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Case Management BasicsPublic Health Nursing Population Centered Health Care in the Community

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Claiming, either orally or in writing, that the case management treatment plan is better than that of a provider's plan is an example of a _________ legal risk.
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Liability for managing care
Inappropriate delegation of care is an example of a _______ legal risk.
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Liability for managing care
Referring clients to treatment furnished by providers related to the case management agency without disclosure is an example of a _______ legal risk.
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Liability for managing care
Failure to review a client's complete medical record, make a timely determination of benefits in light of timeliness of treatment or failure to communicate coverage determined to be needed are all examples of _________ legal risks.
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Experimental treatment and technology
Upcoding intensity of care or intervention requirements is an example of a ______ legal risk.
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Fraud and abuse
What are the legal citations relevant to case management and managed care?
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Negligent referrals, provider liability, payer liability, breach of contract, denial of care, and bad faith
What are the guidelines for reducing risk exposure for legal issues?
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1.Clear documentation of the extent of the client's participation in decision making and reasons for decisions 2. Records demonstrating accurate and complete information on interactions and outcomes 3. Use of reasonable care in selecting referrals sources which may include verifying of licensure 4. Written agreements when arrangements are made to modify benefits other than those in a contract 5. Good communication with clients 6. Informing clients of their rights of appeal
What guides case managers in ethical practice?
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Code of Ethics in Nursing (ANA) Performance indicators from the Standards of Practice for Case Management (CMSA) and the contract expressed in the Nursing's Social Policy Statement developed by the ANA
What is beneficence?
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Doing good
How can beneficence be impaired?
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When a nurse applies excessive attention to containing costs which impacts the nurse's duty to improve health or relieve suffering
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Equak distribution of health care with reasonable quality is the definition of ________.
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Justice
_________ means doing no harm.
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Nonmaleficence
When performing in the advocacy role, what conflicts might emerge?
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Conflicts about the full disclosure of information, territorality, accountability to multiple parties, legal challenges to client's decisions, and competition for scarce resources.
__________ is a systematic approach that includes understanding the values of each party and generating alternative solutions .
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Problem solving
Each individual has a predominant orientation when engaging in conflict, the possibilities are: (5)
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Competing Accomodating Avoiding Collaborating Compromising
As the health care systems moves towards delivery of more services to the community, ___________ will present a greater challenge.
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Continuity of care
  
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