Chapter 1 To 5 Exam

Ethics refers to a set of principles that guide individuals in determining what is right or wrong, good or bad, and acceptable or unacceptable behavior. These principles are often based on morals, which are personal beliefs about what is right and wrong. Values, on the other hand, are the things that individuals consider important in life. Codes of behavior are guidelines or rules that govern how individuals should act in certain situations. Therefore, it is accurate to say that ethics can be defined as morals, values, and codes of behavior.

Honesty and integrity are crucial traits for ambulatory health care professionals because they are responsible for providing accurate and trustworthy medical care to patients. These professionals must maintain the highest ethical standards, ensuring that they act in the best interest of their patients and uphold the integrity of the healthcare profession. By being honest and having integrity, ambulatory health care professionals can build trust with their patients, promote effective communication, and contribute to a safe and reliable healthcare environment.

The statement is true because an "opt-out option" refers to the ability of members to choose to receive treatment outside of their designated health care plan. This means that individuals have the freedom to seek medical care from providers who may not be included in their plan's network. This option can be beneficial for those who prefer specific doctors or hospitals that are not covered by their plan, but it may also result in higher out-of-pocket costs for the member.

An agent is a person appointed by a physician to perform authorized acts in the name, and under the control and direction, of the physician. This means that the agent acts on behalf of the physician and carries out tasks or duties that have been authorized by the physician. The agent operates under the supervision and guidance of the physician, ensuring that they adhere to the physician's instructions and guidelines.

The legislative branch of the federal government is known as Congress. Congress is responsible for making laws and consists of two houses: the House of Representatives and the Senate. The House of Representatives represents the population of each state based on its size, while the Senate provides equal representation for each state with two senators per state. Together, they work to pass bills and oversee the functioning of the government.

In a civil case, the party bringing the action is called the plaintiff. The term "plaintiff" refers to the individual or entity that initiates a lawsuit by filing a complaint against another party, known as the defendant. The plaintiff is responsible for presenting their case and proving their claims in court. They seek to obtain a legal remedy or compensation for the harm or injury they have suffered.

Probate court is a specialized court that handles the administration of a deceased person's estate, including the distribution of their assets and the payment of their debts. One of the purposes of probate court is to simplify and expedite the handling of small claims or debts. This means that probate court provides a streamlined process for resolving smaller claims or debts, making it more efficient and quicker compared to other courts. Therefore, the statement "Probate court simplifies and expedites the handling of small claims or debts" is true.

A wrongful act or injury committed by one person against another person independent of a contract is known as a tort. A tort is a civil wrong that causes harm or loss to someone and can result in legal liability for the person who committed the act. It is different from a breach of contract, as it does not involve a violation of a contractual agreement but rather a violation of a legal duty owed to another person.

Implied contracts are indeed the most common form of contracts in ambulatory health care. Unlike express contracts which are explicitly stated and agreed upon by both parties, implied contracts are formed based on the actions and conduct of the parties involved. In the context of ambulatory health care, these contracts can be formed through the patient's actions, such as seeking medical treatment, and the healthcare provider's actions, such as providing the necessary care. Therefore, it is true that implied contracts are the most common form of contracts in ambulatory health care.

Capitation is a payment model where a fixed amount is paid to healthcare providers on a monthly basis for each member enrolled in a health maintenance organization (HMO). This fixed fee covers a range of services provided to the HMO member, regardless of the actual services utilized. This payment method incentivizes healthcare providers to focus on preventive care and cost-effective treatments, as they bear the financial risk if the cost of care exceeds the fixed fee. Capitation helps control healthcare costs and promotes efficient utilization of resources.

The given statement is false. "Co-payment" is not the expense that providers pay for insurance participation. Instead, it is the fixed amount that the insured person pays out of pocket for a specific service or medication at the time of receiving it. Providers do not pay co-payments; it is the responsibility of the insured individual.

Physicians who practice in any integrated organization must remember that Medicare/Medicaid may not recognize some business arrangements and that Medicare/Medicaid referrals cannot be made to any entity in which they have a financial interest. This means that physicians need to be aware of the potential limitations and restrictions imposed by Medicare/Medicaid when making business arrangements and referrals, especially within integrated organizations.

