CHAPTER 1 Health Care Systems and Settings Flashcards
(155 cards)
1
Q
Medical assistants (along with other health care staff) function as what? What do they do?
A
members of a health care team that perform administrative and clinical procedures and responsibilities
2
Q
When do medical assistants often screen patients?
A
before the provider visit
3
Q
What is the overall role of a medical assistant?
A
primarily work alongside a provider in an outpatient or ambulatory setting
4
Q
What do administrative duties include?
A
greeting patients
handling correspondence
answering telephones
5
Q
What clinical tasks might medical assistants do?
A
-obtaining medical histories from patients
-explaining treatments or procedures
-drawing laboratory tests
-preparing and administering immunizations
6
Q
How might a medical assistant achieve credentialing?
A
by passing a national certification exam
7
Q
MDs stands for:
A
Medical doctors
8
Q
What are the roles and responsibilities of medical doctors (MDs)?
A
diagnose illnesses, provide treatments, perform procedures such as surgical interventions, write prescriptions
9
Q
Who is considered the allopathic providers (modern evidence based providers)?
A
Medical doctors (MDs)
10
Q
DOs stands for:
A
Osteopathic providers
11
Q
What are the roles and responsibilities of osteopathic providers (DOs)?
A
requirements and roles similar to those of MDs
uses modern medicine AND osteopathic manipulative therapy in treating their patients
12
Q
What is osteopathic manipulative therapy (OMT)?
A
uses hands on treatment approach to diagnose, treat, and prevent
uses bodies inter-connected system
13
Q
What are the roles and responsibilities of nurse practitioners?
A
basic patient care services such as: diagnosing and prescribing meds for common illnesses
14
Q
What academic training might nurse practitioners need?
A
advanced academic training beyond the registered nurse (RN) degree with extensive clinical experience
15
Q
What type of care do nurse practitioners typically focus on?
A
preventive care and disease prevention
16
Q
What are the roles and responsibilities of physician assistants?
A
practice medicine under the direction and supervision of a licensed MD or DO
can make clinical decisions and be responsible for a variety of services
17
Q
Medical laboratory technicians do what?
A
perform diagnostic testing on blood, bodily fluids, and other specimens under the supervision of a medical technologist
18
Q
Medical receptionists do what?
A
check patients in and out, answer phones, perform filing, faxing, and other tasks
19
Q
Occupational therapists do what?
A
assist patients who have developed conditions that disable them developmentally, emotionally, mentally, or physically
20
Q
Pharmacy technicians do what?
A
assist pharmacists with duties that do not require the expertise or judgement of a licensed pharmacist
21
Q
Physical therapists do what?
A
assist patients in regaining their mobility and improving their strength and range of motion
22
Q
Radiology technicians do what?
A
use various types of imaging equipment to assist the provider in diagnosing and treating certain diseases
23
Q
What does professionalism consist of?
A
skills, behavior, and appropriate judgment that represent the best qualities of a person in a specific profession
24
Q
What must medical assistants exhibit?
A
a courteous, conscientious, and businesslike manner in the workplace
dependability, initiative, flexibility, confidentiality, and a good attitude are all necessary with a high level of professionalismW
25
What is the appropriate dress attire?
good personal hygiene and appropriate work attire
26
What should you avoid wearing? Why?
perfumes and colognes
due to possible patient sensitivities
27
Makeup? Nails? Dress code overall?
Makeup: conservatively
Nails: clean (no acrylic), reasonable length
Dress code: varies, but should be comfortable and fit appropriately
28
What might many facilities not approve of?
facial piercings
extreme hairstyles
visible tattoos
29
When should you take personal phone calls and text messages?
during scheduled work breaks or lunch hours
30
When should you respond to a call while treating a patient?
NEVER this should not happen
31
What should you do if you do carry a phone?
put it on vibrate
32
What to do if a call MUST BE TAKEN?
step into hall or break area
33
Why is punctuality important?
-maintaining professionalism in health care environment
- reliable employee
- prioritize tasks and arrange-schedules to perform all necessary duties efficiently and effectively
34
What does setting appropriate boundaries in the workplace for coworkers and patients prevent?
awkward situations or misunderstandings
35
Where does most people's personal space range from?
