Ch 3 Terms
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| Accountable Care Organization (ACO) | A predetermined payment for providers who take care of a designated patient population. Providers work together to provide care. Quality targets must be met.
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| Accreditation | a process for officially authorizing, approving, and recognizing quality in health care education programs, facilities, managed care plans, and other health care organizations.
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| Certification | A voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate.
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| Exclusive Provider Organization (EPO) | A managed care plan that pays for health care services only within the plan’s network of physicians, specialists, and hospitals (except in emergencies).
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| Health Maintenance Organization (HMO) | A health plan that combines coverage of health care costs and delivery of health care for a prepaid premium.
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| Health Savings Account (HSA) | Offered to individuals covered by high-deductible health plans, these accounts let these individuals save money, tax free, to pay for medical expenses.
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| High Deductible Health Plan (HDHP) | A plan with a higher deductible than a traditional health plan. The monthly premium is usually lower.
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| Independent 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 HMO members.
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| Licensure | A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors.
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| 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.
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| Managed Care Organization (MCO) | A corporation that links health care financing, administration, and service delivery.
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| Medical Services Organization (MSO) | A physician group purchases a hospital, which then contracts with employers to provide full health care services.
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| Open Access Plan (OAP) | Subscribers may see any in network provider without a referral.
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| Patient Centered Medical Home (PCMH) |
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| 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.
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| Point of Service plan (POS) | A primary care physician determines services for the patients within a network.
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| Practice Acts | State laws written for the express purpose of governing the practice of a specific health care profession.
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| Preferred Provider Organization /Association (PPO/PPA) | 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.
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| Primary Care Physician (PCP) | The physician responsible for directing all of a patient’s medical care and determining whether the patient should be referred for specialty care.
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| Professional Boards | Bodies established by each states practice act for the purpose of protecting the health safety and welfare of health care consumers by proper licensing and regulation of health care practitioners.
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| 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.
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| Registration | Similar to certification, individuals must meet certain educational requirements, as well as possibly successfully completing a nation exam.
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| Scope of Practice | The determination of the duties/procedures that a person may or may not perform under the auspices of a specific health care professional’s license.
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