Henderson Exam 3 Study Guide Chapters 6 & 7

Vocabulary flashcards covering healthcare law, ethics, business, and operations based on Henderson Exam 3 Study Guide Chapters 6 & 7.

Tort

A civil wrong that causes harm and may lead to compensation.

Negligence

Failing to use reasonable care.

Malpractice

Negligence by a healthcare professional that injures a patient.

Four Elements of Negligence

Duty, breach of duty, direct cause, and damages.

Compensatory Damages

Pays for the patient's losses or harm.

Punitive Damages

Punishes intentional or wrongful conduct.

Res Ipsa Loquitur

The injury itself suggests negligence because it normally would not happen without it.

Respondeat Superior

An employer may be responsible for an employee's negligence while the employee is doing the job.

Statute of Limitations

Sets the deadline for filing a lawsuit; the time may start when the injury is discovered.

Mediation

Helps both sides reach their own agreement.

Arbitration

Uses a neutral person who hears the case and makes a decision.

Risk Management

Finds possible dangers and reduces them to protect patients, staff, and the organization.

Comparative Negligence

The patient may share some responsibility for the injury, which can reduce the amount paid.

Assumption of Risk

The patient knew the risks and chose to accept them, usually through informed consent.

Good Samaritan Laws

Protects people who give emergency help in good faith, as long as they do not act recklessly.

Scope of Practice

The duties healthcare workers are trained and allowed to perform to help prevent patient harm and malpractice.

Physician

Licensed doctor.

Specialist

Doctor with advanced training in one area.

Nonphysician Provider

May provide skilled services and sometimes prescribe or bill.

Allied Health Professional

Supports patient care in another healthcare role.

Credentialing

Checking that a healthcare worker's qualifications are valid.

Certification

Shows that a person meets professional qualifications and is competent in the field.

Licensing

Legal permission to perform certain professional duties.

Registration

Being listed as qualified by a professional organization, often after meeting testing or other requirements.

Solo Practice

One physician is the only provider.

Sole Proprietorship

One provider owns the practice but may hire other providers.

Associate Practice

Two or more providers share office expenses but keep their own profits, losses, and liabilities.

Group Practice

Several providers work in one practice and share business operations, benefits, and profits.

Deductible

The amount the patient pays before insurance starts paying under the plan.

Copay

A fixed amount the patient pays for a covered service.

Coinsurance

A percentage of the allowed bill the patient pays after the deductible is met.

Third-Party Payer

An insurance company or other payer that pays healthcare claims for the patient.

Gatekeeper

The primary care provider who controls or authorizes referrals when the plan requires them.

Indemnity Plan

Gives more freedom to choose providers.

Managed Care Plan

Limits provider choices and negotiates costs.

HMO

Uses a provider network, usually requires a primary care physician, and generally covers only in-network care with lower costs and common copays.

PPO

Allows more provider choice and usually no referral is needed for specialists; out-of-network care is allowed at a higher cost.

POS Plan

Combines HMO and PPO features: a primary care provider directs care, but out-of-network care is allowed at a higher cost.

Medicare

A federal program mainly for people age 65 or older and some younger people with qualifying disabilities.

Medicaid

A federal-state program for people who meet income, medical-need, or disability rules.

TRICARE

Healthcare coverage for active-duty military members and dependents, plus eligible retired military members and dependents.

CHAMPVA

VA healthcare coverage for certain family members of qualifying veterans who are not eligible for TRICARE.

Medicare Part A

Covers hospital care.

Medicare Part B

Covers outpatient care.

Medicare Part C

Managed-care Medicare option.

Medicare Part D

Covers prescription drugs.

Incident-To Billing

Billing certain outpatient services provided by a nonphysician provider under the physician's billing, when requirements are met.