Medical Terminology - GAMSS Terminology Test

[blank_start]ECFMG[blank_end] – 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

[blank_start]Credentialing[blank_end] - The collection, review and verification process used to determine the current professional qualifications, such as appropriate training, licensure, 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 settings

[blank_start]Credentials Verification Organization[blank_end] – 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.

[blank_start]Det Norske Veritas[blank_end] – 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.

Enrollment is the process by which a healthcare practitioner signs up for or registers into a private or government-run health plan.

The 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.

[blank_start]American Board of Medical Specialties[blank_end] – 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).

Certificate of Insurance (also known as [blank_start]Evidence of Insurance[blank_end]) – a form provided by the carrier to the 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

A program sponsored by the federal government and administered by states that is intended to provide health care and health-related services to low-income individuals.

Medicare is a federal health insurance program for people age 65 and older and for individuals with disabilities?

Is the leading accreditation body for managed care organizations (MCOs). It is a private, not-for-profit organization that evaluates and accredits managed care plans, networks, CVOs, behavioral health networks, and other managed care entities.

Legal 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.

PHI – [blank_start]Protected Health Information[blank_end]

COP – [blank_start]Conditions of Participation[blank_end]

Board Certification is the process by which medical professionals show core competency in medical specialties via criteria set forth by a specialty board?

Created under HCQIA, this is a national registry of healthcare practitioners that tracks and reports adverse actions against practitioners’ clinical privileges, licensure, federal program participation, malpractice action payments, and professional society memberships.

[blank_start]Adverse Actions[blank_end] – 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.

The limits of liability Indicate the maximum dollar amount the carrier will pay on a claim typically represented by a per claim & aggregate basis.

[blank_start]NPSG – National Patient Safety Goals[blank_end] – TJC developed standards set to promote specific improvement in patient safety that focus on system-wide problematic areas of health care and provide expert/experience-based solutions. Implementation of hand-washing guidelines is an example of a solution to the “prevent infection” goal.

[blank_start]Focused Professional Practice Evaluation[blank_end] - 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 the ability for new privileges or when there are concerns regarding current competency in performing existing privileges.