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Medical Law & Ethics
Chapter Three
| Term | Definition |
|---|---|
| Accreditation | Official authorization or approval for conforming to a specified standard |
| Allopathic | Means "different suffering" and refers to the medical philosophy that dictates training physicians to intervene in the disease process, through the use of drugs and surgery |
| Associate Practice | A medical management system in which two or more physicians share office space and employees but practice individually |
| Certiication | A voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate |
| Corporation | A body formed and authorized by law to act as a single person |
| Cybermedicine | A form of telemedicine that involves direct contact between patients and physicians over the internet, usually for a fee |
| E-Health | A term for the use of the Internet as a source of consumer information about health and medicine |
| Endorsement | The process by which a license may be awarded based on individual credentials judged to meet licensing requirements in a new state. |
| Federal False Claims Act | A law that allows for individuals to bring civil actions on behalf of the U.S. government for false claims made to the federal government, under a provision of the law called qui tam (from Latin meaning "to bring an action for the king and for oneself"). |
| Gatekeeper Physician | The primary care physician who directs the medical care of managed care health plan members |
| 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 |
| Health Care and Education Reconciliation Act (HCERA) | Enacted in 2010, a federal law that added to regulations imposed on the insurance industry by PPACA. |
| Health Care Quality Improvement Act (HCQIA) | A federal statute passed to improve the quality of medical care nationwide. One provision established the National Practitioner Data Bank |
| Health Integrity and Protection Data Bank (HIPDB) | A national health care fraud and abuse data collection program established by HIPAA for the reporting and disclosure of certain adverse actions taken against health care providers, suppliers, or practitioners. |
| Health Insurance Portability and Accountability Act | A federal statute that helps workers keep continuous insurance coverage for themselves & their dependents when they change jobs, protects confidential medical information from unauthorized disclosure or use, & helps curb the rising cost of fraud & abuse. |
| Health Maintenance Organization (HMO) | A health plan that combines coverage of health care costs and delivery of health care for prepaid premium |
| 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 |
| Individual practice association (IPA) | A type of HMO that contracts with groups of physicians who practice in their own offices and receive a per-member payment (capitation) from participating HMOs to provide a full range of health services for members. |
| Licensure | A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors |
| 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. |
| 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 |
| Medical Practice Acts | State laws written for the express purpose of governing the practice of medicine |
| National Practitioner Data Bank | A repository of information about health care practitioners, established by the Health Care Quality Improvement Act of 1986 |
| Open Access Plan | A managed care feature whereby subscribers may see any in-network health care provider without a referral |
| Partnership | 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 |
| Patient Protection and Affordable Care Act (PPACA) | A federal law enacted in 2010, to expand health insurance coverage and otherwise regulate the health insurance industry. Many provisions of the law are scheduled to take effect in 2014 and 2015 |
| Physician-Hospital Organization (PHO) | A 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. |
| 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 (PCP) or via a referral from the PCP |
| Preferred Provider Organization (PPO) | 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. AKA Preferred provider association (PPA) |
| Primary Care Physician (PCP) | The physicians responsible for directing all of a patient's medical care and determining whether the patient should be referred for specialty care |
| 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 |
| Registration | 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 |
| Sole proprietorship | A form of medical practice management in which a physician practices alone, assuming all benefits and liabilities for the business |
| Telemedicine | Remote consultation by patients with physicians or other health professionals via telephone, closed-circuit television, or the Internet. |
| Tertiary Care Settings | Those care settings providing highly specialized services |
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