Healthcare Organizations
Tax exempt nonprofit healthcare organizations that are organized and governed solely by licensed physicians.
What is a 501(a) Corporation?
A healthcare provider may not disclose without the authorization of the patient
What is Protected Health Information?
A physician owes a duty to not discontinue treatment once a doctor-patient relationship has been established.
What is duty to not abandon?
Safeguard employee retirement benefits plans and extend to health benefits
What is ERISA's primary goal?
Responsible for enforcing licensing standards for physicians
What is TBME
What is Corporate Practice of Medicine Prohibition?
Health plans; healthcare clearing houses; healthcare providers who transmit health information in a HIPAA transaction
What is Covered Entities?
A physician's duty in accordance with the standard of care
What is duty to treat?
A regulation will be saved from preemption if the regulation goes to regulating the business not the plan
What is ERISA's savings clause?
Responsible for enforcing licensing standards for nurses
What is TBNE?
Healthcare organization's evaluation process to determine if a physician will have privileges to admit and treat patients at the hospital.
What is credentialing?
Any health-related data (medical records, bills, anything that is individually identifiable).
What is Protected Health Information?
Two types of relationships that will create a duty to not abandon.
What is a long-standing relationship and Doctor-patient relationship
Companies whose main business is not to provide health insurance, but they choose to cover employee medical cost instead of buying insurance from an insurance provider.
What is deemers clause?
Authority to suspended/revoke a nurses license.
What is TBNE?
Evaluation of medical and health services, including evaluation of the qualifications and professional conduct of a physician by the physician's peers
What is Physician Peer Review?
A healthcare provider may disclose medical information without prior authorization with its Business Associates buy only information that is necessary.
What is the minimally necessary rule?
Not established until the physician has begun treatment
What is physician-patient relationship
State regulations that regulate a health insurance plan or aim to challenge the determinations by the insurance companies.
What is preempted by ERISA?
Four step process for dealing with private practice physician competency issues.
What is 1. TBME investigates 2. holds a fair hearing 3. requires physician to get treatment for impairments 4. license suspension/revocation?
Reports created by a hospital committee are protected from discovery and all communications are protected.
What is Texas Medical Committee Privilege?
A valid subpoena from a judicial officer, records are at issue in the case, patient is a party to the case.
What is required before a hospital must disclose PHI?
When a doctor can refuse to treat someone
What is before establishing a doctor-patient relationship?
Recovery for harm is limited to the value of the benefit denied by the insurance plan.
What is sec. 502?
Three express purposes of professional medical licensing
What is (i) to control the quality of healthcare provided by individual professionals, (ii) establish profession criteria/standards, (iii) govern entry into the profession?