Medicare, Legal Doctrines, and Standards Quiz

Questions and Answers

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)

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?

Medical Supervision (correct)

Medical Direction

Personally Performed

Nonmedically Directed CRNA

Which of the following statements regarding the Medical Direction Model is false?

The CRNA will use the QZ billing modifier Signup and view all the answers

What is a correct action by a CRNA giving a deposition?

Answer a question saying, 'I don't know' (if appropriate) Signup and view all the answers

Which of the following is not an activity that the anesthesiologist must perform for payment for medically directed anesthesia services?

Must be overseeing no more than two CRNAs Signup and view all the answers

Which of the following will not help the CRNA avoid litigation?

Working in a day surgery center Signup and view all the answers

In a legal case where the doctrine of res ipsa loquitur is used, the burden of proof lies with whom?

The defendant Signup and view all the answers

What is the most cost-effective anesthesia delivery model?

CRNA-only care Signup and view all the answers

What model does not allow for any reimbursement to an anesthesiologist?

Nonmedically Directed CRNA Signup and view all the answers

Which statement about the doctrine of res ipsa loquitur is incorrect?

The injury must be reported within one month of the occurrence and the anesthesia team must be notified when the injury occurs Signup and view all the answers

If a statute or law established by legislation is breached, the practitioner and facility are held accountable under what consideration?

Negligence per se Signup and view all the answers

The pass-through funding process is currently used to facilitate funding of whom?

Used for qualified healthcare facilities in rural areas Signup and view all the answers

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.

preemption Signup and view all the answers

Which variable is NOT taken into consideration by Medicare when factoring a dollar amount for anesthesia services provided?

The educational level of the anesthesia provider. Signup and view all the answers

_______ describes care provided by an anesthesiologist to more than four concurrent cases, each involving a CRNA.

medical supervision Signup and view all the answers

When damage to a patient is caused by an employee, the employer should be held responsible. This is known as the doctrine of:

Respondeat superior Signup and view all the answers

Which is NOT a variable used by Medicare when establishing conversion factors? (Select all that apply)

The time spent providing care by the physician or CRNA Signup and view all the answers

Which statement best defines the legal doctrine of res ipsa loquitur?

A doctrine that patients can utilize if they are suspicious of negligence made by the anesthetist Signup and view all the answers

Which ACT model is most cost effective?

Medical direction with one anesthesiologist and four CRNAs Signup and view all the answers

Which answer is not a factor for a true case of res ipsa loquitur?

The injury is an exacerbated condition from a previous injury. Signup and view all the answers

The most cost effective model of anesthesia delivery is thought to be:

CRNA Only Model Signup and view all the answers

Which of the following is not an acceptable way to avoid litigation in your anesthetic practice?

Preparation of a personal note detailing any conflict or crisis event that occurs Signup and view all the answers

By which processes can Certified Registered Nurse Anesthetists (CRNAs) be reimbursed for their services?

Negotiate reimbursement for services from the facility and bill third-party payers Signup and view all the answers

Which of the following is false regarding nurse anesthesia practice?

All facilities allow nurse anesthetists to perform local, regional, and general anesthesia Signup and view all the answers

Which of the following actions is outside the jurisdictional limits of the federal courts?

Actions between citizens of the same state Signup and view all the answers

Which anesthesia care model is the most expensive?

Anesthesia care team model with 1 Anesthesiologist to 2 CRNAs Signup and view all the answers

Regarding reimbursement, the method used to quantitatively measure the intensity of anesthesia services provided is:

The Relative Value Scale (RVS) Signup and view all the answers

To prove negligence in a lawsuit, standards of care can be established by the following except:

The jury Signup and view all the answers

Third-party payers view chronic pain management services as what type of services?

Medical services Signup and view all the answers

Communication between attorneys and their clients is protected because of the need to have ______ discussions.

Open, Full, Frank Signup and view all the answers

When did CRNAs become eligible for Medicare reimbursement?

