Professionalism & Legal Considerations Flashcards

A Medicare beneficiary requests a custom orthosis that the practitioner expects Medicare to deny as not reasonable and necessary. What should be done before delivering the device?

Answer: Issue an Advance Beneficiary Notice of Noncoverage (ABN) for the patient to sign

A properly executed ABN signed before service shifts financial liability to the beneficiary when Medicare denial is expected.

Under HIPAA, which disclosure of protected health information (PHI) is permitted without written patient authorization?

Answer: Sharing records with the referring physician for ongoing treatment

HIPAA permits PHI disclosure without authorization for treatment, payment, and health care operations.

A practitioner accepts a manufacturer's paid vacation in exchange for steering patients to its components. Which federal law is most directly violated?

Answer: Anti-Kickback Statute

The Anti-Kickback Statute prohibits offering or receiving remuneration to induce referrals or purchases of items paid by federal health programs.

What is the primary purpose of informed consent before fitting a prosthesis?

Answer: To ensure the patient understands risks, benefits, and alternatives before agreeing to care

Informed consent respects patient autonomy by disclosing risks, benefits, and alternatives so the patient can make a voluntary decision.

A practitioner documents a fitting session two weeks after it occurred without indicating the entry is late. What is the main problem?

Answer: Late entries must be clearly labeled with the current date and identified as addenda

Late entries must be identified as such and dated when written to maintain record integrity.

Which situation best describes a conflict of interest for an O&P practitioner?

Answer: Recommending a component primarily because the practitioner holds stock in its manufacturer

A financial interest that could influence clinical recommendations is a conflict of interest that must be disclosed or avoided.

Negligence in a malpractice claim requires duty, breach, causation, and which fourth element?

Answer: Damages

Negligence requires proof of duty, breach of the standard of care, causation, and actual damages to the patient.