Shared Flashcard Set

Details

Ethics Ch 12
Professional Relationships, Private Practice and Health Care Plans
65
Accounting
Pre-School
02/17/2011

Additional Accounting Flashcards

 


 

Cards

Term
What is conferring?
Definition
the least structured type of communication, an informal comparing of observations
Term
What is consulting?
Definition
one professional solicits advice from another professional
Term
What is coordination?
Definition
procedures that allow service providers to work together for a client from the same treatment plan and goals, make ea. other aware of their various roles/functions in serving the client
Term
What is teamwork?
Definition
structured form of collaboration, often takes place in inpatient settings when various professionals work together to provide a range of services to a client
Term
When should one referral?
Definition
When a prof determines that a type of expertise they don't possess is needed to assist a client
Term
What rights do counselors have as employees?
Definition
- workplace free of discrimination based on race, color, sex, religion, national origin, age, and disability
- To not submit to a supervisor's directive if it constitutes a crime
-
Term
Can an employee refuse a directive because it is unethical?
Definition
Possibly, but it would have to be v. clearly unethical and put clients at substantial risk
Term
What is the "at will" doctrine?
Definition
employees don't have a right to employment and may be dismissed without giving any reasons
Term
What are the 3 legal theories that may lead a court to conclude that the dismissal of an employee was wrongful?
Definition
1. the employer promised the employee he/she wld have employment security
2. the dismissal offends some important public policy
3. the termination was unfair or done in bad faith
Term
Who has the burden of proof when determining if the dismissal of an employee was wrongful in the courts?
Definition
The employee who was dismissed
Term
When disputes arise btw employers and employees who does the law usually favor?
Definition
Employers
Term
What is the basis for dismissal for insubordination?
Definition
When accepting a job an employee agrees to perform the tasks assigned, if he/she fails to follow a directive that it is insubordination and grounds for termination
Term
What are the 4 defenses for refusing to carry out a directive of a supervisor?
Definition
1. it was in violation of an employment contract
2. it was in violation of internal policies or procedures
3. illegally discriminating against protected category of indls
4. constituted a crime
Term
What shld employees do if their supervisor issues a directive that is unethical but not illegal?
Definition
- consult with outside experts/colleagues confidentially
- schedule an appt with the supervisor to address their concerns w/ their employer and work toward change in the organization
- arrange an appt with your supervisor and his/her supervisor to discuss the situation
-refer to the approp certification or accreditation organization
- voluntarily terminate employment
Term
These two constructs only accept ethical complaints about individuals
Definition
licensure and certification boards
Term
What are a counselor's duties when it comes to transferring or sharing records?
Definition
counselor should get the client's fully informed consent
mark all records confidential
transfer only records containing pertinent information
Term
If a client rejects a referral how should the counselor proceed?
Definition
Document and terminate the relationship
Term
What is abandonment?
Definition
Failure of a counselor to assist in making approp arrangements for the continuation of treatment in the short term (vacation) or long term (not competent to give services/retirement of counselor)
Term
Can a counselor recruit clients for their private practice from their place of employment/institutional affiliation?
Definition
Nope
Term
Can a counselor refer a client to a specific counselor within an organization?
Definition
Yes - it is both legal and ethical
Term
Could a counselor be held accountable for the malpractice of a professional to whom they referred a client?
Definition
Generally no, unless the counselor has some reason to know or should have known that particular professional had a negative reputation in the professional community
Term
What is libel?
Definition
false, defamatory, or malicious written statements
Term
What is slander?
Definition
false, defamatory, or malicious statements that are verbal
Term
What is the premise for a suit charging libel or slander?
Definition
a professional believes that said or written comments have damaged their reputation
Term
What are defenses against accusations of libel or slander?
Definition
truth
retraction
absolute privilege and qualified privilege
Term
What is qualified privilege?
Definition
the right to repeat what you have heard in order to protect yourself
Term
What is the definition of a private practice?
Definition
If counselors generate any income at all outside of their salary
Term
What is sole proprietorship?
Definition
an indl professional owns the private practice and no other professional has a financial interest in it
Term
What is usually the best way to structure a private practice?
Definition
Sole proprietorship
Term
In which cases should a counselor chose to set up their private practice as a partnership?
Definition
1. the partnership is reqd to obtain financing for a new business
2. There is a significant advantage in the commercial market for a partnership over a sole proprietorship
Term
What are the arguments against forming a partnership?
Definition
- total agreement on all business decisions is reqd
- ea. partner is fully liable for the acts of omissions of ea. other partner
- there is a presumption of equality of partners regarding liabilities and profits
- personal assets are not protected from business debts
- dissolutions of partnerships can be contentious and expensive
Term
WHat motivates indls to set up their private practice as a corporation?
Definition
if the business involved is v. risky and the owner has substantial personal assets
Term
Name the ways in which corporations offer some advantages?
Definition
a. accumulation of capital
b. transferability of ownership
c. flexible fiscal year
d. employee benefits
e. reduction in liability
f. mgmt structure
Term
What are some of the problems assoc with corporations?
Definition
a. expensive to form
b. mtgs must be held periodically and annual reports must be filed for the corporation to cont to legally exist
- income is taxed to the corporation and is taxed again when distributed to owners
- accountants and lawyers must be retained to ensure the corporation is functioning properly
Term
What are the advantages of forming a non-profit?
Definition
favorable tax laws
eligible for grants
Term
What is the major disadvantage of a nonprofit?
Definition
counselor does not own or control the organization, run by a board of directors, board has the authority to remove the counselor as director and take over the business
Term
What impact does the fiduciary relationship of counselors with their clients have on fees for service?
Definition
must set fees within a framework of basic fairness considering the financial status of clients and locality. Fees shld reflect the local economy
Term
What are the legal responsibilities of a counselor when setting fees?
Definition
counselors can set any fee they wish for their services and can charge different amts for the same service as long as they do not discriminate based on constitutionally protected categories of persons
Term
WHat are your options if a client cannot afford your fees?
Definition
Must help the client by providing a referral to counseling services he/she can afford, until another counselor can be found you must continue to see the client even if they can't pay if they are considered to be in a state of emergency - this wld constitute abandonment
Term
What is a sliding scale fee structure?
Definition
fee for service is based on objective criteria such as amt of income and size of family
Term
Shld a sliding scale apply to clients with health insurance?
Definition
Yes - the sliding scale formula must be applied exactly the same for all clients, even those who have health insurance
Term
What is a counselors ethical obligation when using a collection agency or taking legal measures to collect payment?
Definition
inform the client of the intended action and offer the client opportunities to make payment

