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23 terms

Medical Law and Ethics Third Edition (Chapter Four)

This is for Medical Law and Ethics Proper Terms, and Spelling (Chapter by Chapter) Written by Bonnie F. Fremgen (Third Edition)
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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 member by a limited group of providers
Fixed-Payment Plan
a payment plan for medical bills that offers subscribers (members) complete medical care in return for a fixed monthly fee
Third-Party Payers
a party other than the patient who assumes responsibility for paying the patient's bills (for example, an insurance company)
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
Primary Care Physician (PCP)
HMO-designated physician to manage and control an enrolled patient's medical care
Managed Care Organization (MCO)
a type of medical plan that pays for and manages the medical care a patient receives
Capitation Rate
a fixed monthly fee paid by an HMO to health care providers for providing medical services to patients who are members of that HMO
Copayment
an agreed-upon fee paid by the insured for certain medical services; usually $10 to $20
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 debilitating ailments
Medicaid
federal program, implemented by the individual states, to provide financial assistance for the indigent
Indigent
a person who is without funds
Per Diem
daily rate (4)
Prospective Payment System
payment amount or reimbursement is known in advance
Diagnostic Related Groups (DRGs)
designations used to identify reimbursement per condition in a hospital; used for Medicare patients
Solo Practice
a medical practice in which the physician works alone
Sole Proprietorship
a type of medical practice in which one physician may employ other physicians
Partnership
a legal agreement in which two or more physicians share the business operation of a medical practice and become responsible for the actions of the other partners
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
Group Practice
three or more physicians who share the same facility and practice medicine together
Corporation
a type of medical practice, as established by law, that is managed by a board of directors
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
Conscience Clause
legislation or regulation stating that hospitals and healthcare professionals are not required to assist with such procedures as abortion and sterilization