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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)
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.
Primary care medical home
(PCMH) focus on lowering costs and improving patient outcomes
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
Who is the largest integrated healthcare?
Governmental health care - Veterens Affairs (VA)
Who oversees all educational accrediting bodies?
national associations
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
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
For profit
A business organization whose goal is to make a profit for the owners
Accreditation and who gets it?
Official authorization or approval for an organization conforming to specific standards and hospitals, patient care facilities and health plans
Utilization review?
method used by a health plan to measure the amount and appropriateness of health services used by its members
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.
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
Not for profit
type of business organization that typically uses revenue for charitable or religious purposes
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
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.
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.
indemity plan
coverage of the insured person against a potential loss of money from medical expenses for an illness or accident
Copayment
flat fees that insurance plan subscribers pay for certain medical services (ex: office visits)
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)
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
Coinsurance
the amount of many insurance plan members must pay out of pocket, after the insurance plan pays
Fee for service plan
a health-care plan that pays for covered medical services after treatment is provided
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
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