Chapter 3 Working in Health Care Flashcards
Licensure
A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors
Certification
a voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate.
registration
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
accreditation
official authorization or approval for conforming to a specified standard
reciprocity
the process by which a professional license obtained in one state may be accepted as valid in other states by prior agreement without reexamination
Doctor of Osteopathy
Specializes in musculoskeletal system
allopathic
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
Tertiary care settings
those care settings providing highly specialized services
Reasons Physicians Specialize
- higher financial compensation
- decreased prestige for generalist
- lack of actractiveness of generalist
US Medical Licensing Examination
- 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
Respondeat Superior
Latin for let the master answer
endorsement
the process by which a license may be awarded based on individual credentials judge to meet licensing requirements in a new state.
License revocation or suspension
- conviction of a felony
- unprofessional conduct
- personal or professional incapacity
Medical Boards
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
Unprofessional Conduct
- 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
Types of medical practice
- sole proprietorship
- partnership
- professional corporation
- group practice
Sole proprietorship
a form of medical practice management in which a physician practices alone, assuming all benefits and liabilities for the business
associate practice
a medical management system in which two or more physicians share office and employees but practice individually
partnership
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
Professional corporation
a body formed and authorized by law to act as a single person
group practice
a medical management system in which three or more licensed physicians share the collective income, expenses, facilities, equipment, records, and personnel for the business
Managed Care
a system in which financing, administration, and delivery of health care are combined to provide medical services to subscribers for a prepaid fee.
indemnity
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
Co-insurance
the amount of money insurance plan members must pay out of pocket after the insurance plan pays its share
co-payment
flat fees that insurance plant subscribers pay for certain medical services
deductible
amounts are specified by the insurance plan for each subscriber
formularies
plan’s list of approved prescription medications for which it will reimburse subscribers
Utilization review
method used by a health plan to measure the amount and appropriateness of health services used by its members
HMO
a health plan that combines coverage of health care costs and delivery of health care for a prepaid premium
Individual practice association
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
Preferred Provider Organization
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.
Physician hospital organization
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
primary care physician
the physician responsible for direction all of a patients medical care and determining whether the patient should be referred for specialty care.
point of service (POS) plan
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
Open access plan
a managed care feature whereby subscribers may see any in network health care provider without a referral
Health care and education reconcilitation act
also enacted in 2010, a federal law that added to regulations imposed on the insurance industry by PPACA
Patient protection and affordable care act
a federal law enacted in 2010 to expand health insurance coverage and otherwise regulate the health insurance industry.
HIPAA
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
Health care quality improvement act
a federal statue passed to improve the quality of medical care nationwide. One provision established the National Practitioner Data Bank
National Practitioner Data Bank
a repository of information about health care practitioners, established by the health care quality improvement act of 1986
Telemedicine
remote consultation by patients with physician or other health professional via telephone, closed-circuit television or the internet
cybermedicine
a form of telemedicine that involves direct contact between patients and physicians over the internet usually for a fee
e-health
term form the use of the internet as a source of information about health and medicine
