Managing Legal and Ethical Issues

Legal concepts include understanding and following state and federal regulations. The area that has always been of the most concern is fraud and abuse especially with regard to Medicare, Medicaid, and other federally funded programs.

Ethical issues include understanding and following business and healthcare ethical guidelines. Sometimes ethical issues are also considered as legal issues.  Most medical office compliance policies include both ethical and legal concepts.

Patient Rights Issues

Dental patient signing at the reception, High Angle View
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The most important right that a patient has is the right of informed consent. A patient should only consent to medical treatment if they have sufficient information about their diagnosis and all treatment options available in terms he/she can understand. 

There are seven other patient rights:

  • Patient information
  • Choice of providers
  • Access to emergency services
  • Respect and non-discrimination
  • Confidentiality
  • Complaints and appeals
  • Patient responsibilities

Fraud and Abuse Issues

Fraud generally refers to willfully and knowingly billing medical claims in an attempt to defraud any federally funded program for money.

The most common forms of fraud and abuse include billing for equipment never provided, billing for services never performed, up-coding charges to receive a higher reimbursement rate, and unbundling charges.

Credentialing Procedures

Credentialing is one way insurers protect their patients from unlicensed providers. Partnering with insurance carriers is a necessary process for any medical office. Physicians and other professionals must provide a list of verifications to insurance carriers, including Medicare and Medicaid, in order to be eligible for reimbursable expenses.

The results of not obtaining proper credentialing can result in lost revenues. Insurance carriers will not reimburse any medical office that bills for professionals or for services provided by professionals that have not been properly credentialed.

Chemical Safety and Precaution Procedures

Information should be communicated to the medical office staff regarding the proper safety measures for use, storage and disposal of all hazardous materials.

  • Personal Protective Equipment (PPE):This includes safety goggles, appropriate gloves, and lab coats.
  • Proper Labeling: Hazardous materials should be never be placed in an unlabeled container. All materials should be listed on a Material Safety Data Sheet (MSDS)and be regularly updated.
  • Follow Manufacturers' Guidelines: Use appropriate method for disposal, contact to eyes or skin, or spills.

Proper Disposal Of Patient Information

Any facility defined by HIPAA as a covered-entity has the responsibility to ensure the privacy and security of its patient’s information as well as maintaining the confidentiality of their PHI. Proper disposal of protected health information (PHI) and other confidential information whether paper or electronic format is a requirement of HIPAA.

Malpractice Risk and Prevention

While there is no 100% foolproof method of avoiding any medical lawsuit, there are some ways to reduce the chances of being on the paying end of one. 

Diversity and Corporate Culture

Diversity is all around us yet many organizations find it challenging to incorporate diversity in everyday settings. In today's society, a medical office must incorporate diversity into it's mission, vision, and values in order to provide the best patient care and effectively manage staff.

Understand diversity means being aware of differences other than the obvious reasons like race, language, and gender. Diversity refers to everything about people that makes us different including work styles, ethics and values, education, and communication. 

Accounting Principles

General Accepted Accounting Principles (GAAP) are the common set of accounting principles, standards, and procedures that companies use to compile their financial statements. GAAP, simply put, is the customarily accepted ways of recording and reporting accounting information.

Each organization may operate differently but all have to follow by set guidelines within the organization's community, state and at the federal level. If these standards and procedures are not followed the U.S. Security and Exchange Commission (SEC) will fine the organization and possibly pursue criminal action to enforce compliance. 

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