Healthcare Systems & Settings Exam

Question 1

Diagnose illness, provide treatments, perform procedures, and write prescriptions

Answer 1

Medical doctors

Question 2

Do osteopathic manipulative therapy (OMT) to treat patients

Answer 2

Osteopathic providers (DO’s)

Question 3

Advanced training beyond RN degree, extensive clinical experience, diagnose and treat common illness, and focus on preventive care

Answer 3

Nurse practitioners

Question 4

Practice medicine under MD or DO, advanced degree

Answer 4

Physician assistant

Question 5

Diagnostic testing on blood under supervision of medical technologist

Answer 5

Medical laboratory technicians

Question 6

Check patients in and out, answer, phones, perform feeling, faxing, and other tasks

Answer 6

Medical receptionist

Question 7

HMO

Answer 7

Health maintenance organization

Question 8

PPO

Answer 8

Preferred provider organization

Question 9

ACO

Answer 9

Accountable care organization (capitation)

Question 10

PCMH

Answer 10

Patient centered medical home (global budget, pay for performance)

Question 11

-provides lower costs to plan members
-requires a referral from a PCP to to see specialist
-requires pre-authorization for surgery

Answer 11

HMO

Question 12

-provides lower cost of plan members
-less restrictions to see specialist
-can go out of network providers, but will cost more

Answer 12

PPO

Question 13

Provider network sharing financial and medical responsibility for coordinated patient care, for Medicare patients, ACA (In hopes of limiting unnecessary spending)

Answer 13

Accountable care organizations (ACO)

Question 14

Payment to physician per patient, per time period in advance, and incentives avoiding costly procedures based on demographics

Answer 14

Capitation (full or partial)

Question 15

Primary care provider (PCP) coordinates treatment for patient to ensure they receive necessary care (patient centered)

Answer 15

(PCMH) patient centered medical home

Question 16

Physicians receive fixed payments for patient care, encouraging, cost-effective treatment choices based on in individual factors

Answer 16

Global budget

Question 17

Providers paid for meeting, quality and efficiency criteria

Answer 17

Pay for performance

Question 18

Appropriate dress, personal phone use, punctuality, and respect for boundaries

Answer 18

Professionalism

Question 19

Lifelong goals

Answer 19

Intrinsic Motivation

Question 20

Driven by outside forces, short and less fulfilling

Answer 20

Extrinsic motivation

Question 21

Integrity, accountability, flexibility, and open mindness

Answer 21

Work ethic

Question 22

Delegated to medical assistance, work under supervision

Answer 22

Scope of pratice

Question 23

The degree of care or competence expected in a particular circumstance or role

Answer 23

Standard of care

Question 24

What can MA not do?

Answer 24

Diagnosed, treat, or instruct patients to take course of action

Question 25

What are the types of insurances?

Answer 25

Medicare, Medicaid, TRICARE, SCAMPVA, Worker’s Compensation, and private insurance plans

Question 26

Covers patients 65+ by part A (hospitalization) or part B (routine office visits)

Answer 26

Medicare

Question 27

Provides health insurance to low income individuals

Answer 27

Medicaid

Question 28

Allows dependents of military personal to receive treatment from civilian providers

Answer 28

TRICARE

Question 29

Covers surviving spouses and dependent children of veterans who died as a result of their service

Answer 29

CHAMPVA

Question 30

Covers the cost of medical, resulting from a job injury or accident

Answer 30

Worker’s Compensation

Question 31

Medical coverage purchased directly by an individual

Answer 31

Private insurance

Question 32

Maximum amount and insurance company will pay for a procedure or service

Answer 32

Allowed amount

Question 33

Amount of money paid by the patient for service or prescription

Answer 33

Copayment

Question 34

Patient and insurance company share the cost in a specified ration, such as 80/20

Answer 34

Coinsurance

Question 35

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

Answer 35

Deductible

Question 36

Amount of money paid by the patient (usually money/per paycheck) to have medical insurance, cost often shared between employer and employee

Answer 36

Premium

Question 37

Statement from the insurance company detailing what was paid, denied, reduced, etc

Answer 37

Explanation of benefits

Question 38

Provider agrees to write off the difference between the amount charge and the approved fee established by the insurance company

Answer 38

Participating provider

Question 39

organization that individual is qualified to perform job to professional standards (non-governmental agency/association)

Answer 39

Certification

Question 40

Granting of the title or licensed by board that gives you permission to practice chosen profession (wear pin), usually bored or governmental association

Answer 40

Registration

Question 41

General duties include?

