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a mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors



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



a credentialing procedure whereby one's name is listed on a register as having paid a fee and/or met certain criteria within a profession



official authorization or approval for conforming to a specified standard



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



means "different suffering" and refers to the medical philosophy that dictates training physicians to intervene in the disease process, through the use of drugs and surgery


tertiary care settings

those care settings providing highly specialized services



the process by which a license may be awarded based on individual credentials judged to meet licensing requirements in a new state


medical practice acts

state laws written for the express purpose of governing the practice of medicine


medical boards

bodies established by the authority of each state's medical practice acts for the purpose of protecting the health, safety, and welfare of health care consumers through proper licensing and regulation of physicians and other health care practitioners


sole proprietorship

a form of medical practice management in which a physician practices alone, assuming all benefits and liabilities for the business


associate practice

a medical management system in which two or more physicians share office space and employees but practice individually



a form of medical practice management system whereby two or more parties practice together under a written agreement specifying the rights, obligations, and responsibilities of each partner



a body formed and authorized by law to act as a single person


group practice

a medical management system in which three or more licensed physicians share the collective income, expenses, facilities, equipment, records, and personnel for the business


managed care

a system in which financing, administration, and delivery of health care are combined to provide medical services to subscribers for a prepaid fee



a traditional form of health insurance that covers the insured against a potential loss of money from medical expenses resulting from an illness or accident


health maintenance organization (HMO)

a health plan that combines coverage of health care costs and delivery of health care for a prepaid premium


individual (or independent) practice association (IPA)

a type of HMO that contracts with groups of physicians who practice in their own offices and receive a per- member payment (capitation) from participating HMOs to provide a full range of health services for members


preferred provider organization (PPO)

a network of independent physicians, hospitals, and other health care providers who contract with an insurance carrier to provide medical care at a discount rate to patients who are part of the insurer's plan also called preferred provider association (PPA)


physician- hospital organization (PHO)

a health care plan in which physicians join with hospitals to provide a medical care delivery system and then contract for insurance with a commercial carrier or an HMO


primary care physician (PCP)

the physician responsible for directing all of the patient's medical care and determining whether the patient should be referred for speciality care


gatekeeper physician

the primary care physician who directs the medical care of managed care health plan members


point- of- service (POS) plan

a health care plan that allows members to seek health care from non network physicians but pays the highest benefits fro care when it is given by the primary care physician (PCP) or via a referral from the PCP


open access plan

a managed care feature whereby subscribers may see any in- network health care provider without a referral


patient protection and affordable care act (PPACA)

a federal law enacted in 2010, to expand health insurance coverage and otherwise regulate the health insurance industry. many provisions of the law are scheduled to take effect in 2014 and 2015


health care and education reconciliation act (HCERA)

also enacted in 2010, a federal law that added to regulations imposed on the insurance industry by PPACA


health insurance portability and accountability act (HIPAA) of 1996

a federal statute that helps workers keep continuous health insurance coverage for themselves and their dependents when they change jobs, protects confidential medical information from unauthorized disclosure or use, and helps curb the rising cost of fraud and abuse


healthcare integrity and protection data bank (HIPDB)

a national health care fraud and abuse data collection program established by HIPAA for the reporting and disclosure of certain adverse actions taken against health care providers, suppliers, or practitioners


health care quality improvement act (HCQIA) of 1986

a federal statute passed to improve the quality of medical care nationwide. one provision established the national practitioner data bank