PowerPoint - Analyzing Legal, Ethical and Insurance Considerations in Sports Medicine

Match

Match the following

• The state of being legally responsible for the harm one causes another person

• The failure to use ordinary or reasonable care—the care that persons would normally exercise to avoid injury to themselves or others under similar circumstances

• Legal wrongs committed against the person or property of another

• When an athlete knows of and understands the dangers of an activity and voluntarily chooses to be exposed to those dangers

Liability

Negligence

Torts

Assumption of Risk

• Liability

• Negligence

• Torts

• Assumption of Risk

Open Ended

What measures can be taken to minimize the chances of litigation should an athlete be injured?

Open Ended

What measures can be taken to minimize the chances of litigation should an athlete be injured?

Open Ended

Why is it necessary for an athlete to have both general health insurance and accident insurance?

Match

Briefly discuss the various methods of third-party reimbursement.

• A form of managed care that emphasizes preventive measures and limits where an individual can receive care, generally covering 100% of medical costs if services are rendered at an in-network facility and often utilizing a fixed monthly payment system to providers

• A group of health care providers who agree to offer services to policyholders at discounted rates, where policyholders are not required to pay for care if they go to a preferred facility, and payment is typically on a fee-for-service basis

• A form of reimbursement used by managed care providers where members make a standard monthly payment regardless of the amount of service they receive from the provider

• A traditional billing method where a provider charges the patient or a third-party payer a fee for services based on a set schedule, and it is not considered a type of managed care

• A health insurance program for individuals with low incomes and limited resources, funded by federal and state governments

Health Maintenance Organization (HMO)

Preferred Provider Organization (PPO)

Capitation

Indemnity Plan

Medicaid

• Health Maintenance Organization (HMO)

• Preferred Provider Organization (PPO)

• Capitation

• Indemnity Plan

• Medicaid

Open Ended

Why should an individual carry individual liability insurance?

Match

Match the the critical considerations for filing insurance claims

• Specify the condition or injury that the healthcare provider is treating

• Identify specific medical procedures used in treating a patient

• Healthcare providers must obtain and use or administrative and insurance transactions

Diagnostic Codes (ICD)

Procedural Code (CPT)

National Provider Identifier (NPI

• Diagnostic Codes (ICD)

• Procedural Code (CPT)

• National Provider Identifier (NPI