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Description
Flashcards by Renata Demons, updated more than 1 year ago
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Created by Renata Demons
over 4 years ago
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| Question | Answer |
| ABMS - American Board of Medical Specialties | umbrella organization of the medical specialty boards recognized established medical organizations and accrediting bodies as providing primary source verification for education and training of certified physicians (MD/DO) |
| AANA – American Association of Nurse Anesthetists | the professional association CRNA’s. National Certification for the profession is overseen by this entity. |
| ACCME – Accreditation Council for Continuing Medical Education | group that develops and promotes standards for quality continuing medical education (CME) utilized by physicians in their maintenance of competence and incorporation of new knowledge |
| ACGME - Accreditation Council for Graduate Medical Education | entity responsible for the accreditation of post-MD medical training programs within the United States. Accreditation is accomplished through a peer review process and is based upon established standards and guidelines |
| ACLS – Advanced Cardiac Life Support | is a detailed medical protocol for the provision of lifesaving cardiac care in settings ranging from out-of-hospital environment (i.e. ambulances) to the hospital or acute care settings. Only trained medical personnel (physicians, nurses, EMT) are certified in ACLS |
| Adverse Actions | an event, such as a reduction of privileges because of competence problems that must be reported to the NPDB by hospitals or other entities that grant privileges or membership to practitioners |
| AHP – Allied Health Professional | clinical health care professionals distinct from medicine, dentistry, and nursing; examples would be Dosimetrist, Physical Therapists, and Occupational Therapists. Not all AHPs require licensure, but all require specific training and/or higher educational qualifications. |
| Alternate Carriers | malpractice insurance carriers that provide coverage for practitioners that are not part of the MDA Medical Protective Insurance Company coverage |
| AMA – American Medical Association | a national organization founded in 1897 that represents the collective interests of physicians |
| ANCC – American Nurses Credentialing Center | certification arm of the American Nurses Association; provides certification for educational programs, continuing education, and Nurse Practitioners. |
| AOA – American Osteopathic Association | a member association representing the interests of osteopathic physicians (D.O.s). The AOA serves as the primary certifying body for D.O.s, and is the accrediting agency for all osteopathic medical colleges and health care facilities |
| ATLS – Advanced Trauma Life Support | is a training program in the management of acute trauma cases that require surgical emergency care; its goal is to teach a simplified and standardized approach to trauma patients |
| BLS – Basic Life Support | is a specific level of out of hospital medical care provided by trained responders in the absence of advanced medical care. BLS is focused on the "ABC"s of out of hospital emergency care: Airway, Breathing, and Circulation/CPR. Both medical professional and non-medically trained individuals may become certified in BLS |
| Board Certification | process by which medical professionals show core competency in medical specialties via criteria set forth by a specialty board |
| COI – Certificate of Insurance (also known as Evidence of Insurance) | form provided by carrier to practitioner that shows malpractice coverage; should include carrier name, beginning and ending dates of coverage, name of practitioner, amounts of coverage, policy number, and any pertinent data regarding policy |
| Credentialing | The collection, review and verification process used to determine the current professional qualifications, such as appropriate training, license, certification/accreditation, and academic background, of a medical practitioner and whether the practitioner meets pre-established criteria for participation and/or privileging in a managed care network, a hospital medical staff, or other medical setting |
| CRNA | Certified Registered Nurse Anesthetist |
| CME | Continuing Medical Education |
| CEO | Chief Executive Office |
| CVO - Credentials Verification Organization | an entity which contracts to perform credentialing verifications on practitioners for clients, but does not offer a peer review process, assume risk, or offer privileges or membership to the practitioner |
| DEA – Drug Enforcement Agency | federal agency tasked with the oversight of providing certificates for prescription drug ordering. All eligible practitioners must have a current and valid DEA Certificate to write patient prescriptions. Appropriate drug schedules must be maintained as well by eligible practitioners |
| DO | Doctor of Osteopathy |
| DNV - Det Norske Veritas | international accreditation body that also has deeming status from CMS for hospitals and other healthcare facilities. Will most likely focus on providing a regulatory program that includes both CMS and ISO 9001 (International Organization for Standardization) oversight and compliance. |
