Chapter 3 Working in Health Care

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

Certification

Answer 2

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

Question 3

registration

Answer 3

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

Question 4

accreditation

Answer 4

official authorization or approval for conforming to a specified standard

Question 5

reciprocity

Answer 5

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 6

allopathic

Answer 6

different suffering and refers to the medical philosophy that dictates raining physicians to intervene in the disease process, thorough the use of drugs and surgery

Question 7

Tertiary care settings

Answer 7

those care settings providing highly specialized services

Question 8

Reasons Physicians Specialize

Answer 8

• higher financial compensation
• decreased prestige for generalist
• lack of actractiveness of generalist

Question 9

US Medical Licensing Examination

Answer 9

• aka medical boards
• part 1 after first year of medical school
• part 2 during 4th year of medical school
• part 3 during the 1st year of post graduate training

Question 10

Respondeat Superior

Answer 10

Latin for let the master answer

Question 11

endorsement

Answer 11

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

Question 12

License revocation or suspension

Answer 12

• conviction of a felony
• unprofessional conduct
• personal or professional incapacity

Question 13

Medical Boards

Answer 13

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 14

Unprofessional Conduct

Answer 14

• physical abuse of a patient
• inadequate record keeping
• failure to recognize or act on common symptoms
• the prescription of drugs in excessive amounts or without legitimate reason
• impaired ability to practice due to addiction or physical or mental illness

Question 15

Types of medical practice

Answer 15

• sole proprietorship
• partnership
• professional corporation
• group practice

Question 16

Sole proprietorship

Answer 16

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

Question 17

associate practice

Answer 17

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

Question 18

partnership

Answer 18

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

Question 19

Professional corporation

Answer 19

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

Question 20

group practice

Answer 20

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 21

Managed Care

Answer 21

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

Question 22

indemnity

Answer 22

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 23

copay

Answer 23

the amount of money insurance plan members must pay out of pocket after the insurance plan pays its share

Question 24

co-payment

Answer 24

flat fees that insurance plant subscribers pay for certain medical services

Question 25

deductible

Answer 25

amounts are specified by the insurance plan for each subscriber

Question 26

formularies

Answer 26

plan’s list of approved prescription medications for which it will reimburse subscribers

Question 27

Utilization review

Answer 27

method used by a health plan to measure the amount and appropriateness of health services used by its members

Question 28

HMO

Answer 28

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

Question 29

Individual practice association

Answer 29

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

Question 30

Preferred Provider Organization

Answer 30

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.

Question 31

Physician hospital organization

Answer 31

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

Question 32

primary care physician

Answer 32

the physician responsible for direction all of a patients medical care and determining whether the patient should be referred for specialty care.

Question 33

point of service (POS) plan

Answer 33

a health care plan that allows members to seek health care from nonnetwork physicians but pays the highest benefits for care when it is given by the primary care physician or via referral from the PCP

Question 34

Open access plan

Answer 34

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

Question 35

Health care and education reconcilitation act

Answer 35

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

Question 36

Patient protection and affordable care act

Answer 36

a federal law enacted in 2010 to expand health insurance coverage and otherwise regulate the health insurance industry.

Question 37

HIPAA

Answer 37

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 38

Health care quality improvement act

Answer 38

a federal statue passed to improve the quality of medical care nationwide. One provision established the National Practitioner Data Bank

Question 39

National Practitioner Data Bank

Answer 39

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

Question 40

Telemedicine

Answer 40

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

Question 41

cybermedicine

Answer 41

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

Question 42

e-health

Answer 42

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