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Two basic ways of controlling health care costs are
competition and regulation
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related medical groups contributing their diagnosis of the nature of a patient's disease on which standardized fees are based.
diagnostic related groups (DRGs)
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likely to come about; looking forward to the future
prospective payment system
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ownership of a business by one person
sole proprietorship
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an association of two or more individuals to act as co-owners of a business venture
partenrship
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a means by which a group of people can unite to create an entity to do something impossible for the individual members. The organization is established by filling a certification of corporation in the state where its main place of business is located
corporation
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a corporation diversifying operations by acquuiring varied enterprises
conglomerate
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business structure with corporation and partne5rship qualities, which provides protection from personal liabilities like a corporation and the tax advantages of a partnership.
limited liability corporation
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a form of general partnership that provides protection from liability for an individual partner for certain partnership obligations
limited liability partnership
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the assents in money or property accumulated by individual, partnership, or corporate owndrship of a business; net worth
capital
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personal belongings and property owned by a person or, if he or she has died, by his or her estate
assets
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an announcement, written or displayed, gibing peertinent information to whose interested in a certain person, place, or event, or in any legal agreement such as a partnership
notice
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money, services, or goods owned to some person or persons to some person or persons to whom one is obligated.
debts
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those to whom money or its equivalent is owed
creditors
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units of stock giving the possessor part ownership in a corporation
shares
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persons holding formal positions of trust in an organization, especially those involved in high levels of management
officers
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a term used to describe a system of integration of the financing and delivery of health
managed care
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those elected and terminated by stockholders to management responsibility in a corporation
directors
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those who hold an interest (stock) in a corporation
stockholders
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In the context of managed care, what does gatekeeper mean to you?
Primary physician control who you see
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What
are the benefits of managed care?
keeps costs down
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what are the disadvantages of managed care
may not receive care you need
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what is prior authorization for managed care?
ask insurance if procedure can be done
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expenditure of capital to secure income or profit
investment
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direction or administration of the affiars of a person, business, or organization
managmement
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regulations adopted by a corporation or association to govern its internal
bylaw
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the gains accrued from a business or investment after the payment of expenses
profits
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profits of a corporation
dividends
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pay equally according to the number of individuals
per capita payment
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one who agrees to buy or belong for a peroid of time
subscriber
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payment in a lump sum to physicians, HMO's, and health care facilities to deliver health care to a segment of the population
capitation
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basis of professional billing, either so much per hour or per identified procedure
fee-for-service
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covering completely or broadly: inclusive
comprehension
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a group of persons together performing some business undertaking
joint venture
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the process of the submission and consideration of offers until an offer is accepted. Fee schedule refers to the amount an insurance company or other third-party payer will reimburse for a medical procedure.
negotiated fee schedules
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a process by which hostipals review patient progress to efficiently allocate scarce medical resources
utilization review
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failure to treat all persons equally when there is no reasonable distinction between those favored and those unfavored
discrimimation
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the movement of goods and services , or services that rely on the movement of goods, which cross state borders within the United States
interstate commerce
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between two or more states
interstate
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the force of impression of one thing on another
disparate impact
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a marked difference between two things
disparate treetment
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process of reasoning by which a fact is deduced as a logical consequence of other facts
inference
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on the surface the matter is impartial, or does not take an active part in either side
facially neutral
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having more evidence for than against
probable cause (reasonable cause)
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a way of practicing medicine when the patient is in one location and the treating physician is in another, possibly thousands of miles away.
telemedicine
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benefits paid to an employee for a prior term of service after he or she discontinues work for that employer
retirement benefits
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the representation of one thing or person similar to another
comparable
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procedural attempt to achieve collective agreements between an employer and accredited representative of employees, to improve the condition of employment
collective bargoning
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the labor union, or group of employees with similar interests, authorization to conduct negotioations on bhalf of the employees who are members of the union or group
barganing unit
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honesty of intention
good faith
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minimizing the danger or hazard
risk management
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responsibility to uphold the quality of care of patients in treatment situations
quality assurance
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conduct that is against common knowledge that, by its act, without argument, can be deligated negligence
negligent per se
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make less severe due to considerations of fairness and mercy
mitigating
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to raise or execute a tax
levy
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an offer of money from one person to another
tendered
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the particular county or geographic area where a court may try a case
venue
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FMLA
Family and Medical Leave Act
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a federal insurance program for people who are entitled to _____ from their social security contributions and payment of premiums.
Medicare
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is a program jointly administered by the federal government and state government for low-income individuals obtainable through social services or welfare departments
Medicaid
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