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 recieve a certificate.
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.
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.
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 practioners.
Ambulatory Care Setting
facility, such as a medical office, clinic, or outpatient surgical center, that provides medical care for patients who can walk and are not bedridden.
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.
Tertiary Care Settings
those care settings providing highly specialized services.
the process by which a license may be awarded based on individual credentialsjudged to meet licensing requirements in a new state.
literally, "let the master answer" a doctrine under which an employer is legally liable for the acts of his or her employees, if such acts were performed within the scope of the employee's duties.
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 two or more physciains 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 responsibilites of each partner.
a body formed and authorized by law to act as a single person.
a medical management system in which three or more licensed physicians share the collective income, expenses, facilities,records, and personnel for the business.
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 resulting freom an illness or accident.
Health Maintenance Organization (HMO)
a health plan that combines coverage of health care costs and delivery of health care for perpaid premium.
term for the use of the internet as a sorce of consumer information about health and medicine.
a form of telemedicine that involves direct contact between patients and physicians over the internet, usually for free.
remote consultation by patients with phsycians or other health professionals via telephone, closed-circut television, or the internet.
Federal False Claims
a law that allows for individuals to bring civil actions on behalf of the United States government for false claims made to the federal government, under a provision of the law called quitam.
Healthcare Intergrity 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 of 1996 (HIPAA)
a federal statue that helps workers keep continuous health insruance 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.
Health Care Quality Improvement Act of 1996 (HCQIQ)
a federal statue passed to improve the quality of medical care nationwide. one provision established the national practice data bank.
a managed care feature whereby subscribers may see any in-network health care provider without a referral.
Individual (or independent) practice association IPA
an HMO that contracts with groups of physcians who practice their own offices and recieve a per-member payment (capitation) from participating HMOs to provide a full range of health services for members.
Preferred Provider Organization (PPO)
a network of independent physcians, 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 insuer's plan aka PPA
Physician Hospital Organization (PHO)
a health care plan in which physcians join with hospitals to provide a medical care delivery system and then contract for insurance with a commercial carrier or an HMO.
Primary Care Physcian
the physcian responsible for directing all of a patient's medical care and determing whether the patient should be referred for specialty care.
the primary care physcian who directs the medical care of managed care health plan members.
Point of Service (POS) Plan
a health care plan that allows members to seek health care from non-network physcians but pays the highest benefits for care hwen it is given by the primary care physcian or via referral from the PCP.