1 1/2 to 4 feet
36
What should you be aware of in regards to respect for boundaries?
any nonverbal communication from the patient which might indicate she/he is feeling an invasion of personal space
RESPOND IMMEDIATELY
37
Intrinsic motivation
originates within an individual and focuses on lifelong goals
38
Extrinsic motivation
physical in nature and driven by outside forces
short-lived, less fulfilling
39
Why should you remain motivated in the workplace?
to provide quality patient care and remain an important part of the health care team
40
What is work ethic?
a set of values based on the moral virtues of hard work and diligence
41
What are the work ethic values based on?
an individual's diligence, virtues, morals, and desire to put forth a strong effort in their chosen profession
42
In the clinical or administrative work setting, what should a medical assistant do work ethic wise?
display initiative
be reliable
assist others
be present and ready to work
43
What is integrity?
the quality of being honest and having strong moral principles
44
What must all members of the health care team have a high level of?
integrity
45
What is this referring to?
Honesty, truthfulness, and equal treatment of all patients is a necessity for quality care in administrative and clinical settings.
integrity
46
What is accountability?
being responsible for one's own actions
also means- being able to explain and answer questions relating to their actions
47
Should medical assistants be accountable for their actions regarding any clinical or administrative tasks at all times? Or should someone else be held accountable?
YES MA'S SHOULD BE HELD ACCOUNTABLE
48
What must a medical assistant be able to do for a wide variety of situations?
be able to ACCLIMATE to a wide variety of situations
49
In the event of an emergency, what must staff be able to do?
be FLEXIBLE enough to adjust to schedule changes for all patients
50
What does being flexible also mean?
staff members are willing to assist each other when workloads are uneven
51
What is something a medical assistant should NEVER say?
"That's not my job." to a task within their scope of practice
52
What does an open-minded individual do?
listens to her opponent in a discussion rather than immediately shutting him out due to differences in opinion
53
What is open-mindedness?
willingness to try new things and be considerate of others ideas is a welcome characteristics, personally and professionally
54
What does scope of practice describe?
describes the duties that can be delegated to medical assistants based on their education, training, and experience
55
The scope of practice for the medical assistant does NOT constitute the practice of what?
the practice of medicine
56
The medical assistant works under who and performs what?
works under supervision of provider
performs tasks allowed by state and provider approval
57
Can medical assistants perform tasks they are not trained to do?
NOPE
should only perform duties that they have been trained or are certified to do
58
What are the variables that affect the scope of practice for medical assistants?
the regulations and policies issues by state medical boards
59
A medical assistant, with appropriate training may do what?
may safely provide technical supportive services that are simple, routine medical tasks under the supervision of a licensed physician
60
Can a medical assistant provide technical supportive services that are NOT set forth by the medical office's organizational policies?
NO NO
may ONLY provide these supportive services that are clearly set forth by the medical office's organizational policies
61
Can organizational policies set by a medical office be whatever they wish them to be?
NO they must adhere to state and government guidelines to ensure they are in compliance with current applicable laws
62
What is standard of care?
the degree of care or competence expected in a particular circumstance or role
63
Does standard of care only apply to MA's?
NOPE
applies to all health care professionals who provide care to patients
64
Can medical assistants diagnose a patient?
NO
they cannot diagnose, treat, or instruct patients to take any course of action
65
What must you be careful of as a medical assistant?
be careful to remain within the medical assistant scope of practice when carrying out duties at work
66
What are the titles and credentials that a medical assistant can pursue for career-building opportunities (there are five listed)?
Certified phlebotomy technician (CPT)
Certified EKG technician (CET)
Certified billing and coding specialist (CBCS)
Certified electronic health records specialist (CEHRS)
Certified health coach or patient navigator
67
What is a certified health coach or patient navigator/ what does this mean?
often directs patients through the health care system
help organize patient care, connect patients to additional resources, and help patients understand the health care system
68
What do many health coaches or patient navigators often have?
often have a chronic disease focus area:
cancer
heart disease
diabetes
69
What must a medical school graduate have before beginning to practice medicine?
must be licensed
70
Licensure for physicians is mandatory and controlled by what?
by a state board of medical examiners
71
What does every state require for MDs to practice?
a written examination
72
Graduates of medical schools in the US are licensed by endorsement of the...
the national board certificate
73
If a graduate of medical school is not licensed by endorsement, what must they do?
must pass the state board exam
74
As an MA, do you have to be certified?
generally optional BUT some states require official education and training for an MA to administer medication or perform phlebotomy procedures
75
Can any MA make a computerized physician order entry (CPOE) ...aka enter prescriptions into this?
no, the government may require certification for this
76
What are the advantages of certification as an MA?
increased initial job placement
higher wages
career advancement opportunities
77
Health care delivery is also known as what?
the health care system
78
What is health care delivery?
the organization of individuals, establishments, and resources to deliver health care services and meet the health needs of specific populations
79
What does the payment model issue?
issues a single bundled payment to providers or health care facilities for all services rendered to treat a given condition or provide a given treatment
80
What did The Affordable Care Act do?
promoted newer health care system and payment models by testing new methods of health care delivery and moving from a reimbursement structure (based on the amount of services rendered) to a method established on the value of care
81
What are the seven types of health care delivery models?