| ECFMG – Educational Commission for Foreign Medical Graduates | organization that grants certification to physicians (MD) graduating from medical school programs outside of the United States. This program assesses the readiness of foreign graduates to enter residency programs within the United States |
| Enrollment | the process by which a healthcare practitioner signs up for or registers into a private or government-run health plan |
| EPLS – Excluded Parties List System (also known as SAM) | service from the GSA and lists all entities (companies and individuals) that are excluded from receiving Federal contracts, certain subcontracts, and certain Federal financial and non-financial assistance and benefits; more far-reaching than the OIG exclusions report |
| FACIS – Fraud and Abuse Control Information Center | web-based information service that allows subscribers to look up the sanction history of both individuals and entities associated with the healthcare field |
| FCVS - Federation Credentials Verification Service | part of the FSMB, the FCVS was established in 1996 to provide a centralized, uniform process for state medical boards to obtain a verified, primary source record of a physician's core medical credentials. FCVS allows a physician and/or physician assistant to establish a professional portfolio which can be forwarded, at the provider’s request, to any state medical board that has established an agreement with FCVS, hospital, health care or any other entity |
| FLEX – Federation Licensing Exam | a standardized objective exam given by licensing board to quality a physician (MD/DO) to obtain a state medical license. It has been replaced by the USMLE |
| FPPE – Focused Professional Practice Evaluation | monitoring and evaluation of a practitioner's performance and competency when a provider is new an organization and requesting privileges or when concerns about a provider’s competency or ability for new privileges or when there are concerns regarding current competency in performing existing privileges. |
| FSMB – Federation of State Medical Boards | national organization whose membership consists of all state medical boards. THE FSMB maintains a registry of all licensed physicians (MD/DO) who have been subjected to disciplinary actions by a state board. A FSMB Query is used to show and verify actions against a physician license. |
| Fifth Pathway | program that allows medical students which have studied abroad to complete their supervised clinical work at a U.S. medical school, become eligible for entry to U.S. residency training, and ultimately obtain a license to practice in the U.S. |
| GME – Graduate Medical Education | formal medical education pursued after receipt of the doctor of medicine (M.D.) or other professional degree in the medical sciences, usually as an intern, resident, or fellow. |
| GSA – General Services Administration | federal agency that oversees the business of the U.S. federal government; including the SAM/EPLS database |
| HIPAA – Health Insurance Portability and Accountability Act of 1996 | HIPAA is a far-ranging law that covers several areas, but most specifically it created the HIPDB and it called for the protection of confidentiality and security of health data through setting and enforcing standards, including the standardization of electronic patient health, administrative and financial data, unique health identifiers for individuals, employers, health plans and health care providers, and security standards protecting the confidentiality and integrity of individually identifiable health information - past, present or future |
| HIPDB – Health Integrity and Protection Data Bank | created under HIPPA, the HIPDB is primarily a flagging system that may serve to alert users to reported fraud and abuse of the Medicare/Medicaid, and other federally and state funded programs. Integrated w/ NPDB in 2014. |
| HMO – Health Maintenance Organization | is a type of MCO that provides healthcare through hospitals, doctors, and other providers with which the HMO has a contract. The Health Maintenance organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers only care rendered by those doctors and other professionals who have agreed to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a dedicated pool of patients |
| Limits of Liability | indicates the maximum dollar amount the carrier will pay on a claim typically represented by a per claim & aggregate basis |
| LIP – Licensed Independent Practitioner | any individual permitted by law and by the organization to provide care and services, without direction or supervision, within the scope of the individual's license and consistent with individually granted clinical privileges |
| Locum Tenens | (Latin: "holding the place", i.e., "Placeholder") A person who is temporarily fulfilling the duties and responsibilities for another member of the same profession |
| Malpractice | lgal liability against a practitioner or healthcare entity resulting from negligence or unprofessional treatment in the practice of a health care professional when professional skills are obligatory and expected |
| Managed Care | this is a comprehensive approach to healthcare delivery that encompasses planning, educating, monitoring, coordinating, and controlling quality, access, and cost while considering the interests of patients, providers, and payers; or a system that uses financial incentives and management controls to direct patients to providers who are responsible for giving appropriate care in cost-effective treatment settings |
