Identify 4 principles of implied consent

Types of Consent and Payers

HCS/430 Version 6

3

University of Phoenix Material

Types of Consent and Payers

Part 1: Complete the chart and questions that follow.

Type of Consent

Define type of consent (20- to 45- words).

Identify 4 principles of the consent (20- to 45- words).

Describe the impact on the health care industry (45- to 90- words).

Informed Consent

A process that makes plain the risk, benefits, and alternatives of a particular treatment/procedure that allows them to make an informed decision.

1. Description of the procedure

2. Disclosure of appropriate alternatives procedures or course of treatment

3. Disclosure of benefits that can be expected

4. Disclosure of any risk associated with a procedure/treatment.

One of the ways that an informed consent poses an impact on the healthcare industry is from a safety standpoint, it can be an issue for the patients when performing procedures without it. Performing a procedure on a patient without consent has been considered by the court of law to be a form of battery (Cordasco, 2013).

Implied Consent

Implied consent is the granting of permission (usually verbal) for care without giving a formal agreement between patient and the provider.

1. Implied consent is obvious when a patient rolls up their sleeve to have blood drawn.

2. Scheduling an appointment and walking into a doctor’s office voluntarily implies you want treatment.

3. Disclosure of any risk that maybe associated.

4. Treatment and Procedure must be disclosed to the patient.

Implied consent is not the preferred way of consenting. If a procedure or treatment fails or the patient is not satisfied with the outcome, the patient can always say they did not give consent and the hospital or provider have not evidence to prove otherwise.

Answer the each of the following questions using 90- to 175- words.

1. Describe 4 exceptions to consent.

2. How do exceptions to consent impact the health care industry.

3. Describe 2 exceptions to consent within your state.

Part 2: Complete the chart.

Identify 3 Third-Party Payers

Describe third-party payer (20- to 45- words)

Describe the legal issues that regulate the third-party payers (45- to 90-words).

Describe an applicable law that regulates the third-party payers (45- to 90- words).

Describe the impact that the legal issue and applicable laws have on the third-party payers (45- to 90- words).

1. Health maintenance organizations (HMO)

Managed care plan that offers various services for a set fee per patient. With an HMO the patient must see a primary care physician (PCP) and that doctor manages all of the patients’ healthcare. If the patient must see a specialist, their PCP will refer them to a specialist in that network. Out of network medical care is not covered and the patient will be responsible for the care at full price.

2. Medicare

Federal insurance program that pays a portion of medical care costs to people that are over 65 or disabled and eligible for Social Security benefits.

Stark law regulates physician self-referrals for Medicaid and Medicare patients. The Stark law prohibits physicians from referring patients to another doctor or organization that the physician is related to or has a vested interest in. This is to keep doctors from making a profit off of referral’s and reduce over-utilization of services to help keep healthcare costs down.

Medicare is a federally funded program that only has so much money set aside. Medicare ends up paying out reimbursement for referral’s that may not be needed, that money takes away from the next person that may need it.

3. Medicaid

One of the largest payers of healthcare for low-income people and families. Also provides medical coverage to children of families that make too much to qualify for Medicaid but not enough to provide private insurance.

Physicians were found to be submitting false claims to Medicare and Medicaid fraudulently. They were billing multiple times for services and medical equipment, charging for services and procedures that were never performed and submitting claims for services and procedures that were not necessary to the patients care.

Contracts and programs that are federally funded are protected by the False Claims. This act protects these programs from fraudulent claims submitted by physicians. The federal government is enforcing strict civil penalties as well as jail time.

Physicians that abuse federally funded programs are essentially taking resources away from beneficiaries that need the services offered. According to Ellison (2014), “The Patient Protection and Affordable Care Act made it a violation of the FCA for a healthcare organization to knowingly retain an overpayment for more than 60 days” (para. 13). Under the False Claims Act as of 2014 the government has been able to recover $2.8 billion dollars from physicians and organizations that were found in violation.

References

Cordasco, K.M. (2013). NCBI. Obtaining Informed Consent Form Patient: Brief Update Review. Retrieved from http://www.ncbi.nlm.nih.gov