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32 terms

Law and Ethics Chapter 2 Working in Health Care Review 2

Law and Ethics
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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.