| MCO – Managed Care Organization | an organization that combines the functions of health insurance, delivery of care, and administration. Examples include the independent practice association, third-party administrator, management service organization, and physician-hospital organization |
| MD – Medical Doctor | graduate of a medical school being granted the degree |
| MEC – Medical Executive Committee | a hospital committee that administers the medical staff and acts as an interface between the medical staff and the hospital's governing body; the committee consists of medical staff officers and is chaired by the chief of the medical staf |
| NCQA – National Committee for Quality Assurance | NCQA is the leading accreditation body for managed care organizations (MCOs). NCQA is a private, not-for-profit organization that evaluates and accredits managed care plans, networks, CVOs, behavioral health networks, and other managed care entities |
| Negligence | failure to exercise the care toward others which would reasonably be expected of a person in the circumstances, or taking action which a reasonable person would not |
| NP – Nurse Practitioner | a registered nurse (RN) with additional education and training, usually a Master’s or Doctoral degree, and hold national certification is areas of specialty (i.e. women’s health, adult, pediatric) as well being appropriately licensed through state nursing boards |
| NPDB – National Practitioner Data Bank | created under HCQIA, this is a national registry of healthcare practitioners that tracks and reports adverse actions against practitioners’ clinical privileges, license, federal program participation, malpractice action payments, and professional society memberships |
| NPI – National Provider Identifier | a unique 10-digit numeric identifier assigned to health care providers and organizations defined as covered entities under HIPAA. The NPI will be a permanent identifier assigned for life and used in all electronic healthcare data transfers; in 2007, it will replace all other provider identifiers previously used by health care providers (for example, UPIN, Medicare/Medicaid numbers, etc.) |
| OIG - Office of the Inspector Genera | division of US Health and Human Services Department, the OIG investigates and reports any fraud or abuse of practitioners enrolled in Medicaid and Medicare. The OIG report is available on-line to review current provider sanctions with these two programs |
| OPPE – Ongoing Professional Performance Evaluation | monitoring and evaluation of a practitioner's continuing performance and competency when a provider already has privileges at an organization. |
| PA – Physician Assistant | a specially trained person who is certified to provide basic medical services (as the diagnosis and treatment of common ailments) usually under the supervision of a licensed physician |
| PALS – Pediatric Advanced Life Support | an education certification course for advanced healthcare providers. It teaches advanced resuscitation techniques such as advanced airway management, cardiac drug therapy and arrhythmia interpretation for children (ages 1-8 years) and infants (ages 1-12 months) |
| Professional Liability Insurance | malpractice insurance that covers some of the major liability exposures of a company |
| PSV – Primary Source Verification | process by which practitioner credentials are verified directly from the source of the credential; PSV for a medical residency would be a letter directly from the residency program |
| Risk Management | review and assessment activity aimed to prevent the loss of resources resulting from actual or alleged accidents, negligence, or incompetence |
| RN – Registered Nurse | a nurse who has graduated from a college's nursing program or from a school of nursing and has passed a national licensing exam |
| Secondary-Source Verification | process by which practitioner credentials are verified indirectly or via a secondary source than directly from the source of the credential; secondary source verification for a medical residency would be a copy of the provider’s AMA Profile; the AMA has done PSV on the residency and this is allowed to be used as a secondary source |
| The Joint Commission | s the leading accrediting body of acute care (Hospital) facilities. A private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations providing home care, mental health, managed care, ambulatory care, long term care, and other healthcare related services. Before 2007, known as Joint Commission on Accreditation of Healthcare Organizations (JCAHO) |
| UPIN - Unique Physician Identification Number | Medicare Identification number for providers and groups; being replaced by the NPI and will be discontinued entirely in May 2007 |
| URAC – Utilization Review Accreditation Committee | a not-for-profit organization that performs reviews on external utilization review agencies, and other healthcare entities, such as managed care networks and triage call centers |
| USMLE – United States Medical Licensing Examination | a single, three-step examination for medical license in the United States. The exam assess ability to apply knowledge, concepts and principles important in health and disease, and concepts and principles that constitute the basis of safe and effective patient care. |
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