The Big Business of Health Care and You – Vocabulary Flashcards

Vocabulary flashcards covering key terms related to professional standards, legal concepts, and health care delivery systems from the lecture notes.

License

A credential issued by a licensing board that authorizes a person to practice a profession; indicates minimum competency and is often required to practice; not a guarantee of excellence.

Certification

A voluntary credential earned by passing an exam or meeting standards; signals competency and can aid employment; not the same as a license.

Board Certification

Advanced credential earned after completing additional education and passing a specialty exam; allows the provider to be viewed as an expert, but may set higher performance standards.

Discipline

Actions taken by a licensing board (warnings, suspensions, or revocations) for violations of rules or ethics to ensure professional conduct.

Vicariously Liable

A legal principle that an employer may be held responsible for the acts of its employees when those acts occur within the scope of employment.

Respondeat Superior

Latin for 'let the master answer'; the employer may be liable for the actions of its employees performed within the scope of their duties.

Scope of Practice

The defined range of professional activities a practitioner is authorized to perform; acting outside this scope can affect liability and accountability.

Medical Assistant (MA)

A non-licensed but registered clinical staff member who cannot independently decide on treatment and works under a physician as part of the care team.

HIPAA

The Health Insurance Portability and Accountability Act; a federal law protecting patient privacy and the confidentiality of health information.

Litigious

Describes a person or environment inclined to sue; a tendency to pursue legal action.

Liability Insurance (Malpractice Insurance)

Insurance that protects medical professionals from financial loss due to malpractice claims; typically includes defense, litigation expenses, and settlements up to policy limits; often occurrence-based.

Occurrence-Based Policy

A malpractice policy that covers incidents occurring during the policy period; the insurer on the date of the incident handles defense and coverage for the claim.

Malpractice Policy Benefits

What the policy provides: attorney fees, litigation expenses, court costs, and judgments or settlements up to the policy limit.

Sole Proprietorship

A business structure in which the physician/practice is one entity; carries personal liability for debts and judgments and may have simpler operations.

Partnership

A business structure with two or more doctors sharing income and debts; can offer shared resources but may involve personality clashes.

Corporation

A separate legal entity with limited liability; shareholders elect a Board of Directors; company officers manage daily operations; fiduciary duties apply.

Limited Liability Company (LLC)

A hybrid business structure combining limited liability with tax treatment like a partnership; separates personal assets from business debts.

Health Maintenance Organization (HMO)

A network-based health plan that requires using in-network providers and referrals for specialists; typically lower costs and restricted out-of-network coverage.

Preferred Provider Organization (PPO)

A health plan offering greater provider flexibility; can see in- or out-of-network providers; higher deductibles and payments often based on negotiated rates or UCR.