CCM Ethical & Legal Issues in Care Management 2

Question 1

Under HIPAA, which category of information is protected from unauthorized disclosure?

Accepted Answer

Protected Health Information (PHI) in any form

Answer

Only electronically stored health information

Answer

Only written medical records

Answer

Only information shared between providers

Question 2

A care manager may legally share a patient's health information without explicit written authorization when it is for:

Accepted Answer

Treatment, payment, or healthcare operations (TPO)

Answer

A family member who requests it verbally

Answer

Another provider for marketing research

Answer

The patient's employer upon request

Question 3

A patient's right to access and receive copies of their own medical records is primarily protected under:

Accepted Answer

HIPAA's Privacy Rule

Answer

The Americans with Disabilities Act

Answer

The Affordable Care Act

Answer

ERISA

Question 4

In which situation is a care manager legally REQUIRED to breach patient confidentiality?

Accepted Answer

When there is a credible threat of harm to an identifiable third party

Answer

When a supervisor requests patient details for a meeting

Answer

When the patient's adult children are worried about their health

Answer

When a payer requires additional clinical documentation

Question 5

For informed consent to be legally and ethically valid, the patient must:

Accepted Answer

Understand the proposed plan, its risks, benefits, and alternatives

Answer

Simply sign a consent form prepared by the provider

Answer

Agree to all recommendations made by the care team

Answer

Provide consent only once at the start of care

Question 6

When a patient has been determined to lack decision-making capacity, healthcare decisions should be made by:

Accepted Answer

A legally designated surrogate acting in the patient's best interest

Answer

A court for every individual decision required

Answer

The care manager as the patient's primary advocate

Answer

The treatment team by consensus without a surrogate

Question 7

Which legal document allows a competent patient to specify their healthcare wishes in the event they become incapacitated?

Accepted Answer

A living will or advance directive

Answer

A general durable power of attorney

Answer

A HIPAA authorization form

Answer

A do-not-hospitalize order signed by the physician