CCMA prep Flashcards
(53 cards)
a form provided to the patient when the provided believes Medicare will probably not pay for the services received.
advance beneficiary notice (ABN)
the maximum amount a third-party payer will pay for a procedure or service.
allowed amount
an amount of money that is paid at the time of service
copayment
a policy provision found in medical insurance where the policyholder and the insurance company share the cost of covered losses in a ratio
coinsurance
a specific amount of money a patient must pay out of pocket before the insurance carrier begins paying
deductible
a statement from the insurance carrier detailing what was paid, denied, or reduced in payment. Contains information about amounts applied to deductible, coinsurance, and allowed amounts.
explanation of benefits
providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurance
participating provider (PAR)
Medicare covers;
- part A
- part B
patients age 65 and older
Part A: hospitalization
Part B: routine medical office visits
Tricare
authorized depnedents of military personnel to receive treatment from civilian providers at the expense of hte federral governmeent.
CHAMPVA
covers spouses and dependent children of veterans who died as a result of service-related disabilites
Medicaid
health insurance to medically indigent population through a cost-sharing program between federal and state governments
Managed Care
umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals.
Workers’ compensation
protects wage earners against the loss of wages and cost of medical care resulting from an occupational accident or as disease
Examples of private insurance plans
Blue cross blue shield, Aetna, United Healthcare
PPO vs HMO
PPO: not required to choose a PCP
HMO: comprehensive and required to choose a PCP
Which of the following duties is a medical assistant allowed to perform independently?
a. prescribe medication
b. record vital signs
c. give medical advice
d. provide medication samples
record vital signs
Which insurance provider is the oldest and largest system of independent health users in the US?
a. Tricare
b. Medicare
c. Blue Cross/Blue Shield
d. Medicaid
Blue Cross/Blue shield
A patient experiencing a subluxation should be treated by which of the following?
a. acupuncture
b. chiropractic care
c. biofeedback
d. herbal medicine
chiropractic care
Which of the following types of providers is qualified to assess patients of all ages with a variety of acute to severe conditions?
family practitioner
which of the following health care delivery models emphasized patient’s involvement in organizing their own health care?
a. hospice
b. home health agency
c. accountable care organization
d. patient-centered medical home
PCMH
PCMH
- five core attributes
health care delivery models coordinated through a patient’s PCP
1. comprehensive care
2. patient-centered care
3. coordinated care
4. accessible services
5. quality and safety
Which of the following insurance plan models requires a referral from a PCP to schedule an appointment with a specialist?
HMO
ac
before meals
ad lib
as needed
