considered:
The type of professional liability insurance that is most preferable to the CRNA and covers the insured for all acts occurring within the policy period, regardless of when the lawsuit is filed is called:
The type of professional liability insurance that is most preferable to the CRNA and covers the insured for all acts occurring within the policy period, regardless of when the lawsuit is filed is called:
What Billing modifier would a CRNA who is medically directed by an anesthesiologist use for reimbursement through Medicare part B?
What Billing modifier would a CRNA who is medically directed by an anesthesiologist use for reimbursement through Medicare part B?
Which of the following is NOT recommended to prevent a lawsuit against you as a CRNA?
Which of the following is NOT recommended to prevent a lawsuit against you as a CRNA?
The CRNA is practicing in a care model with a billing modifier of QX. Under Medicare Part B, this indicates the CRNA is working in which type of practice setting?
The CRNA is practicing in a care model with a billing modifier of QX. Under Medicare Part B, this indicates the CRNA is working in which type of practice setting?
Medical Negligence of the CRNA must be proven by the plaintiff and include negligence by the CRNA on all of the following elements EXCEPT:
Medical Negligence of the CRNA must be proven by the plaintiff and include negligence by the CRNA on all of the following elements EXCEPT:
Which statement best describes reimbursement of CRNAs by Medicare?
Which statement best describes reimbursement of CRNAs by Medicare?
What is the most commonly considered evidence of whether an appropriate standard of care was upheld in court cases?
What is the most commonly considered evidence of whether an appropriate standard of care was upheld in court cases?
What is the name of the specific alpha-numeric coding scheme developed to identify every known medical condition and disease?
What is the name of the specific alpha-numeric coding scheme developed to identify every known medical condition and disease?
Which way is NOT considered an effective way of lobbying?
Which way is NOT considered an effective way of lobbying?
Which of the following models is the one in which an anesthesiologist provides care in one to four simultaneous cases, with each case having a CRNA as the primary anesthetist?
Which of the following models is the one in which an anesthesiologist provides care in one to four simultaneous cases, with each case having a CRNA as the primary anesthetist?
Study Notes
Medicare and Reimbursement
- Medicare does not consider the time spent providing care as a variable for conversion factors.
- CRNAs are reimbursed through Medicare Part B when working in designated healthcare facilities.
- The most cost-effective anesthesia delivery model involves one anesthesiologist directing up to four CRNAs, known as the medical direction model.
- The billing modifier "QZ" is used for CRNAs under medical direction by an anesthesiologist.
Legal Doctrines and Malpractice
- Res ipsa loquitur allows patients to claim negligence by demonstrating that an injury would not typically occur without negligence.
- To establish negligence, a plaintiff must show that the injury arose from actions exclusively controlled by the defendant.
- Common defenses against lawsuits include postoperative follow-up and obtaining informed consent; however, writing a personal note summarizing conflicts is not recommended.
Professional Standards
- The standard of care for nurse anesthetists is established by the American Association of Nurse Anesthetists and varies among communities.
- An expert witness is typically relied upon in court to determine if the proper standard of care was upheld.
- Civil litigation can involve claims of negligence, emphasizing the importance of adherence to established standards.
Tort Law Implications
- Under tort law, all CRNAs owe a duty of care to act as a reasonable person would, and failure to do so can lead to malpractice claims.
- "Negligence per se" simplifies the plaintiff's burden by not requiring them to provide expert testimony about the standards of care in certain cases.
- Compensatory damages are awarded based on the value of the injury caused in malpractice cases.
Clinical Practice Models
- The least cost-effective anesthesia model is one anesthesiologist operating solely without CRNAs.
- Medical supervision entails one anesthesiologist managing multiple cases, but the anestheologist can only supervise one case at a time under the medical direction model.
- It is crucial for anesthesiologists to meet all Medicare requirements for reimbursement when directing CRNAs.
Communication and Evidence
- Effective communication in legal situations requires open, full, and frank discussions.
- Testimonies from CRNAs and anesthesiologists are pivotal in establishing standards of care in negligence cases.
- CRNAs serving in teaching capacities may be subject to different billing modifiers while providing anesthesia services.
Regulations and Compliance
- Mandatory licensure laws primarily aim to protect the public's health and welfare.
- Anesthesiologists determine reimbursement eligibility by performing required oversight functions during anesthesia care.
- Civil litigation cases are characterized by actions involving negligence or intentional injury between individuals, contrasting with actions involving solely federal statutes.### Anesthesia Practice Responsibilities
- A pre-anesthetic examination and evaluation is crucial for patient safety.
- Continuous monitoring of anesthesia administration is required at frequent intervals.
- CRNAs must remain physically present for immediate emergency response and treatment.
- Oversight limits involve supervising a maximum of two CRNAs.
Legal Considerations in Anesthesia
- Respectful communication with patients and families helps reduce the risk of litigation.
- Informed consent is essential for legal protection.
- Working in a day surgery center does not inherently mitigate risks of litigation.
- Documentation of standards of care is vital for legal defense.
Legal Doctrines and Responsibilities
- Under the doctrine of res ipsa loquitur, the burden of proof lies with the defendant in negligence cases.
- The most cost-effective anesthesia delivery model is CRNA-only care.
- Nonmedically directed CRNAs do not allow for any reimbursement to anesthesiologists.
- For res ipsa loquitur to apply, specific criteria must be met; timely reporting of injury is not required.
Negligence and Regulations
- Negligence per se holds practitioners accountable for breaches of established statutes or laws, regardless of professional practices.
- The pass-through funding process is utilized for qualified healthcare facilities, primarily in rural regions.
Federal and State Law Interaction
- The principle of preemption establishes that state laws may not apply when federal legislation governs an area.
Medicare and Anesthesia Services
- Medicare does not consider the educational level of the anesthesia provider when calculating reimbursement amounts.
- Factors that do influence reimbursement include liability insurance costs, the provider's work effort, and practice expenses.
Supervision Models
- Medical supervision occurs when an anesthesiologist directs more than four concurrent cases involving CRNAs.
- The doctrine of respondeat superior holds employers responsible for the actions of their employees.
Studying That Suits You
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Description
Test your knowledge on Medicare reimbursement practices, legal doctrines related to malpractice, and professional standards in nursing. This quiz explores how various regulations and legal principles apply in healthcare settings, including the roles of CRNAs and anesthesiologists.
