Law and Ethics Chapter 2 Working in Health Care Review 2

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Law and Ethics

Involves a mandatory credentialing process established by law, usually at the state level.

licensure

Involves simply paying a fee

registration

Involves a voluntary credentialing process, usually national in scope, most ofter sponsored by a private-sector group.

certification

Required of all physicians, dentists, and nurses in every state

licensure

Consists simply of an entry in an official record

registration

A process that implies that health care facilities or HMOs have met certain standards

accreditation

The legal principle that says that the physician is responsible for the negligent acts of those employees under his/her supervision is called

respondeat superior

A copayment is

a set amount that each patient pays for each office visit.

Under this type of plan, insured patients must designate a primary care physician (PCP)

preferred provider plan

When physicians, hospitals, and other health care providers contract with one or more HMOs or directly with employers to provide care, this is called

a physician-hospital organization

Under this type of plan, a patient may see providers outside the plan, but the patient pays a higher portion of the fees:

preferred provider plan

Which od the following is mandatory for certain health professionals to practice in their field?

licensure

The National Practitioner Data Bank:

is accessible only to hospitals and health care plans

Licensure to practice medicine is done by

each individual state

Physicians today practice primarily

...

The Patient's Bill of Rights

has still not become law

What is the purpose of medical practice acts

to govern the practice of medicine

List four requirements that must be met before a physician can be granted a license to practice medicine

must have reached the age of majority, generally 21; must be of good moral character; must have completed required preliminary education, including graduation from an approved medical school, must have completed an approved residency program.

List four instances in which a physician might not need a license

when responding to emergencies; while establishing state residency requirements in order to obtain a license; when employed by the U.S. Armed Forces, Public Health Service, Veterans Administration, or other federal facility; when engaged solely in research and not treating patients.

Name three circumstances under which a physician's license may be revoked

conviction of a felony; unprofessional conduct; personal or professional incapacity.

Who has the authority to revoke a physician's license?

the state's medical board

sole proprietorship

advantage: solo practice
disadvantage: the physician has unlimited personal liability.

partnership

advantage: include sharing workload and expenses, and pooling profits and assets;
disadvantage: is that each partner has equal liability for the acts, conduct, losses, and deficits of the partnership, unless specific provisions are made for the contingencies in the initial agreement.

corporation

advantage: there are financial and tax advantages to forming a corporation, and fringe benefits to employees may be more generous than with a sole proprietorship or partnership. Incorporators and owners have limited liability in case lawsuits are filed.
disadvantage: state law governs corporations, so requirements for incorporation may vary.

List two types of managed care health care plans

HMO- health maintenance organization
PPO- preferred provider organization

Name the "whistleblower" statue that deals with fraud and abuse in health care.

the Federal False Claims Act allows to 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 "qui tam."

Define managed care plan

a system in which financing, administration, and delivery of health care are combined to provide medical services to subscribers for a prepaid fee.

Distinguish the term telemedicine

refers to remote consultation with physicians or other health care professionals via telephone, closed circuit television, fax machine, or the Internet.

Distinguish the term cybermedicine

involves direct contact between patients and physicians over the Internet usually for a fee.

Distinguish the term e-health

a term for the use of the Internet as a source of consumer information about health and medicine.

What telemedicine issues must state laws address?

reimbursement, licensure, funding, and confidentiality

What is the sole authority granted the federal government concerning the licensing of physicians?

the permit issued by Drug Enforcement Administration (DEA) for any physicians who dispenses, prescribes, or administers controlled substances, including narcotics and non-narcotics.

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