Ch. 3 Ethics – Flashcards

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

law, usually at the state level.Licenses to practice are required in every state for all physicians and nurses and for many other health care practitioners as well.

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

usually national in scope, and is most often sponsored by a nongovernmental, private-sector group. Certification by a professional organization, usually through an examination, signifies that an applicant has attained a certain level of knowledge and skill

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.

an official registry or record, listing the names of persons in a certain occupation who have satisfied specific requirements

Official authorization or approval for conforming to a specified standard, for health care education programs, health care facilities, and managed care plans.

Assurance of high-quality standards at your school.nAn opportunity for you to participate in federal and state financial aid programs. Better chance credits at your present school will be accepted at another institution if you transfer schools or attend graduate school.

State laws written for the express purpose of governing the practice of medicine.

Define what is meant by "practice of medicine" in each state. Explain requirements and methods for licensure.nProvide for the establishment of medical licensing boards. Establish grounds for suspension or revocation of license. Give conditions for license renewal.

public libraries, in some university libraries, and on the Internet.

Physical abuse of a patient. Inadequate record keeping. Failure recognize or act on common symptoms. prescription drugs in excessive amounts or without legitimate reason. Impaired ability to practice due to addiction or physical or mental illness. Failure to meet continuing education requirements. performance of duties beyond scope of license. Dishonesty. Conviction of a felony. The delegation of the practice of medicine to an unlicensed individual.

do not fall under the heading of misconduct.

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

the health, safety, and welfare of healthcare consumers through proper licensing and regulation of physicians and, in some jurisdictions, other health care practitioners. Board membership is composed of physicians and others who are, in most cases, appointed by the state's governor.

licensing and registration fees. Most boards include an executive officer, attorneys, and investigators. Some legal services may be provided by the state's office of the attorney general.

proof of education and training.mwork history. Pass an examination designed to assess their knowledge and their ability to apply that knowledge and other concepts and principles important to ensure safe and effective patient care.Reveal information about past medical history including alcohol and drug abuse, arrests, and convictions

Billing a governmental agency for services not rendered. Falsifying medical reports. Falsely advertising or misrepresenting to a patient "secret cures" or special powers to cure an ailment.

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

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

three or more physicians engage full time in providing health care services. They share the collective income of the practice, as well as expenses, facilities, equipment, patient records, and personnel necessary for running the business.

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

Two or more physicians decide to practice individually but agree to share office space and employees. This arrangement allows a sharing of expenses, but usually not a sharing of profits or liability.

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.

rights, obligations, and responsibilities of each partner. Advantages of partnerships include sharing the workload and expenses, and pooling profits and assets. disadvantage each partner has equal liability for acts, conduct, losses, and deficits of the partnership, unless specific provisions are made for these contingencies in the initial agreement.

A body formed and authorized by law to act as a single person. constituted by one or more persons and legally endowed with various rights and duties. State law governs corporations

shareholders and employees of the organization.financial and tax advantages to forming a corporation, and fringe benefits to employees may be more generous. have limited liability in case lawsuits are filed.

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

pay for and deliver healthcare to subscribers for a set fee using a network of physicians and other health care providers.

refers to the amount of money insurance plan members must pay out of pocket, after the insurance plan pays its share. example, plan agrees pay 80 percent of the cost for a surgical procedure, and subscriber pays remaining 20 percent.

amounts are specified by the insurance plan for each subscriber. example deductible for a single subscriber $500 a calendar year. the plan does not begin to pay benefits until the $500 deductible has been satisfied.

flat fees that insurance plan subscribers pay for certain medical services. example subscriber might be required to make a $20 copayment for each visit to a physician office.

are a plan's list of approved prescription medications for which it will reimburse subscribers.

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

A health plan that combines coverage of health care costs and delivery of health care for a specific payment.. Under HMO plans, all health services are delivered and paid for through one organization.

independent groups of physicians to provide coordinated care for large numbers of HMO patients for a fixed, per-member fee. include prepaid group practices. Physicians in PGPs are salaried employees.

to staff model HMOs can often see their doctors, get laboratory tests and X-rays, prescriptions filled, and order eyeglasses or contact lenses all in one location.

type of HMO contracts groups of physicians who practice in their own offices and receive a per-member payment or capitation from participating HMOs to provide a full range of health services for members. see patients outside the contracting HMO gives them a larger patient and income base.

A network of independent physicians, hospitals, and other health care providers for set fees. Subscribers may choose their primary health provider from an approved list for discount rate. pay higher out-of-pocket costs for care provided outside the PPO group list.

The physician responsible for directing all of a patient's medical care and determining whether the patient should be referred for specialty care. aka Gatekeeper or primary care plan.

Under open access plans, subscribers may see any in-network health care provider without a referral.

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

accountable care organizations (ACOs). The accountable care model emphasized preventive care, health care team coordination, electronic health records, treatment based on proof, and day or night access.

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

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.

Accelerating billing processes. reduce paperwork. healthcare billing fraud. tracking health information. Improving accuracy and reliability of shared data. Increasing access to computer networks within health care facilities. Help employees keep health insurance when transferring jobs . Protect confidential medical information from unauthorized disclosure or use.

HIPDB with the National Practitioner Data Bank. HIPDB is a national health care fraud and abuse data collection program for the reporting and disclosure of certain adverse actions taken against health care providers, suppliers, or practitioners.

Information that must be reported to the NPDB includes medical malpractice payments, adverse licensure actions, adverse clinical privilege actions, and adverse professional society membership actions. a resource to assist state licensing boards, hospitals, and other healthcare entities in investigating the qualifications of physicians, dentists, and other health care practitioners.

Patient Protection and Affordable Care Act or ACA. Data from the combined HIPDB and the NPDB are available to federal and state government agencies and to health plans, but are not available to the general public.

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