Ethical and bioethical standards can be applied at different levels - personal, organizational, institutional, and worldwide. At a personal level, individuals have their own set of ethical standards that guide their behavior and decision-making. Organizations and institutions also have their own ethical standards that govern their practices and policies. These standards can vary depending on the specific context and values of the organization or institution. Lastly, ethical standards can also be applied at a global level, where there are international agreements and guidelines that aim to promote ethical behavior and protect human rights on a worldwide scale.

The correct answer is "Correctly apply codes to procedures, supplies, etc., for billing purposes." This answer is supported by the information provided in the question, which states that professional coders are responsible for applying codes to procedures, supplies, etc., for billing purposes. The other options mentioned in the question, such as determining how physicians will be paid or providing doctors with personal identification codes, are not mentioned as responsibilities of professional coders.

Bonding is not an example of payment for medical services. Bonding refers to a process where a healthcare professional purchases a bond to protect against potential financial loss resulting from malpractice or negligence. It is a form of insurance and does not directly involve payment for medical services rendered. On the other hand, Pay for Performance (P4P), co-payment, and deductible are all examples of payment methods commonly used in healthcare.

The correct answer is a period of time or a deadline for initiating legal action. The statute of limitations is a law that sets a specific time frame within which a lawsuit can be filed. It is designed to encourage timely resolution of legal disputes and prevent parties from bringing claims after an unreasonable amount of time has passed. This ensures fairness and allows defendants to have a sense of finality and security, knowing that they cannot be sued indefinitely for past actions.

State statutes can determine the scope of practice for health professionals, meaning they define the specific tasks and responsibilities that professionals in the healthcare field are allowed to perform. These statutes can vary from state to state, as each state has the authority to establish its own regulations. Additionally, state statutes can also outline the punishment for failure to comply with these regulations. Therefore, all the given statements are true.

The Geneva Convention Code, Nuremberg Code, and Declaration of Helsinki are three Codes of Ethics that apply to worldwide issues. The Geneva Convention Code is a set of international humanitarian laws that protect the rights of victims of armed conflicts. The Nuremberg Code was developed after World War II to establish ethical principles for human experimentation. The Declaration of Helsinki is a set of ethical principles for medical research involving human subjects. These three codes address important ethical concerns in various fields, such as armed conflicts, medical research, and human rights.

Physicians who dispense controlled substances are required to take inventory on their date of registration and every 2 years thereafter. This ensures that they have an accurate record of the controlled substances they have on hand and helps prevent any potential misuse or diversion of these substances. Regular inventory checks also help to maintain compliance with legal and regulatory requirements surrounding the dispensing of controlled substances.

Respondent superior is a legal doctrine that holds an employer or principal responsible for the actions of their employees or agents. Under this doctrine, the employer can be held liable for the wrongful acts or negligence committed by their employees during the course of their employment. This doctrine is based on the principle that the employer benefits from the actions of their employees and should therefore bear the responsibility for any harm caused. It is an important concept in tort law and helps ensure that victims can seek compensation from the party with greater resources and control over the situation.

The statement is incorrect because registration is not the strongest form of regulation. The strongest form of regulation is licensure, which requires individuals to meet specific qualifications and pass an examination in order to practice a certain profession. Registration, on the other hand, typically involves a less rigorous process and may only require individuals to provide basic information and pay a fee to be included on a list or database. Therefore, the correct answer is false.

The statement is false because a nurse practitioner (NP) is not a practical nurse. While both roles require additional education and training beyond basic nursing, a nurse practitioner has advanced knowledge and skills, allowing them to diagnose and treat illnesses, prescribe medications, and provide comprehensive healthcare services. In contrast, a practical nurse has a more limited scope of practice and typically works under the supervision of a registered nurse or physician.

Dispensing a drug means to deliver it in a container to a client. This involves preparing and packaging the drug in a suitable form, such as tablets, capsules, or liquid, and providing it to the client for use. It does not involve the act of actually administering the drug into the client's body, issuing a drug order, or calling in a prescription.

An expert witness is not necessarily a special trained person who can testify in a court of law regarding the professional standard of care in the same or similar communities. While an expert witness may possess specialized knowledge or expertise in a particular field, their role is to provide an opinion or testimony based on their expertise, rather than specifically addressing the professional standard of care in a community. Therefore, the statement is false.

Physicians must keep clients' medical information confidential, but this does not mean that they have the right to privacy. While physicians have a professional obligation to maintain the confidentiality of their patients' medical information, their own right to privacy may be limited in certain situations, such as when there is a legal requirement to disclose information or when it is necessary to protect public health. Therefore, the statement that physicians have the right to privacy is false.