1989 Signup and view all the answers

What is the definition of Tort's Law?

When engaged in activities during which a failure to act reasonably can be foreseen to result in harm, each of us owes a duty of care to others. Signup and view all the answers

What is the billing modifier used in the Medicare Part B Reimbursement Model for care delivered by a CRNA without medical direction?

QZ Signup and view all the answers

Which of the following is the most commonly considered evidence used in trials of whether an appropriate standard of care was upheld?

Testimony of an expert witness Signup and view all the answers

What is the least cost-effective model for providing anesthesia?

MDA only Signup and view all the answers

Why is the principle of 'negligence per se' helpful to the plaintiff?

Plaintiff doesn't have to offer expert testimony on standards of care followed by the profession. Signup and view all the answers

Which of the following is/are considered methods of establishing a measurement intensity for a particular anesthesia service?

Both A and B Signup and view all the answers

Damages based on the value of the injury caused are called:

Compensatory damages Signup and view all the answers

CRNAs can receive direct reimbursement from:

Medicare Part B Signup and view all the answers

Who can testify to a CRNA's standard of care in anesthesia administration?

CRNAs and Anesthesiologists Signup and view all the answers

The Medicare RVS (relative value scale) measures the ____ of a particular anesthesia service and combines with anesthesia time to determine a charge for services.

intensity Signup and view all the answers

What situation is most likely to prevent the filing of a lawsuit against a CRNA?

There is no evidence of deviation from standards of care. Signup and view all the answers

The sum of what anesthesia-related 'units' equal the total 'procedure units'?

Base units + Time units Signup and view all the answers

Which court system is most likely to handle this lawsuit?

Federal Courts Signup and view all the answers

Pain management services provided by CRNAs:

Use resource-based relative value scales (RBRVS) to measure intensity for a medical service. Signup and view all the answers

In the tort justice system:

The majority of the liability insurance premium goes toward defense costs, operating expense of the insurance company, and to the company's shareholders. Signup and view all the answers

Tort liability utilizes the standard of care for Nurse Anesthetists. This standard is:

Set by the American Association of Nurse Anesthetists. Signup and view all the answers

Which of the following is true regarding the medical direction reimbursement model?

The anesthesiologist has to meet 7 Medicare requirements to be reimbursed for directing a CRNA. Signup and view all the answers

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:

Maintains an annual average length of stay of 48 hours per patient for acute inpatient care Signup and view all the answers

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:

The responsibility of providing proof is on the plaintiff. Signup and view all the answers

Under the anesthesia care team (ACT) model using both anesthesiologists and CRNAs, which method of reimbursement is most often used?

Medical direction Signup and view all the answers

Damages based on the value of the injury caused, are called ___________.

compensatory damages Signup and view all the answers

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:

Both A & B Signup and view all the answers

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:

Occurrence Signup and view all the answers

What Billing modifier would a CRNA who is medically directed by an anesthesiologist use for reimbursement through Medicare part B?

QX Signup and view all the answers

Which of the following is NOT recommended to prevent a lawsuit against you as a CRNA?

Telling the patient everything will be okay Signup and view all the answers

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 Direction Signup and view all the answers

Medical Negligence of the CRNA must be proven by the plaintiff and include negligence by the CRNA on all of the following elements EXCEPT:

Negligence of Practice Signup and view all the answers

Which statement best describes reimbursement of CRNAs by Medicare?

CRNAs cannot receive direct reimbursement from Medicare Part A but can receive direct reimbursement through Medicare Part B. Signup and view all the answers

What is the most commonly considered evidence of whether an appropriate standard of care was upheld in court cases?

Expert witness Signup and view all the answers

What is the name of the specific alpha-numeric coding scheme developed to identify every known medical condition and disease?

ICD-9 Signup and view all the answers

Which way is NOT considered an effective way of lobbying?

Visiting the legislator's personal residence Signup and view all the answers

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?

Medical direction Signup and view all the answers

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.

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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.