don't ever sue a client for payment
Term
What is the best way of preventing a client from developing a large unpaid bill for services?
Definition
expect clients to pay for ea. session at the time the session is held
Term
What is a non-competition agreement?
Definition
prohibits employees from practicing the profession for a specified time or within a geographic region when the employee leaves the organization.
Term
What are the three issues that have the biggest effect on client welfare during a counselor's transition out of an organization?
Definition
informed consent
transfer of clients
solicitation of of clients
Term
Who are the working poor?
Definition
People who produce an income that exceed the eligibility limits for Medicaid, have jobs that don't provide health insurance, and cannot afford to purchase health care plans on their own

they make up most of the people who do not have health care plans
Term
What is Medicaid
Definition
Insurance from the govt for indigent or disabled persons who cannot purchase their own insurance
Term
What is Medicare
Definition
govt insurance for older persons
Term
Who determines what kinds of health care plan contracts can be sold?
Definition
ea. indl state, states also mandate which categories of professionals are eligible for reimbursement by health care plans
Term
What is the freedom of choice legislation?
Definition
allows consumers of health care services to choose the provider they prefer rather than allowing health care companies to limit categories of approved providers
Term
What is an HMO?
Definition
Health maintenance organization
consumers agree to go to the HMO for all their health care needs and agree to accept the provider of health care services assigned to them by the HMO, HMOs hire health care providers and members cannot go outside of the organization for their health care
Term
What is a PPO?
Definition
Preferred Provider Organization
consumers agree to go to providers who have been preapproved by the organization for all their health care needs, members can choose their providers from a list of approved providers, PPOs do not hire providers of health care, members pay for health care services and are reimbursed by the PPO
Term
What is a traditional indemnity health insurance policy?
Definition
works similarly to a PPO except members do not have to go to pre-approved providers, members pay for services and then are reimbursed by the insurance company
Term
What does EPO stand for?
Definition
exclusive provider organizations, type of health care plan
Term
What does MCO stand for?
Definition
managed care organization, type of health care plan
Term
What does IPA stand for?
Definition
individual practice assoc, a type of health care plan
Term
What is managed care?
Definition
people are not given all the health care services they want - instead they are given the services the health care plan company has determined are appropriate and necessary (managing the care provided)
Term
What is a utilization review?
Definition
when a physician panel reviews requests for services from the treating service provider to determine whether services will be allowed by the health care plan company
Term
What is the conflict of interest counselors experience when working with PPOs?
Definition
must avoid alienating the health care company from whom they need referrals and advocate for quality care for their clients at the same time
Term
What does HIPAA say about client privacy and insurance companies?
Definition
insurance companies are limited to the types of information they may request, and are not allowed to disallow claims if clients refuse to provide them with certain types of information such as psychotherapy notes
Term
What is a gag clause?
Definition
a contract with a managed care company that says a counselor cannot discuss alternative treatments w/ clients that fall outside the boundaries of plan-approved services
Term
How does insurance impact informed consent?
Definition
Counselor must discuss any limits on treatment options or number of sessions imposed by insurance companies with their clients and what information their managed care organization requires the counselor to disclose as well as the ramifications of any diagnosis that might be assigned
Term
What is a co-payment?
Definition
a portion of the professional's fees that most PPOs and health insurance companies require clients to pay
Term
What are a counselor's responsibilities if they assess a client cannot be treated in the number of sessions their health insurance will pay for?
Definition
assess accurately
make a referral
appeal to the health care company for addl sessions
Term
What can health care companies do if they expect fraud by a counselor?
Definition
civil lawsuits to recover payments or reimbursements made inappropriately
OR
criminal charges bc fraud is a crime
Supporting users have an ad free experience!