Accountable care organizations (ACOs)
Capitation (partial or full)
Global budget
Health maintenance organization (HMO)
Patient-centered medical home (PCMH)
Pay for performance
Preferred provider organization (PPO)
82
What is the Accountable care organizations (ACOs) payment model?
these groups of physicians, hospitals, and other health care providers come together voluntarily to provide coordinated high-quality care to their Medicare patients
when successful, they will share in the savings it achieves for the Medicare program
83
What is the Capitation (partial or full) payment model?
patients assigned a per-member, per-month payment based on their age, race, sex, lifestyle, medical history, and benefit design
payment rates tied to expected usage regardless of how often they visit
84
What is the Global budget payment model?
fixed total dollar amount paid annually for all care
participating providers can determine how money is spent
limit the level and the rate of increase of health care cost
85
What is the Health maintenance organization (HMO) payment model?
contracts with a medical center or group of providers to provide preventive and acute care for the insured person
generally require referrals to specialists as well as recertification and preauthorization for hospital admissions, outpatient procedures and treatments
86
What is the Patient-centered medical home (PCMH) payment model?
a primary care provider (PCP) coordinates treatment to make sure patients receive the required care when and where they need it and in a way they can understand
87
What is the Pay for performance payment model?
compensates providers only if they meet certain measures for quality and efficiency
generating quality benchmark measures connects provider reimbursement directly to the quality of care they provide
88
What is the Preferred provider organization (PPO) payment model?
an insured person doesn't need a PCP, bUT can go directly to a specialist without referrals
although patients can see providers in or out of their network, an in-network provider usually costs less
89
What plan has more flexibility than HMO plans?
Preferred provider organization (PPO)
90
In general vs. specialty services what does a generalist do?
provider is able to assess a wide range of symptoms, diagnoses, and conditions while using a variety of resources to build a treatment plan
91
In general vs. specialty services what does a specialist do?
provider assesses a more specific set of symptoms, diagnoses, and conditions
92
General practitioners (GPs) are what?
medical doctors who treat acute and chronic illnesses and provide preventive care and health education to patients
may take holistic approach
93
Family practitioners are what?
offer care to the whole family from newborns to older adults
familiar with a range of disorders and diseases
PREVENTATIVE CARE IS THEIR PRIMARY CONCERN
94
What are internists?
provide comprehensive care of adults, often diagnosing and treating chronic, long-term conditions
offer treatment for common illnesses and preventive care
broad understanding of body and its ailments to be able to diagnose conditions and provide treatment
95
Allergists
evaluate disorders and diseases of the immune system
including adverse reactions to medications and food, anaphylaxis, problems related to autoimmune disease, asthma
96
Anesthesiologists
manage pain or use sedation during surgical procedures
97
Cardiologists
specialize in diagnosing and treating diseases or conditions of the heart and blood vessels
98
Dermatologists
specialize in conditions of the skin
99
Endocrinologists
specialize in hormonal and glandular conditions
often work with patients who have diabetes mellitus
100
Gastroenterologists
specialize in managing diseases of the gastrointestinal tract
the stomach, intestines, esophagus, liver, pancreas, colon, and rectum
101
Gynecologists
specialize in the female reproductive system and fertility disorders
102
Hematologists
deal with blood and blood-producing organs
often work with patients who have anemia, leukemia, and lymphoma
103
Hepatologists
specialize in the study of body parts such as the liver, biliary tree, gallbladder, pancreas
104
Neonatologists
specialize in the care of newborns
105
Nephrologists
specialize in kidney care and treating diseases of the kidneys
106
Obstetricians
specialize in care of women during and after pregnancy
107
Oncologists
specialize in treatment and care of patients who have cancer
108
Ophthalmologists
specialize in eye conditions
109
Orthopedists
specialize in bones, joints, muscles, tendons, and ligaments
110
Otolaryngologists
specialize in ear, nose, and throat
111
Neurologists
specialize in nervous system
112
Pathologists
specialize in body tissues, blood, urine, and other body fluids to diagnose or treat medical conditions
113
Psychiatrists
specialize in mental disorders and conditions
114
Pediatricians
specialize in newborn, infant, child, and adolescent health care
115
Radiologists
specialize in the use of x-rays, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging to detect abnormalities throughout the body
116
Urologists
specialize in disorders of the urinary tracts
117
What are the five types of ancillary services?
