Administrative and Clinical Procedures
for the Canadian Health Professional
Chapters 4 &15 Exam Q&A
Partnership - ANSWER-Is a business formed by two or more individuals who are
jointly and separately financially liable for the operation of the business.
Professional Corporation - ANSWER-Is a legally incorporated business that allows
professionals to reap many of the benefits of a for-profit corporation.
Primary Care Groups - ANSWER-Called FHOs or family health organizations.
Clinic - ANSWER-Is a health-care setting that offers services to outpatients.
Types of Clinics: - ANSWER-Walk-in
After-hours
Urgent care
Outpatient
After-hours clinic - ANSWER-Organized by physicians within a community to ease
the stress on local Emergency departments and are operated on a fee for service
basis
Walk-in clinic - ANSWER-Offer medical services to clients usually without
appointments
Urgent care clinics - ANSWER-Offer services without appointments with the focus on
immediate care of urgent but not life threatening complaints
Outpatient clinics - ANSWER-Provide medical services to clients who have been
discharged from a facility; clients who need their often-specialized services.
Managed Care - ANSWER-A set of strategies, procedures, and policies designed to
control the use of health-care services, sometimes by organizing doctors, hospitals,
and other providers into groups in order to improve the quality and cost effectiveness
of health care.
Health Management Organizations (HMOs) - ANSWER-Offer prepaid,
comprehensive health coverage for hospital and physician services.
Global Budget - ANSWER-Any arrangement in which a facility/provider receives a
fixed amount of money for medical services, regardless of client volume,length of
stay, or services rendered.
, Capitation/population based funding - ANSWER-A funding system that pays a
physician a given amount per client enrolled,regardless of the number of services
performed.
Patient Enrollment Models - ANSWER-Mix of primary health care models
Rostering - ANSWER-Clients sign a form agreeing that they will seek all of their
primary care services from that group, or from one physician within that group (PEM)
Establishing a list of clients who agree to participate in a primary health network
according to the rules of the province/territory.
Fee-for-service - ANSWER-Describes a system under which a provider is paid by
public health insurance for each insured service rendered to an insured client. These
providers are considered "opted-in" to the public payment system.
Shadow billing - ANSWER-Is used in some primary care groups (PCG) to allow
direct comparison of the cost-effectiveness of capitation and fee-for-service.
Opted-In - ANSWER-(Of a physician) billing the provincial or territorial plan for health
services rendered.
Opted-Out - ANSWER-(Of a physician) billing clients for services rendered; clients
pay the fee to the doctor and submit a claim to the health plan. Very few physician
chose to opted-out.
Extra-billing - ANSWER-Charging a client more than the amount paid by the
provincial or territorial health plan for a medically necessary service.
Clawback - ANSWER-The amount, dollar for dollar, that the federal government cuts
cHT payments to a province or territory that permits extra-billing.
Salaries - ANSWER-Salaried doctor is paid a set fee for all services rendered during
a designated time frame. Usually paid for a full-time position contract. eg) physician
at a university performs a mix of research, teaching, and clinical work.
Sessional payment - ANSWER-Is similar to a salary but is not usually for a
permanent position.
Capitation - ANSWER-Provides a fixed payment for all medical services a client may
require in a given time frame.
Indirect Capitation - ANSWER-Occurs when an organization is given a set amount of
money to manage health care for a designated population base.
Blended Payment - ANSWER-Payments can be made in numerous combinations of
salary, fee-for-service, and capitation.
Physician Incentives - ANSWER-Physicians are monetarily remunerated if they
maximize services for their clients related to preventative medicine eg)
for the Canadian Health Professional
Chapters 4 &15 Exam Q&A
Partnership - ANSWER-Is a business formed by two or more individuals who are
jointly and separately financially liable for the operation of the business.
Professional Corporation - ANSWER-Is a legally incorporated business that allows
professionals to reap many of the benefits of a for-profit corporation.
Primary Care Groups - ANSWER-Called FHOs or family health organizations.
Clinic - ANSWER-Is a health-care setting that offers services to outpatients.
Types of Clinics: - ANSWER-Walk-in
After-hours
Urgent care
Outpatient
After-hours clinic - ANSWER-Organized by physicians within a community to ease
the stress on local Emergency departments and are operated on a fee for service
basis
Walk-in clinic - ANSWER-Offer medical services to clients usually without
appointments
Urgent care clinics - ANSWER-Offer services without appointments with the focus on
immediate care of urgent but not life threatening complaints
Outpatient clinics - ANSWER-Provide medical services to clients who have been
discharged from a facility; clients who need their often-specialized services.
Managed Care - ANSWER-A set of strategies, procedures, and policies designed to
control the use of health-care services, sometimes by organizing doctors, hospitals,
and other providers into groups in order to improve the quality and cost effectiveness
of health care.
Health Management Organizations (HMOs) - ANSWER-Offer prepaid,
comprehensive health coverage for hospital and physician services.
Global Budget - ANSWER-Any arrangement in which a facility/provider receives a
fixed amount of money for medical services, regardless of client volume,length of
stay, or services rendered.
, Capitation/population based funding - ANSWER-A funding system that pays a
physician a given amount per client enrolled,regardless of the number of services
performed.
Patient Enrollment Models - ANSWER-Mix of primary health care models
Rostering - ANSWER-Clients sign a form agreeing that they will seek all of their
primary care services from that group, or from one physician within that group (PEM)
Establishing a list of clients who agree to participate in a primary health network
according to the rules of the province/territory.
Fee-for-service - ANSWER-Describes a system under which a provider is paid by
public health insurance for each insured service rendered to an insured client. These
providers are considered "opted-in" to the public payment system.
Shadow billing - ANSWER-Is used in some primary care groups (PCG) to allow
direct comparison of the cost-effectiveness of capitation and fee-for-service.
Opted-In - ANSWER-(Of a physician) billing the provincial or territorial plan for health
services rendered.
Opted-Out - ANSWER-(Of a physician) billing clients for services rendered; clients
pay the fee to the doctor and submit a claim to the health plan. Very few physician
chose to opted-out.
Extra-billing - ANSWER-Charging a client more than the amount paid by the
provincial or territorial health plan for a medically necessary service.
Clawback - ANSWER-The amount, dollar for dollar, that the federal government cuts
cHT payments to a province or territory that permits extra-billing.
Salaries - ANSWER-Salaried doctor is paid a set fee for all services rendered during
a designated time frame. Usually paid for a full-time position contract. eg) physician
at a university performs a mix of research, teaching, and clinical work.
Sessional payment - ANSWER-Is similar to a salary but is not usually for a
permanent position.
Capitation - ANSWER-Provides a fixed payment for all medical services a client may
require in a given time frame.
Indirect Capitation - ANSWER-Occurs when an organization is given a set amount of
money to manage health care for a designated population base.
Blended Payment - ANSWER-Payments can be made in numerous combinations of
salary, fee-for-service, and capitation.
Physician Incentives - ANSWER-Physicians are monetarily remunerated if they
maximize services for their clients related to preventative medicine eg)