Answer 41

Communicating and educating patients, patient navigator, and maintain medical records

Question 42

Administrative duties include?

Answer 42

Scheduling appointment, handling correspondence or billing, medical transcript, and answering telephones

Question 43

Clinical duties include?

Answer 43

Performing diagnostic test, recording, vital signs, history, administrating, medications allowed, and assist with minor surgery phlebotomy

Question 44

Laboratory duties include?

Answer 44

Performing CLIA wave tests, collecting and preparing laboratory specimens, teaching patients to collect specific specimens

Question 45

Medical assistant duties include?

Answer 45

General, administrative, clinical, and laboratory

Question 46

Greeting, and correspondence cell phone calls

Answer 46

Administrative roles of a medical assistant

Question 47

Medical history, explaining treatment, drawing labs, immunization prep

Answer 47

Clinical roles of medical assistant

Question 48

Providers of medical or health services, individually, or as organizations, that furnish, bill for, or are paid for services or products

Answer 48

Healthcare providers

Question 49

Are considered allopathic providers and are the most widely recognized type of doctor. They: diagnose, provide treatments, perform procedures, and write prescriptions.

Answer 49

Medical doctor (MD)

Question 50

Complete requirements that are similar to this of MDs to graduate and practice medicine. They: diagnose, provide treatments, perform procedures, and write prescriptions along with using osteopathic manipulative therapy in treating patients

Answer 50

Osteopathic providers (ODs)

Question 51

Provide basic patient care, including diagnosing and prescribing medication’s for common illnesses. They require advanced, academic training beyond the registered nurse are in degree and have an extensive amount of experience generally nurse practitioners focus on preventative care and disease prevention.

Answer 51

Nurse practitioner (NP)

Question 52

Practices medicine under the direct supervision of a licensed MD or DO. Additionally, are able to make clinical decisions and a responsible for variety of services.

Answer 52

Physician assistant (PA)

Question 53

Another term for conventional, or western, medical practices, and systems of health

Answer 53

Allopathic medicine

Question 54

A form of medical practice that provides all the benefits of conventional allopathic medicine, including prescription, drugs, and surgery, and emphasizes the interrelationship between the structure the function of the human body.

Answer 54

Osteopathic medicine

Question 55

Individuals with training and responsibilities that support, supplement, and assist the professional functions of physicians

Answer 55

Allied health personnel

Question 56

Check patients in and out, answer, phones, and perform filling, faxing, and other task

Answer 56

Medical receptionist

Question 57

Assist patients who have developed conditions that disable them developmentally, emotionally, mentally, or physically

Answer 57

Occupational therapist

Question 58

Assist pharmacist with preparation and administration of medications, and perform receptionist and billing duties

Answer 58

Pharmacy technician

Question 59

Assist persons with musculoskeletal problems. Focuses on restoring function and preventing disability. Do not require the expertise or judgment of a licensed pharmacist.

Answer 59

Physical therapist

Question 60

Good qualities of medical assistant

Answer 60

Professionalism, appropriate dress, punctuality, work, ethic, integrity, etc.

Question 61

Duties a medical profession is allowed to carry out based on job description, training, and qualifications

Answer 61

Scope of practice

Question 62

Giant blood screening, building administration, and vital science lab

Answer 62

Duties of a MA

Question 63

The degree of care that a reasonably prudent person should exercise under the same or similar circumstances. Cannot put beliefs or feelings into work. Must treat each patient with the same care.

