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Rad Law Ch-4
Medical Practice and Allied Health Professionals
| Question | Answer |
|---|---|
| Associate practice | a legal agreement in which physicians agree to share a facility and staff but do not, as a rule, share responsibility for the legal actions of each other |
| capitation rate | a fixed monthly fee paid by an HMO to healthcare providers for providing medical services to patients who are members of that HMO |
| conscience clause | legislation or regulation stating that hospitals and healthcare professionals are not required to assist with such procedures as abortion and steriliation |
| copayment | a agreed-upon fee paid by the insured for certain medical services |
| corporation | a type of medical practice, as established by law, that is managed by a board of directors |
| diagnostic related groups (DRGs) | designations used to identify reimbursement per condition in a hospital; used for Medicare patients |
| exclusive provider organization (EPO) | a type of managed care that combines the concepts of the HMO and PPO |
| fee splitting | an agreement to pay a fee to another physician ro agency for the referral of patients; this is illegal in some states adn is considered to be an unethical medical practice |
| fixed-payment plan | a payment plan for medical bills that offers subscribers complete medical care in return for a fixed monthly fee |
| franchise | a business run by an individual to whom a franchisor grants the exclusive right to market a product or service in a certain market area |
| franchisees | persons or companies who hold a franchise |
| gatekeeper | the person, such as a primary care physician, or entity, such as an insurance company, that approves patient referrals to other physicians or services |
| group practice | three or more physicians who share the same facility and practice medicine together |
| health maintenance organization (HMO) | a type of managed care plan that offers a range of health services to plan members for a predetermined fee per month by a limited group of providers |
| indegent | a person who is withou funds |
| managed care organization (MCO) | a type of medical plan that pays for and manages the medical care a patient receives |
| medicaid | federal program, implemented by the individual states, to provide financial assistance for the indegent |
| medicare | federal program that provides healthcare coverage for persons over 65 years of age as well as for disabled persons or those who suffer kidney disease or other debilitaitng ailments |
| partnership | a legal agreement in which two or more physicians share the business operations of a medical practice and become responsible for the actions of the other partners |
| per diem | dailly rate |
| preferred provider organization (PPO) | a managed care concept in which the patient must use a medical provider who is under contract with the insurer for an agreed-upon fee in order to recieve copayment form the insurer |
| primary care physician (PCP) | HMO-designated physician to manage and control an enrolled patients's medical care |
| prospective payment system | payment amount or reimbursement is known in advance |
| sole proprietorship | a type of medical practice in which one physician may employ other physicians |
| solo practice | a medical practice in which the physician works alone |
| thrid-party payers | a party other than the patient who assumes responsibilty for paying the patient's bill (an insurance company) |
Created by:
smweckler
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