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100

Who does the joint commission accredit?

variety of hospitals, long-term care facilities, clinical laboratories, ambulatory care (outpatient surgery, rehabilitation centers, group practices, home care)

100

What does licensure mean and when is it needed?

Mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors. Required in every state for physicians, nurses, and other health care practitioners.

100

Primary care medical home

(PCMH) focus on lowering costs and improving patient outcomes

100

Physician hospital organization

organizations that include physicians, hospitals, surgery centers, nursing homes, labs, and other medical service providers that contract with one or more HMO, insurance plans or direct employers to provide health care services

100

Who is the largest integrated healthcare?

Governmental health care - Veterens Affairs (VA)

200

Who oversees all educational accrediting bodies?

national associations

200

 What is a certification? and who has one?

A voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate.

Usually, a specific education and a national exam is required. 

CCMA

200

Independent practice home

is organized and owned by a network of independent physician practices that contract with employers and/or managed care organizations such as PPOs or HMOs

200

For profit

A business organization whose goal is to make a profit for the owners

200

Accreditation and who gets it?

Official authorization or approval for an organization conforming to specific standards and hospitals, patient care facilities and health plans

300

Utilization review?

method used by a health plan to measure the amount and appropriateness of health services used by its members

300

What does endorsement mean and when is it needed?

is another process by which a license may be awarded based on individual credentials judged to be licensing requirements in the new state of residence.

300

Health maintenance plan

all health services are are delivered and paid for through one organization. Group of physicians where there is a per-member fee

300

Not for profit

type of business organization that typically uses revenue for charitable or religious purposes

300

Reciprocity

the process by which a professional license obtained in one state may be accepted as valid in other states by prior agreement without re-examination

400

Where can a health care professional find the scope of practice for their job?

Duties determined by each state’s laws, regulations, educational requirements, and licensing bodies.

400

What does registration mean and when is it needed?

credentialing procedure whereby one’s name was listed on a register as having paid a fee and/or met certain educational criteria within a profession.

400

indemity plan

coverage of the insured person against a potential loss of money from medical expenses for an illness or accident

400

Copayment

flat fees that insurance plan subscribers pay for certain medical services (ex: office visits)

400

Which agency accredits nursing programs and which accredits long term care facilities?

Joint Commission - long term care facilities


Nursing - post-secondary Nursing education programs (ACEN)

500

What are 5 reasons why a physician's license may be revoked or suspended?

Sexual Misconduct

Substance Abuse

Professional Discipline

Fraud

Patient Abuse

Medication Violations

Unethical Behavior

Poor Documentation

Unlicensed Practice

Boundary Violations

500

Coinsurance

the amount of many insurance plan members must pay out of pocket, after the insurance plan pays

500

Fee for service plan

a health-care plan that pays for covered medical services after treatment is provided

500

Preferred provider plan

managed care plans that contract with a network of doctors, hospitals, and other health care providers who provide services for set fees. Can be seen outside of the plan for higher fees

500

What may the national practitioner data bank do?

may disclose information to the state licensing boards regarding malpractice payments and actions toward the health care providers and suppliers

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