Urgent Care
Laboratory services
Diagnostic imaging
Occupational therapy
Physical therapy
118
What does providing ancillary services in the provider office do?
adds convenience for patients and increases revenue for the organization
119
What do ancillary services do?
meet a specific medical need for a specific population
120
What are urgent cares/ what do they provide?
provide an alternative to the emergency department
cost less, shorter wait time, conveniently located
flexible hours and offer walk-in appointments
121
What are laboratory services?
perform diagnostic testing on blood, body fluids, and other types of specimens to conclude a diagnosis for the provider
122
What is diagnostic imaging?
machines such as x-ray equipment, ultrasound machines, magnetic resonance imaging (MRI), and computerized tomography (CT) take images of body parts to further diagnose a condition
123
What is occupational therapy?
assists patients who have conditions that disable them developmentally, emotionally, mentally or physically
helps patient compensate for loss of functions and rebuild to a functional level
124
What is physical therapy?
assists patients in regaining mobility and improving strength and range of motion
often impaired by an accident, injury or as a result of a disease
125
What are the four alternative therapies?
Acupuncture
Chiropractic
Energy therapy
Dietary supplements
126
What is acupuncture therapy?
involves pricking the skin or tissues with needles to relieve pain and treat various physical, mental, and emotional conditions
127
What is chiropractic therapy?
medicine diagnoses and treats mechanical disorders of the musculoskeletal system (particularly the spine)
128
What is energy therapy?
the calm method of clearing cellular memory through the human energy field promoting health, balance, and relaxation
centered on idea of connection between physical, emotional, mental states of life found in various holistic healing techniques
129
What is dietary supplements therapy?
contain one or more dietary ingredients including vitamins, minerals, herbs, or other botanicals
a plant or part of a plant is used for its flavor, scent, or potential therapeutic properties
130
Medical insurance coverage is available to individuals and families through what two plans?
individual or group plans
131
Why can't everyone get health insurance if it is available to everyone?
not everyone can afford it
132
In insurance terminology, what is:
Advance beneficiary notice (ABN)
a form provided to the patient when the provider believes medicare will probably NOT pay for services received
133
In insurance terminology, what is:
Allowed amount
the max amount a third-party payer will pay for a particular procedure or service
134
In insurance terminology, what is:
Copayment
an amount of money that is paid at the time of medical service
135
In insurance terminology, what is:
Coinsurance
a policy provision frequently found in medical insurance where the policyholder and insurance company share the cost of covered losses in a specified ratio scubas 80:20
136
In insurance terminology, what is:
Deductible
a specific amount of money a patient must pay out of pocket before insurance carrier begins to pay
137
In insurance terminology, what is:
Explanation of benefits
statement from insurance carrier detailing what was paid, denied, or reduced in payment
also contains information about amounts applied to the deductible, coinsurance, and allowed amounts
138
In insurance terminology, what is:
Participating provider (PAR)
providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer
139
What are the six types of insurance plans that federal and state government plans include?
Medicare
Tricare
CHAMPVA
Medicaid
Managed care
Workers' compensation
140
What is medicare?
covers patients age 65 and older by Part A (hospitalization) or Part B (routine medical office visit) benefits
141
What is tricare?
authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government
142
What is CHAMPVA?
covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities
143
What is medicaid?
provides health insurance to the medically indigent population through cost-sharing program between federal and state governments for those who meet specific eligibility criteria
144
What is managed care?
plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals
145
What is workers' compensation?
protects wage earners against the loss of wages and the cost of medical care resulting from an occupational accident or disease as long as the employee is not proven negligent
146
What are three private insurance plans?
Blue Cross Blue Shield
Aetna
United Healthcare
147
What is America's oldest and largest system of independent health insurers?
Blue Cross Blue Shield
148
What do private insurance plans offer?
two basic managed care models
PPO (preferred provider organization): allows more flexibility in the plan, not being required to choose a PCP
HMO (health maintenance organizations): comprehensive and most plans require their insured to choose a PCP
149
Most health care payers use what claim form for claims submitted by a provider or supplier?
the CMS-1500 health insurance claim
150
To complete the CMS-1500 health insurance claim, what information must medical assistants need?
Patient's and guarantor's demographic and insurance information
diagnostic test
treatment
procedure information
billing information
151
How many blocks or items does the CMS-1500 have?
33
152
What does the administrative simplification compliance act (ASCA) require?
requires that claims to Medicare be transmitted electronically
but draft can be completed on paper, sent electronically
153
Any new version of the CMS-1500 form must be approved by who?
The White House Office of Management and Budget (OMB)
154
What character should you used in the CMS-1500 when marking boxes?
X
155
