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16 Cards in this Set
- Front
- Back
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Locality Rule
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Advances in the
-profession -Avability of facilities. -Speclization/general practice. -Proximity of specalists -Special facilities together are taken into account. |
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Rational Choice Theory
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1)Individuals will not choose something that will make them worse off.
2)You can rank order your preferences. 3)You will pick the same option given the same circumstances |
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Profession Costume Rule
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Courts no longer defer to professional costume to solely determine whether a physicians actions reached the standard of care.
Courts now analyze if the costume itself is reasonable based on current medical knowledge. |
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Corporate Liability
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Holding hospitals responsible for their own instituional acts.
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Vicarious Liability
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One party can be held legally accountable for the actions of another based solely on the type of relationship existing between the 2 parties.
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Manage Care
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Health insurance arrangements that integrate the financing and delivery of services to covered individuals.
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Health Maintence Orgization (HMO)
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Health Insurance plan that provides various preventive and treatment services for a fixed payment per month.
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Utilization Review
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Uses MCO personnel to review and approve/deny services requested by a provider to make sure only necessary and approiate care is provided.
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Case Management
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Uses MCO personnel to manage and coordinate patient care to make sure care is provided in the best way possible.
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Childrens Health Insurance Program (CHIP)
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Health insurance program targeted to low income children administered by states and funded through federal and state payments.
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Asymetric Information
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When one party has more information than the other party.
For insurance, the imbalance often favors the consumer because insurance carriers don't know as much about the individuals health as they do. |
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HIPAA
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A federal law that regulates health insurers and health benefit plans in the group market and provides privacy protect regarding health information.
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Changes to protect insurance companies from raising premiums?
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1) Health Status
2) Physical/Mental medical conditions. 3) Claims history 4) Receipt of healthcare. 5) Medical History 6) Genetic Information 7) Evidence of Insurability 8) Disability |
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Who is covered by Medicaid?
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1) Categorical
2) Income 3) Resources 4) Residency 5) Immigration |
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What are the Affordable Care Act changes to Medicare?
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1) New coverage for preventive services.
2) Bonus payment for primary care services. 3) Assistance in pay for prescription drugs. 4) Changes will result in reduced reimbursement for providers. |
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In order, 4 things you demonstrate in a malpractice suit.
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1) Negligent Errors
2) Negligence in a professional relationship 3) Fee Disputes 4) Claims filed by a non-client against a lawyer. |
