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Healthcare Terms


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A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors.
A voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate.
An entry in 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.
The process by which a professional license obtained in one state may be accepted as valid in other states by prior agreement without reexamination.
medical practice acts
State laws written for the express purpose of governing the practice of medicine.
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 throught proper licensing and regulation of physicians and other health care practitioners.
ambulatory-care setting
Medical care provided in a facility such as a medical office, clinic, or out-patient surgical center for patients who can walk and are not bedridden.
The process by which a license may be awarded based on individual credentials judged to meet licensing requirements in a new state.
respondeat superior
Latin for "Let the master answer." Means that employers are liable for the acts of their employees performed within the scope of employment.
sole proprietorship
A form of medical practice management in which a physician practices alone, assuming all benefits and liabilities for the business.
associate practice
A medical management system in which two or more physicians share office space and employees but practice individually.
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.
A body formed and authorized by law to act as a single person.
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.
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.
A traditional form of health insurance that covers the insured against a potential loss of money from medical expenses for an illness or accident.
health maintenance organization (HMO)
A health plan that combines coverage of health care costs and delivery of health care for a prepaid premium.
individual practice (or independent)association (IPA)
A type of HMO that contracts with groups of physicians who practice in their own offices and receive a per-member payment from participating HMOs to provide a full range of health services for members.
preferred provider organization(PPO) or preferred provider association (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.
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.
gatekeeper physician
The primary care physician who directs the medical care of managed care health plan members.
open access
A managed care feature whereby subscribers may see any in-network health care provider without a referral.
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.
point-of-service plan (POS)
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 PCP or via a referral from the PCP.
Health Care Quality Improvement Act of 1986 (HCQIA)
A federal statute passed to improve the quality of medical care nationwide. One provision established the National Practitioner Data Bank.
National Practitioner Bank (NPDB)
A repository of information about health care practitioners, established by the Health Care Quality Improvement Act of 1986.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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 to curb the rising cost of fraud and abuse.
Healthcare Integrity and Protection Data Bank (HIPDB)
Established by HIPAA. 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.
Federal False Claims Act
A law that allows for individuals to bring civil actions on behalf fo the United States 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 one's self").
risk management
Steps taken to minimize danger, hazard, and liability.
quality improvement (QI) (or quality assurance)
Measures taken by health care providers and practitioners to uphold the quality of patient care.
Remote consultation by patients with physicians or other health professionals via telephone, closed-circuit television, or the Internet.
A form of telemedicine that involves direct contact between patients and physicians over the Internet, usually for a fee.
The term for the use of the Internet as a source of consumer information about health and medicine.
executive order
Order issued by the president that becomes law without Congressional approval.
checks and balances
The division of power among the three branches of government that keeps any one branch from assuming too much power.
case law
Law established through common law and legal precedent.
common law
The body of unwritten law developed in England, primarily from judicial decisions based on custom and tradition.
legal precedents
Decisions made by judges in various courts that become rule of law and apply to future cases, even though they were not enacted by legislation.
statutory law
Law passed by the U.S. Congress or state legislature.
administrative law
Enabling statutes enacted to define powers and procedures when an agency is created.
criminal law
Law that involves crimes against the state.
An offense punishishable by death or by imprisonment in a state or federal prison for more than one year.
A crime punishable by fine or by imprisonment in a facility other than a prison for less than one year.
The complaining party in a lawsuit.
The government as plaintiff in a criminal case.
The person or party against whom charges are brought in a criminal or civil lawsuit.
civil law
Does not involve crimes, but, instead, involves wrongful acts against persons.
A civil wrong committed against a person or property, excluding breach of contract.
The person guilty of committing a tort.
An unintentional tort alleged when one may have performed or failed to perform an act that a reasonable person would or would not have done in similar circumstances.
The power and authority given to a court to hear a case and to make a judgment.
A voluntary agreement between two parties in which specific promises are made for a consideration.
Without legal force or effect.
breach of contract
May be charged if either party fails to comply with the terms of a legally valid contract.
mentally incompetent
Unable to enter into a legal contract because of mental impairment.
Able to be set aside or to be revalidated at a later date.
Anyone under the age of majority--18 in most states, 21 in some jurisdictions.
expressed contract
Explicitly stated in written or spoken words.
implied contract
The conduct of the parties, rather than expressed words, creates the contract.
Statute of Frauds
State legislation governing written contracts.
third party payor contract
A written agreement signed by a party other than the patient who promises to pay the patient's bill.
Fair Debt Collection Practices Act
Requires debt collectors and creditors to treat debtors fairly. It prohibits certain methods of debt collection, including harassment, misrepresentation, threats, disseminating false information about the debtor, and engaging in unfair or illegal practices in attempting to collect a debt.
law of agency
The law that governs the relationship between a principal and his or her agent.
In performing workplace duties, the employee acts as the agent, or authorized representative, of the employer.

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