chapter 3

Question 0

certification

Answer 0

a voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate

Question 1

licensure

Answer 1

a mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors

Question 2

registration

Answer 2

a credentialing procedure whereby one’s name is listed on a register as having paid a fee and/or met certain criteria within a profession

Question 3

accreditation

Answer 3

official authorization or approval for conforming to a specified standard

Question 4

reciprocity

Answer 4

the process by which a professional license obtained in one state may be accepted as valid in other states by prior agreement without reexamination

Question 5

allopathic

Answer 5

means “different suffering” and refers to the medical philosophy that dictates training physicians to intervene in the disease process, through the use of drugs and surgery

Question 6

tertiary care settings

Answer 6

those care settings providing highly specialized services

Question 7

endorsement

Answer 7

the process by which a license may be awarded based on individual credentials judged to meet licensing requirements in a new state

Question 8

medical practice acts

Answer 8

state laws written for the express purpose of governing the practice of medicine

Question 9

medical boards

Answer 9

bodies established by the authority of each state’s medical practice acts for the purpose of protecting the health, safety, and welfare of health care consumers through proper licensing and regulation of physicians and other health care practitioners

Question 10

sole proprietorship

Answer 10

a form of medical practice management in which a physician practices alone, assuming all benefits and liabilities for the business

Question 11

associate practice

Answer 11

a medical management system in which two or more physicians share office space and employees but practice individually

Question 12

partnership

Answer 12

a form of medical practice management system whereby two or more parties practice together under a written agreement specifying the rights, obligations, and responsibilities of each partner

Question 13

corporation

Answer 13

a body formed and authorized by law to act as a single person

Question 14

group practice

Answer 14

a medical management system in which three or more licensed physicians share the collective income, expenses, facilities, equipment, records, and personnel for the business

Question 15

managed care

Answer 15

a system in which financing, administration, and delivery of health care are combined to provide medical services to subscribers for a prepaid fee

Question 16

indemnity

Answer 16

a traditional form of health insurance that covers the insured against a potential loss of money from medical expenses resulting from an illness or accident

Question 17

health maintenance organization (HMO)

Answer 17

a health plan that combines coverage of health care costs and delivery of health care for a prepaid premium

Question 18

individual (or independent) practice association (IPA)

Answer 18

a type of HMO that contracts with groups of physicians who practice in their own offices and receive a per- member payment (capitation) from participating HMOs to provide a full range of health services for members

Question 19

preferred provider organization (PPO)

Answer 19

a network of independent physicians, hospitals, and other health care providers who contract with an insurance carrier to provide medical care at a discount rate to patients who are part of the insurer’s plan also called preferred provider association (PPA)

Question 20

physician- hospital organization (PHO)

Answer 20

a health care plan in which physicians join with hospitals to provide a medical care delivery system and then contract for insurance with a commercial carrier or an HMO

Question 21

primary care physician (PCP)

Answer 21

the physician responsible for directing all of the patient’s medical care and determining whether the patient should be referred for speciality care

Question 22

gatekeeper physician

Answer 22

the primary care physician who directs the medical care of managed care health plan members

Question 23

point- of- service (POS) plan

Answer 23

a health care plan that allows members to seek health care from non network physicians but pays the highest benefits fro care when it is given by the primary care physician (PCP) or via a referral from the PCP

Question 24

open access plan

Answer 24

a managed care feature whereby subscribers may see any in- network health care provider without a referral

Question 25

patient protection and affordable care act (PPACA)

Answer 25

a federal law enacted in 2010, to expand health insurance coverage and otherwise regulate the health insurance industry. many provisions of the law are scheduled to take effect in 2014 and 2015

Question 26

health care and education reconciliation act (HCERA)

Answer 26

also enacted in 2010, a federal law that added to regulations imposed on the insurance industry by PPACA

Question 27

health insurance portability and accountability act (HIPAA) of 1996

Answer 27

a federal statute that helps workers keep continuous health insurance coverage for themselves and their dependents when they change jobs, protects confidential medical information from unauthorized disclosure or use, and helps curb the rising cost of fraud and abuse

Question 28

healthcare integrity and protection data bank (HIPDB)

Answer 28

a national health care fraud and abuse data collection program established by HIPAA for the reporting and disclosure of certain adverse actions taken against health care providers, suppliers, or practitioners

Question 29

health care quality improvement act (HCQIA) of 1986

Answer 29

a federal statute passed to improve the quality of medical care nationwide. one provision established the national practitioner data bank

Question 30

national practitioner data bank (NPDB)

Answer 30

a repository of information about health care practitioners, established by the health care quality improvement act or 1986

Question 31

federal false claims act

Answer 31

a law that allows for individuals to bring civil actions on behalf of the U.S. government for false claims made to the federal government, under a provision of the law called qui tam (from latin meaning “to bring an action for the king and for oneself”)

Question 32

telemedicine

Answer 32

remote consultation by patients with physicians or other health professionals via telephone, closed- circuit television, or the internet

Question 33

cybermedicine

Answer 33

a form of telemedicine that involves direct contract between patients and physicians over the internet, usually for a fee

Question 34

e- health

Answer 34

term for the use of the internet as a source of consumer information about health and medicine