Risk Management & Legal Issues
A legal responsibility to provide a certain standard or quality of care
What is liability?
What do policies and procedures do?
Any 1 of the following:
-Provide a clear understanding of program functions
-Provide a foundation for continuity of care
-Provide a uniform guide for daily operations
-Establishes fair and equitable practices
-Allows greater shared vision in the application of the program’s vision
A formal agreement to purchase items that have been requisitioned.
What is a purchase order?
Documentation must demonstrate the patient’s need for skilled rehab services by relating _____________ to ____________.
Impairments to functional limitations
What type of insurance is first responsible for claims?
Primary insurance
What are two primary methods to limit risk?
1.Emergency action plan
2.Policies and procedures
What are the 2 types of pre-participation physical examinations?
1. Office based exam: Individual exam with personal physician
2. Station based exam: Used for large number of people in a short period of time
What are expendable items vs non-expendable items?
Expendable: Cannot be reused (tape, first aid)
Non-expendable: Reusable with predetermined lifespan (elastic wraps, hand weights)
Name 2 of the 4 things a plan of care should include.
Any 2 of the following:
Duration of treatment
Frequency of treatment
Intervention list
Goals
Who is a contracted provider?
A provider who completes contract between themselves and insurance provider and are considered to be in-network
What are the 4 basic elements of negligence?
2. Breach of duty
3. Action or failure to act caused harm
4. The actual harm caused
Authorization for release of information must be in compliance with ______ and ______.
HIPAA and FERPA
What do you call expensive items that are not paid for in a typical annual budget?
Capital expenses or capital outlays
What are the 3 main purposes of an initial evaluation with the patient?
1. Introduce, describe, identify, and address the patient problems
2. Build rapport/establish trust
3. Introduce patient to rehab process
What protects an insurance plan against moral hazard?
A deductible
Athlete assumes risk for participating if he or she is made fully aware of the risks
What is the doctrine of assumption of risk?
Name 4 differences between an athletic trainer in a collegiate setting vs a clinical setting.
Any 4 of the following:
Collegiate- Reports to: athletic director, or academic department chair. Duties include: working with collegiate athletes, instructing students, research and scholarly activities. Often requires: Prior college-level instruction, athletic team care, supervision of students. Hours: evening and weekend
Clinical - Reports to: clinic manager, or other practice administrator. Duties include: working with broad patient age groups, assisting the physician, rehabilitation services, providing high school and event coverage, supervise and develop a sports performance program. Often requires: Previous clinical experience. Hours: Mon-Fri 9-5
What is included in the operational portion of a budget?
Salaries, administrative costs, office operations, office supplies, phone, travel, etc.
Getting the patients perspective on functional improvements, their functional abilities with continued dysfunction, and their pain level is considered what type of information?
What kind of note is this information put in?
Subjective
Progress note
Which type of insurance plan has many restrictions and does not recognize athletic trainers as rehabilitation providers?
Medicare and Medicaid
An SA injures their ankle but doesn’t complete their rehab because they believe they’re ready to return to play. You allow this because they said they feel fine, but one game later they re-injure the same ankle. Is there a case for proximate cause?
Yes; you had a duty to provide care, you breached the duty by allowing them to return to the field before completing rehab, and if you had not allowed them to return to play they wouldn’t have re-injured the ankle in a game
What are 3 objectives for an athletic trainer in terms of marketing and public relations?
1. Make local groups aware of the services athletic trainers provide as a health care professional
2. Make local groups aware that these services are available
3. Make local groups aware that this particular group provides these services in an excellent and cost-effective manner
Explain the purchasing process.
plan needs for purchase (permission for capital items), review items available, identify and best price obtained through bids, requisition requested, contact vendor, PO written and sent, vendor agrees, item received, payment made
Name the 5 things a medical record contains.
1. Patient history
2. Current patient health problems
3. Interventions
4. Communication with patient and other providers
5. Billing records/ICD-10 codes
List the 4 steps for any health care provider to be reimbursed.
1. Patient must be injured and seek care
2. Patient must be subscriber of insurance payer
3. Health care provider must be willing to bill insurance carrier
4. Carrier must be willing to pay the health care provider for services rendered