Hcm 337 dbr1,2,5 | HCM337 Current Legal, Ethical and Regulatory Issues in Healthcare | Colorado Technical University

**Write a 100-word reply to the 6 individual questions below.** Use APA formatting and citation standards. Use at least two (2) scholarly references published within the last 5 years to substantiate your work on questions 1-4 only. 

To help you with your discussion, please consider the following questions:  

  • What clarification do you need regarding the posting?  
  • What differences or similarities do you see between your posting and other classmates’ postings?  
  • What additional questions do you have after reading the posting?  
  • What item you found to be compelling and enlightening.   
  1. Kerry-  

Law and Ethics are important to practitioners and managers because, without them, there would be no guide to follow, and everyone staff and patients alike would do as they please. Laws and Ethics help show what is right and what is wrong not only in healthcare but also in life. Ethics means what is right and wrong regarding how a person acts and what they do. Law is a practice or procedure that is enforced by a higher authority in regard to a profession. Law and ethics go hand-in-hand in the healthcare world and are used and practiced on a daily basis. 

The relationship between law and ethics is weaved together for what people believe is good and evil. The law has the ability to force doctors and practitioners to perform what they may feel to be unethical in their practice. Doctors and practitioners who believe that the rules force them to be unethical must work within the legal world to change it to what they feel is ethical in practice. Both laws and ethics work to build a moral line for all people in healthcare and the world. Breaking an ethical code will cause embarrassment, confusion, and dissatisfaction; however, ethical principles do not carry legal penalties with them as the law does. A personal example of how law and ethics can be fused was when I replaced my hip. I wanted to make sure that the nurses, doctors, anesthesiologist, and all other staff helping with the procedure were on the same page and that there weren’t conflicting issues among all of them. This shows ethics between all of the team, along with wanting them on the same page. I would also like to make sure that my privacy was vital, that my information would not be given out to whoever asked for it, and that my surgery, diagnosis, etc., was not talked about to other staff members not working with me personally. If this privacy were to be broken, that would be a violation of HIPPA, which is a law of protection of privacy. 

There are four primary sources of law. Those are constitutional law, case law, statutory law, and administrative law.  Constitutional law is derived from federal and state constitutions and is the highest law in the country. Case law, also known as common law, is a law set by legal precedent. Legal precedent means decisions made by judges in the several courts that become the rule of law even though they were not established by legislation. Statutory law is laws passed by the U.S. Congress or state legislatures. Individual laws in this group of laws are called statutes. Statutes begin as bills at the federal or state levels. The bills then may become laws, or the governors may deny them. If the bills are passed, the laws may be altered, revoked, revised, or replaced by legislatures. Administrative law is statutes established to determine specific powers and procedures when agencies are created. Administrative agencies are created by Congress, the president, or individual state legislatures. Regulations may be passed that concern the functions of one agency, such as the IRS or OSHA. 

2. Kimberly  

Knowledge of law and ethics is important to healthcare practitioners and managers because it helps guide them when making decisions in their daily work. As a healthcare manager your job duties include creating new policies,  implementing new procedures, and managing employees. To effectively manage a facility and employees the healthcare manager needs to be knowledgeable of the laws that govern the healthcare industry and understand the healthcare organization’s code of ethics. The healthcare organization will have a code of ethics for all employees to follow stated in their mission and vision statements with further information through the human resources department. Healthcare practitioners are involved directly with the patients providing care. Through their education they are taught a code of morals and ethics when practicing medicine. Laws and ethics are in place to protect both the healthcare worker and the patient. It enables the healthcare practitioner to provide the best patient care and avoid potential legal issues(Judson & Harrison, 2021,p.4). 

    Laws are a set of societal rules enforced by public authorities, even though they are clearly written, are often still debated. Ethics are standards of conduct and moral judgment. Ethical situations are often debated because what is right from one person’s perspective is considered wrong by the opposing person. Laws are created as a minimum standard for a society to follow. Some issues are both right legally and ethically, which make them easier to follow, others are not. Healthcare organizations will often have ethics committees to handle ethical dilemmas. In the healthcare profession, members are expected to uphold the law and perform at a higher  standard(M.U.S.E., 2021). 

    There are four primary types of law: Constitutional, Case, Statutory, and Administrative. Constitutional laws originate from federal and state constitutions. Legal precedence are past cases, that are written down and referred to, to decide current cases. Case law is set by legal precedence. Laws that federal or state legislatures enact are statutes. They start out as federal or state bills, if the bill is past it becomes a Statutory law. Administrative law is statutes enacted to define the powers and procedures of an agency that is created by the president, Congress, or state legislatures(Judson & Harrison, 2021,p.75). 

3. Adrianna             Building a provider patient relationship is such an important part of being in healthcare. Without having a good provider patient relationship, you risk losing patient’s and possibly not being able to keep the lights on in the clinic. One way to maintain this relationship is by keeping the patient’s information confidential. This includes securing all documents with patient information on it, locking your computer, not accessing the patient information unless needed and discussing the patient information only when needed. One thing to keep in mind when discussing patient information is where you are discussing it at. For example, you do not want to discuss a situation with a patient in the middle of a busy hallway or an elevator with other people on it. Keeping the patient’s information private allows the patient to trust you in the long run. One other way to maintain the provider patient relationship is to prepare and maintain health records. This can be done by documenting a visit with the patient soon after the visit took place and ensuring everything is document thoroughly. Meaning, if the patient received an immunization at the visit, this is documented. Maintaining this documentation can help keep the patient on top of their health and can better manage care when it is needed (Health IT, 2016). Which builds a better provider patient relationship. 

