Ch 3: Working In Health Care

Front 1

licensure

Back 1

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

Front 2

certification

Back 2

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

Front 3

registration

Back 3

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

Front 4

accreditation

Back 4

official authorization or approval for conforming to a specified standard

Front 5

reciprocity

Back 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

Front 6

allopathic

Back 6

means "different suffering"

refers to the medical philosophy that dictates training physicians to intervene in the disease process, through the use of drugs and surgery.

Front 7

tertiary care settings

Back 7

care settings providing highly specialized services

Front 8

endorsement

Back 8

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

Front 9

situations where physicians don't need valid license to practice in a specific state

Back 9

when responding to emergencies

while establishing state residency requirements in order to obtain license

when employed by US armed forces, Public Health Service, Veterans Admin, other federal facility

engaged solely in research and not treating patients

Front 10

licensed revoked or suspended

Back 10

revoked (canceled)
suspended (temporarily recalled)

felony
unprofessional conduct
personal or professional incapacity

Front 11

medical practice tests

Back 11

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

Front 12

medical boards

Back 12

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

Front 13

sole proprietorship

Back 13

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

Front 14

associate practice

Back 14

form of medical practice management in which 2 or more physicians share office space and employees but practice individually

Front 15

partnership

Back 15

form of medical practice management whereby 2 or more parties practice together under a written agreement specifying the rights, obligations and responsibilities of each partner

Front 16

corporation

Back 16

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

Front 17

group practice

Back 17

a medical management system in which 3 or more licensed physicians share the collective income, expenses, facilities, equipment, records, and personnel for the business

Front 18

managed care

Back 18

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

Front 19

indemnity

Back 19

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

Front 20

health maintenance organization (HMO)

Back 20

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

Front 21

individual (independent) practice association (IPA)

Back 21

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

Front 22

preferred provider organization (PPO)

Back 22

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

Front 23

physician-hospital organization (PHO)

Back 23

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

Front 24

primary care physician (PCP)

Back 24

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

Front 25

gatekeeper physician

Back 25

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

Front 26

point of service (POS) plan

Back 26

health care plan that allows members to seek health care from non-network physicians but pays the highest benefits for care when it is is given by the PCP or via referral from the PCP

Front 27

open access plan

Back 27

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

Front 28

Patient Protection and Affordable Care Act (PPACA)

Back 28

federal law enacted in 2010; many provisions to take effect 2014-15

expand health insurance coverage and otherwise regulate the health insurance industry

Front 29

Health Insurance Portability and Accountability Act (HIPAA) of 1996

Back 29

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

Front 30

Health Care Quality Improvement Act (HCQIA)

Back 30

federal statute passed to improve the quality of medical care nationwide. One provision established the National Practitioner Data Bank (NPDB)

Front 31

National Practitioner Data Bank (NPDB)

Back 31

A repository of information about health care practitioners, established by the Health Care Quality Improvement Act of 1986