Discussion 7

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Law, Liability, & Ethics For Medical Office Professionals

Sixth Edition

Chapter 2

Laws and Regulations You Will Encounter

Objectives (1 of 2)

Recognize complexity of government influence on practice and licensing of medicine

Describe importance of understanding basic employment, discrimination, and harassment laws when hiring, promoting, and terminating employees

Identify provisions of Family and Medical Leave Act

Recognize situations affected by Americans with Disabilities Act (ADA)

Identify four social security benefits

Objectives (2 of 2)

Recognize differences between Medicare and Medicaid

Define Employee Retirement Income Security Act (ERISA)

Recognize importance of Occupational Safety and Health Act (OSHA) regulations

Define job descriptions, procedures, manuals, and employee handbooks

Describe basic collection protocol

Introduction to Health Care Laws, Regulations, and Business Protocols

As a medical office professional, you will want to be aware of:

Medical practice laws and regulations

The nature of your employment

Discrimination

Sexual harassment

Health care laws and regulations

Union membership and collective bargaining.

Government Regulation of Health Care Providers (1 of 2)

Medical practice laws control practice of medicine

State legislatures establish state medical boards with authority to control health care provider licensing

Government Regulation of Health Care Providers (2 of 2)

Licensing boards grant, renew, and revoke licenses

Physicians to submit reports under certain circumstances.

Child and elder abuse

Controlled substances acts restrict distribution, classification, sale, and use of certain drugs

Employment Law (1 of 3)

Discrimination law does not allow employers to ask questions concerning, race, religion, age, or whether a woman is pregnant

Pre employment testing ensures that tests will only measure skills and abilities necessary to do job

Drug testing is necessary to ensure public’s safety

Equal Opportunity Employment prohibits employment based on race, color, religion, sex, or national origin

Employment Law (2 of 3)

Drug Testing

Employers allowed to test potential employees as part of hiring process

EEOC administers and enforces Title VII of the Civil Rights Act of 1964

Employment Law (3 of 3)

Disparate Treatment does not allow employers to treat employees differently because of their race, sex, religion, or national origin

Disparate Impact ensures that employers do not treat employees differently in an “adverse” manner on a particular protected group

For example, a minimum height requirement may discriminate against women

FMLA

The Family and Medical Leave Act of 1993 (FMLA) requires employers of 50 or more to provide up to 12 weeks of unpaid leave each year for “serious health condition” of an employee or member of employee’s immediate family or for birth or adoption of a child

ADA

The Americans with Disabilities Act (ADA) covers physical as well as mental disabilities in employment, public services, public accommodations, and telecommunications

Federal Age Discrimination Act

The Federal Age Discrimination in Employment Act of 1967 (FADA) covers age discrimination and protects rights of older workers

Equal Pay Act

The Act was passed in 1963 to end the practice of paying women less than men for the same job

Fair Labor Standards Act

The Fair Labor Standards Act (FLSA) establishes federal minimum wage, mandates extra pay for overtime work, and regulates the employment of children

Workers’ Compensation

Workers’ compensation laws are administered by state governments and create a mandatory insurance system that reimburses employees for losses sustained because of work-related injury or disease, regardless of fault.

Social Security (1 of 2)

Social security (Ss) include several different but related programs:

Retirement

An individual becomes eligible for retirement benefits at the age 62

Retirement benefits require a total of 40 quarters or 10 years of work credit from covered employment

Disability

Benefits are paid to individuals who are disabled

Any medical condition that prevents an individual from being gainfully employed may be considered a disability

Social Security (2 of 2)

Dependent’s/Survivor’s Benefits

Certain dependents of a retired or disabled worker are eligible for monthly benefits if worker is eligible for retirement or disability benefits

Surviving family members of a deceased worker may be entitled to survivor’s benefits

Medicare

Medicare is a federal insurance program for people who are entitled to Medicare from their social security contributions and payment of premiums

Medicaid

Medicaid is a program jointly administered by federal government and state government for low-income individuals obtainable through social services or welfare departments

Employee Retirement Income Security Act (ERISA)

Protects and regulates pensions

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Guarantees renewal and transferability of health insurance coverage to those already with coverage and to their dependents

HITECH Act

The Health Information Technology for Economic and Clinical Health Act (HITECH) encourages and requires use of various methods of health care technology with improved health care as objective

Occupational Safety and Health Act (OSHA)

OSHA rules and regulations are intended to prevent injuries and promote job safety

OSHA is authorized to enforce standards through:

Complaint

Inspection

Investigation

Unions and Health Care Workers

In 1919, American Federation of Labor organized engine room, laundry, and dietary employees; nurse’s aides; and orderlies in three San Francisco hospitals

American Nurses’ Association (ANA) supports collective bargaining

Working Conditions

Every position in an office should have a job description divided into two parts:

Responsibilities of each employee

Listing of tasks to be performed by each employee

Procedure Manuals and Handbooks

Procedures Manual describe in detail the manner in which a task in job description should be carried out

Handbooks provide personnel policies and related instructions

Collections

Steps

Notification

Contact individual

Determine if there is a valid reason for failure to pay

Discuss alternative payment schedule