      Maintaining a standard of care is also an important piece in healthcare. Standard of care refers to the level or performance that is expected of that individual in the healthcare field (Judson, K. 2020). Keeping the patient’s information confidential is sort of a given in the healthcare industry. You should not be discussing the patient’s personal health information unless it is necessary for you to do so. If it is not, it is kind of gossiping about the patient. Thus, keeping the patient information confidential and secure is a level of care that is expected of a healthcare provider. Another area that is expected is health records and preparing them and maintaining them. The golden rule in health care is if it is not documented it did not happen. Which is why documentation is something that is expected of healthcare providers. Ensuring documentation of a recent visit with the patient is completed in a timely manner helps out other departments as well. For instance, the billing department. They are not able to submit a claim with the insurance company until the chart is completely documented, and you can only bill the insurance company so long after a date of service. With that being said, preparing and maintain health records helps maintain a standard of care. 

4. Zachary Henderson  

                            The two guidelines from this list I have chosen are “document accurately” and “follow legal guidelines and maintain awareness of health care legislation and regulations”.  Documenting accurately is vital in healthcare whether it is inputting the patients’ information/demographics or inputting their medical information in order to bill. The information reported on MUST be ACCURATE. How are we to build effective provider/patient relationships if we mistakenly enter the wrong contact number, date of birth, billing house address, etc. These mistakes can be costly. On a more serious scale, what happens if a patient’s left leg is injured but we mistakenly document the right leg? Human nature suggests these types of errors will occur but again it is imperative that they do not. In-home healthcare (The field I work in) I understand when an RN (registered nurse) completes an assessment/evaluation on a patient they are to document the primary reason and secondary reason for the visit. There are codes called Diagnosis codes (DX codes) that are generated based on the specific issue a patient is having. For example: If a patient has hypertension their DX code is I10 or if they have COVID 19 it is U00. Documenting the correct Diagnosis is important because these DX codes help determine the HIPPS code. The HIPPS code is a billing code based on the patient’s source & timing, Clinical Group, functional level, and comorbidity. Simply, if the DX code is not documented correctly if will impact the reimbursement rate and or if the patient meets the medical criteria for the services provided. In the case of misdiagnosing or choosing the wrong code by mistake, the outcome can be the cancellation of care which could potentially harm a patient who truly does need care. Documenting correctly directly affects the standard of care the patient receives. 

Following legal guidelines and maintaining awareness of healthcare legislation and regulations is clearly important. As healthcare professionals, we need to be aware of the laws and regulations that are in place to ensure compliance and help maintain adequate levels of care. As a provider (from my experience) it eases a patient’s mind when they are confident the people who are in charge of their care are educated medically, on regulations, and on the law. As a provider, we are to understand the entire process from start to finish. Example: The centers for Medicare and Medicaid (CMS) changed the billing process from a Prospective payment system (PPS) into Patient-Driven Grouping Model (PDGM) in 2020. This payment structure change also changed how providers provide care. PDGM was created and implemented in ensure patients are receiving the highest level of care and not looked at as easy money (My words). This change will (in my opinion) help providers and healthcare professionals build better relationships with their patients and truly provide better quality care. If we as providers were not educated and were not aware of these changes, we would not be able to service the patients and community with the highest level of care. In conclusion, being aware of the laws, regulations, and legislation directly affects patient care and the level of confidence they (the patient) have in our services. In order to provide quality care (which should be the goal), we MUST document accurately, follow the law, maintain awareness of healthcare legislation and regulations.                                                                  

5 . Suwah-  

What were the most compelling topics learned in this course? 

This course was very much interesting and informative, however, the most compelling topics for me is as follows:
Chapter 4. Law, the courts, and contracts
Chapter 8. Privacy, Security, and fraud
Chapter 13. Stakeholders, costs and patient’s Rights.
The above topics were compelling for me because the information pertaining to these topics are dense and informative. One has to do a lot of research in order to be concise with information I put out there. 

How did participating in discussions help your understanding of the subject matter? Is anything still unclear that could be clarified? 

Participating in this class discussion was so essential for me. I learned a whole lot more from my classmates and I was able to gather information from my classmates’ posts and did further research that guided me along the way. 

What approaches could have yielded additional valuable information? 

The approaches taken during this course period was very educational. Knowing my strength and weakness in presenting paper writing was phenomenal. For me, I don’t think any additional valuable information needs to be yield, the course was taught with great communication, knowledge and understanding. 

How do you think the HIPAA certificate will help you as you seek a job in health care? 

Though I have not done it yet, I believe having a HIPAA certificate will be of more help in my career path as I pursue my degree in Healthcare Management. However, I am closely looking into doing it before the end of this week. 

6. Maria 

I enjoyed this class; I learned a lot which is pertinent to my career path. Every topic and discussion helped me to explore and gain a more in-depth knowledge of the healthcare system. Healthcare is such a vast technical topic, but this class has helped me gain more insight and understanding. The topic on HIPAA was very compelling, not only about patient confidentiality, privacy, and security, but also learning what is contained in each standard, all the rules and regulations. I knew about HIPAA, but not to the extent of what I gleaned from this class. Research on the different topics, and live chats (archived) has allowed me to garner more information on this very important piece of legislation.  

I currently work for a healthcare organization and my goal is to continue my career in the industry. I am glad I did the training because it not only enhanced what I already knew about HIPAA, but I learn so much more. I believe the HIPAA certification will give me an edge towards my career advancement. (Thanks a lot, CTU). 

The only approach that I think would have made a difference would be to have live chats the first day of class as oppose to the day before an assignment is due. 

Information gained from the textbook and live chats have helped tremendously. I enjoyed the discussion boards because for the most part there are no right or wrong answers, just different perspectives which I appreciate. 

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