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Medical Assistant > Health Care Systems and Settings > Flashcards

Health Care Systems and Settings Flashcards

1
Q

What do MAs do

A
  • perform administrative and clinical procedures and responsibilities
  • screen pts before provider visit
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2
Q

Role of MA

A
  • work alongside a provider in an outpatient or ambulatory setting
  • administrative and clinical (crosstrained)
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3
Q

administrative duties of MA

A
  • greeting pts
  • handling correspondence
  • answering phones
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4
Q

clinical duties of MA

A
  • medical histories
  • explaining treatments or procedures
  • drawing lab tests
  • preparing and administering immunizations
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5
Q

Medical Doctors MD

A
  • allopathic providers
  • diagnose
  • treat
  • procedures
  • prescriptions
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6
Q

Osteopathic providers DO

A

-use osteopathic manipulative therapy (OMT) in treating pts

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7
Q

nurse practitioners

A
  • basic pt care service
  • diagnosing
  • prescribing
  • preventive care
  • disease prevention
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8
Q

physician assistant

A

-under the direction and supervision of MD or DO

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9
Q

medical lab tech

A
  • diagnostic testing on blood, bodily fluids

- under supervision of medical tech

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10
Q

medical receptionist

A
  • check pts in and out
  • answer phones
  • perform filing, faxing etc
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11
Q

occupational therapist

A

-assist pts who are disabled

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12
Q

pharmacy tech

A

-assist with duties that dont require the expertise or judgement of a licensed pharmascist

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13
Q

physical therapist

A

-assist pts in regaining mobility and improving strength/motion

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14
Q

radiology tech

A

-use imaging equipment to assist provider in diagnosing and treating

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15
Q

additional credentials for MA

A
  • phlebotomy
  • EKG
  • billing and coding
  • electronic health records
  • health coach or pt navigator
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16
Q

accountable care organizations (ACOs)

A
  • voluntarily provide coordinated high quality care to medicare pts
  • share in the savings it achieves for the medicare program
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17
Q

capitation (partial or full)

A

-pts are assigned per-member, per-month payment based on age, race, sex, lifestyle, medical history, and benefit design

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18
Q

global budget

A
  • fixed total dollar amount paid annually for all care

- limits the level and rate of increase of health care cost

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19
Q

health maintenance organization (HMO)

A
  • contracts with medical center or group of providers to provide care to insured persons
  • usually require referrals
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20
Q

patient center medical home (PCMH)

A
  • primary care provider coordinates treatment
  • comprehensive care, pt-centered care, coordinated care, accessible services, quality and safety
  • emphasizes pts involvement in organizing their own health care
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21
Q

pay for performance

A

-compensates providers only if they meet certain measure for quality and efficiency

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22
Q

preferred provider organization (PPO)

A
  • flexible
  • pt can go directly to specialist without referral
  • can see providers in and out of network
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23
Q

general practitioners (GPs)

A
  • medical doctors who treat acute and chronic illnesses
  • may take holistic approach -> considers biological, psychological, and social aspects of care
  • general
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24
Q

family practitioners

A
  • offers care to whole family
  • preventive care
  • general
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25
Q

internists

A
  • comprehensive care of adults
  • chronic long term conditions
  • general
26
Q

specialized practices

A
  • allergist
  • anesthesiologist
  • cardiologist
  • dermatologist
  • endocrinologist
  • gastroenterologist
  • gynecologist
  • hematologist
  • hepatologist
  • neonatologist
  • nephrologist
  • obstetricians (preg)
  • oncologist
  • ophthalmologist
  • orthopedists
  • otolaryngologist
  • neurologist
  • pathologist
  • pediatricians
  • psychiatrists
  • radiologist
  • urologist
27
Q

ancillary service

A
  • provides convenience for pts
  • meet specific medical need for a specific population
  • ex. occupational therapist- assist pts in day to day tasks
  • ex. urgent care- more locations and flexibility
  • labs
  • diagnostic imaging
  • physical therapy
28
Q

alternative therapies

A
  • acupuncture
  • chiropractic
  • energy therapy
  • dietary supplements
29
Q

advanced beneficiary notice (ABN)

A

-form when provider believes medicare will not pay for services received

30
Q

allowed amount

A

-maximum amount a third party payer will pay for a service

31
Q

copayment

A

-amount of money that is paid at time of medical service

32
Q

coinsurance

A
  • policyholder and insurance company share the cost of covered losses in a specified ratio
  • ex. 80:20
33
Q

deductible

A

-specific amount of money a pt must pay out of pocket before the insurance carrier begins paying

34
Q

explanation of benefits

A
  • statement from the insurance carrier detailing what was paid, denied, or reduced in payment
  • contains information about amounts applied to the deductible, coinsurance and allowed amounts
35
Q

participating provider (PAR)

A

-providers who agree to write off the difference between the amount charged by the provider and the approved fee established the insurer

36
Q

federal and state government plans

A
  • medicare
  • tricare
  • CHAMPVA
  • medicaid
  • managed care plans
  • workers compensation
37
Q

medicare

A
  • 65 and older

- by hospitalization or routine medical office visits

38
Q

tricare

A

-military personnel to receive treatment from civilian providers

39
Q

CHAMPVA

A

-covers surviving spouses and dependent children of veterans who died

40
Q

medicaid

A

-health care for medically indigent population through cost sharing program between federal and state government

41
Q

managed care

A

-plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals

42
Q

workers compensation

A

-protects wage earners against the loss of wages and cost of medical care resulting from occupational accident or disease

43
Q

private insurance

A
  • blue cross blue shield
  • aetna
  • united healthcare
  • 2 basic managed care models:
  • preferred provider organization PPO- flexibility in changing PCPs around
  • health maintenance organizations HMO- require to choose a PCP
44
Q

PCP

A

-primary care provider

45
Q

CMS-1500 form

A
  • health insurance claim form for claims submitted by a provider or supplier
  • MA needs pts and guarantors demographic and insurance information, diagnostic test, treatment, procedure info, and billing info
  • 33 blocks or items divided into 3 sections
46
Q

CMS-1500 form sections

A
    1. carrier block- address of insurance carrier
    1. pt insured section- info about pt (1-13)
    1. physician/supplier section- info about physician (14-33)
47
Q

administrative simplification compliance act (ASCA)

A
  • requires that claims to medicare by transmitted electronically
  • submitted electronically through billing or to a claim clearing house
  • must be no later than 12 months after date of service
48
Q

CPOE

A

computerized provider order entry

49
Q

lincensure

A
  • state regulated
  • issued upon graduation
  • not required for MA
50
Q

certification

A
  • generally optional

- requires continuing education to keep current

51
Q

who is responsible for the MA

A

-licensed health care professional

52
Q

preventive medicine specailist

A
  • evaluates mental illness, physical illness, and disability by analyzing pt health needs
  • all ages
53
Q

blue cross blue shield

A

-oldest and largest insurance

54
Q

vertigo

A

otolaryngologist

-eyes nose ear disease

55
Q

require a license

A
  • PA
  • radiologist
  • anesthesiologist
  • MA
  • DO
56
Q

exclusive provider organization (EPO)

A
  • shares features of HMO and PPO
  • pts can choose from a network of providers
  • do not need referral to see specialist
57
Q

fee schedule

A

-list of charges for procedures and services performed in the providers office

58
Q

subluxation

A
  • dislocation, misalignment

- treated by chiropractic care

59
Q

biofeedback

A
  • help pts relax by recognizing bodily functions

- teaches pts how to control physiologic responses to stress

60
Q

home health agency

A

-provide pts with in home services

Medical Assistant (9 decks)

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