Answer 63

Standard of care

Question 64

Same day in an out patient care

Answer 64

Ambulatory care

Question 65

MA credentials

Answer 65

CPT, CET, CCS, CEHRS

Question 66

Process of electronica data entry a provider instructions for treatment

Answer 66

Computerized physician order entry (CPOE)

Question 67

Providing more Americans with access to affordable health insurance, improving the quality of healthcare and health insurance, regulating the health insurance industry, and reducing healthcare spending in the US

Answer 67

Affordable care act

Question 68

Insurance method that focuses on prevention of disease requires referrals for specialist, pre-certification for hospitals, and outpatient procedure treatments

Answer 68

HMO, health maintenance organization

Question 69

A link of institutions and healthcare professions that together take on the responsibility of delivering coordinated care

Answer 69

Healthcare delivery system

Question 70

More flexible, does not need primary care provider, can go directly to specialist without referrals

Answer 70

Preferred provider, organization, PPO

Question 71

Able to service a wide range of symptoms, diagnosis and conditions using variety of resources

Answer 71

General medicine

Question 72

Treat acute and chronicle illnesses, take hass to look approachable, biological psychological social aspects

Answer 72

General practitioner (GP)

Question 73

Aftercare to the whole family from newborn to elders, use preventative care

Answer 73

family practitioner

Question 74

Provide comprehensive care for adults, often diagnosed and treat chronic long-term conditions

Answer 74

Internist

Question 75

Assess a more specific set of symptoms diagnosis, and conditions

Answer 75

Specialty medicine

Question 76

Specialize in heart and blood vessels

Answer 76

Cardiologist

Question 77

Specialize in conditions of the skin

Answer 77

Dermatologist

Question 78

Specialize in stomach, intestines, esophagus, liver, pancreas, colon and rectum

Answer 78

Gastroenterologist

Question 79

Specialize in female reproductive system, and fertility disorders

Answer 79

Gynecologist

Question 80

Specialize in the liver, biliary tree, gallbladder, and pancreas

Answer 80

Hepatologist

Question 81

Specialize in kidney care

Answer 81

Nephrologist

Question 82

Specialize in pregnancy, labor and delivery OB/GYN

Answer 82

Obstetrician

Question 83

Specialize in tumors/cancer

Answer 83

Oncologist

Question 84

Specialize in bones, joints, muscles, tendons, ligaments

Answer 84

Orthopedist

Question 85

Specialize in body, blood, urine, and other body fluids

Answer 85

Pathologist

Question 86

Specialize in x-rays, ultrasounds, MRIs, CT

Answer 86

Radiologist

Question 87

A doctor or specialist who studies the diseases of the urinary system

Answer 87

Urologist

Question 88

Provide convenience for your patience

Answer 88

Ancillary services

Question 89

Alternative emergency department shorter, waiting time and flexible hours

Answer 89

Urgent care

Question 90

X-rays, ultrasounds, and MRIs, CT

Answer 90

Diagnostic imaging

Question 91

MRI

Answer 91

Magnetic resonance imaging

Question 92

CT

Answer 92

Computed tomography

Question 93

EKG

Answer 93

Electrocardiogram

Question 94

EEG

Answer 94

Electroencephalogram

Question 95

Assisting patients regarding mobility, improving strength, and range of motion

Answer 95

Physical therapy

Question 96

Alternative therapies examples

Answer 96

Acupuncture, Chiropractic, Energy Therapy, Dietary Supplements

Question 97

Provides healthcare and return for pre-CERT scheduled payments and coordination care, defined network of providers in hospitals

Answer 97

Managed care

Question 98

Americans oldest and largest system of independent health insurance

Answer 98

Blue Cross Blue Shield

Question 99

Examples of private insurance plans

Answer 99

Blue Cross Blue Shield, United healthcare was once Aetna

Question 100

Health insurance claim form

Answer 100

CMS1500 form