Medical Law and Ethics Chapter 4 with Verified Answers

Medical Law and Ethics Chapter 4 with Verified Answers 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. 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. Certification a voluntary credentialing process usually offered by a professional organization. Conscience clause legislation or regulation stating that hospitals and healthcare professionals are not required to assist with such procedures as abortion and sterilization. Copayment an agreed-upon fee paid by the insured for certain medical services; usually $10 to $20. Corporation a type of medical practice, as established by law, which is managed by a board of directors. Diagnostic related groups (DRGs) designations used to identify reimbursement per condition in a hospital; used for Medicare patients. Exclusive provider organization (EPO) a type of managed care that combines the concepts of the HMO and PPO. Fee splitting an agreement to pay a fee to another physician or agency for the referral of patients; this is illegal in some states and is considered to be an unethical medical practice. Fixed-payment plan a payment plan for medical bills that offers subscribers (members) complete medical care in return for a fixed monthly fee. 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. Franchisee person or company who holds a franchise. 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. Group practice three or more physicians who share the same facility and practice medicine together. Health Care Quality Improvement Act provides for peer review of physicians by other physicians and healthcare professionals. 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. Indigent a person who is impoverished and without funds. Laws rules or actions prescribed by a governmental authority that have a binding legal force. Licensure a mandatory credentialing process that allows an individual to perform certain skills. Managed care organization (MCO) a type of medical plan that pays for and manages the medical care a patient receives. Medicaid federal program, implemented by the individual states, to provide financial assistance for the indigent. 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. National Practitioners Data Bank (NPDB) a listing of names that assists with peer review of 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. Per diem daily rate Preferred Provider Organization (PPO) a managed care concept in which the patient must use a medical provider who is under contract with the insurer for an agreed-upon fee in order to receive copayment from the insurer. Primary care physician (PCP) HMO-designated physician to manage and control an enrolled patient's medical care. Prospective payment system the payment amount or reimbursement with a set rate for certain procedures is known in advance. Registration indicates that the person whose name is listed on an official record or register has met certain requirements in that particular profession. Sole proprietorship a type of medical practice in which one physician may employ other physicians. Solo practice a medical practice in which the physician works alone. Third-party payers a party other than the patient who assumes responsibility for paying the patient's bills (for example, an insurance company).