Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CCMA (School Edition) > Insurance/ Basic Knowledge > Flashcards

Insurance/ Basic Knowledge Flashcards

(57 cards)

Start Studying
1
Q

Define Scope of Practice

A

Describes the procedure, actions, and process that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional training, licensure, or certificate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is within the Medical Assistants Scope of Practice?

A
  • Educating patients on how to take their medication
  • Health promotion of the patient
  • Performing an EKG
  • Taking a patient’s vitals
  • Performing a urinalysis and a throat culture
  • Patient education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is outside the Medical Assistants Scope of Practice?

A
  • Diagnosing a patient
  • Administering Narcotics
  • Interpreting lab results
  • Pathogenic identification
  • Performing an Arterial Blood Gas (ABG)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Assult

A

Open threat of bodily harm against another person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Battery

A

An action that causes bodily harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Fraud

A

Deception with the intent to deprive another person of his/ her rights

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Invasion of Privacy

A

Intruding on a patient’s private affairs, or disclosure of private information

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Malpractice

A

The negligent delivery of professional services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Negligence

A

The failure to do something that a reasonably prudent individual would do under similar circumstances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Spousal Abuse/ Intimate Partner Abuse

A

Provide a list of organizations within the local community that can assist with the situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tort

A

A civil wrong committed against a person or property

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chain of Custody

A

In legal context, refers to the chronological documentation showing the paper trail, custody, control, transfer, analysis, and disposition of physical or electronic evidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical Laboratory Improvement Amendments (CLIA)

A

Sets quality standards and issues certificates for human clinical laboratories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Health Insurance Portability and Accountability Act (HIPAA)

A

The right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the privacy rule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Two main purposes of HIPAA

A
  • To provide continuous health insurance coverage for workers who lose or change their job
  • To reduce the administrative burdens and cost of healthcare by standardizing the electronic transmission of administrative and financial transactions and protecting the patient’s personal medical info and confidentiality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The Joint Commission

A

Regulates that correctly identifying patients is crucial to improving patient safety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Occupational Safety and Health Administration

A

Federal agency that oversees and regulates safety in the workplace

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Quality Control (QC)

A

Promotes accurate test results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

True/ False: Always ask patients to confirm their full name and DOB

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Implied Consent

A

Extending arm for phlebotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Informed Consent

A

Informing the patient of the risk, possible outcomes, and alternative therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Written Consent

A

Must have a patient’s signature to perform the procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Patient’s Bill of Rights

Study These Flashcards
A

A list of guarantees for those receiving medical care

24
Q

Problem Oriented Medical Record (POMR)

Study These Flashcards
A

Should always be filled out in chronological order

25
Centers for Medicare and Medicaid Services (CMS-1500)
Basic standard claim form used by health care professionals to request reimbursement for services provided to patients
26
Encounter Form (Superbill)
An itemized for of services submitted to insurance carriers for reimbursements of rendered services
27
Release Information Form
Allows a patient access to his own medical records and allows the patient control over to whom those records are released
28
Preferred Provider Organization (PPO)
Managed care organization of providers, hospitals, and other healthcare providers who agreed with an insurer or a third-party administrator to provide health care are reduced rates to the insurer's or administrator's clients
29
Medicaid
Provides health insurance for the medically needy
30
Medicare
Federal insurance plan that generally covers those over the age of 65
31
Tricare
Healthcare for military personnel and their dependents to receive care from civilian providers at the expense of the federal government
32
Workers' Compensation
Wage replacement and medical benefits for those injured on the job
33
Advance Beneficiary Notice (ABN)
Waiver of liability is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service
34
Coinsurance
An amount a policyholder is financially responsible for according to their insurance policy
35
Copay
A specified sum of money based on the patient's insurance policy benefits due at the time of service
36
Deductible
Specific amounts of money a patient must pay out-of-pocket before the insurance carrier begins paying for services in a calendar year
37
Explanation of Benefits (EOB)
A statement detailing what services were paid, denied, or reduced in payment by the patient's insurance company
38
Preauthorization
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary
39
Precertification
The process of obtaining eligibility, certification, or authorization and collecting information from the health plan prior to inpatient admissions and selected ambulatory procedures and services
40
Referral
The process of directing or redirecting to a medical specialist or agency for definitive treatment
41
Verification of Eligibility
Important to confirm how a patient will pay for services
42
Diagnosis Code
Medical necessity
43
CPT
Current Procedural Terminology (5-digit code)
44
International Classification of Diseases (ICD)
Each diagnostic and procedural code allows for submission of services for reimbursement from insurance companies and to provide statistical data for research studies
45
What does the first character mean for ICD Coding?
Main term when searching in the alphabetical index
46
What does the second and third character mean for ICD Coding?
Numeric Codes
47
What does the fourth, fifth, sixth, or seventh character mean for ICD Coding?
Being either alphabetical or numeric
48
Modifier
Indicates one procedure was used multiple times on a patient
49
Advance Booking
Making an appointment for a patient in advance
50
What does clustering mean in terms of scheduling?
Seeing patients on the same day at the same time
51
Double Booking
2 patients are given the same appointment time
52
How do you deal with Hard of Hearing or Deaf Patients?
Get an interpreter
53
How to deal with a Late Provider?
Offer to reschedule a patient's appointment if the provider is late
54
New Patient (NP)
A patient who has not been seen by the provider before r who has not been seen in 3+ years is considered a new patient for coding and billing purposes
55
No Show (NS)
Patients who have missed their scheduled appointment
56
How do you schedule tests?
Schedule the least invasive test first if a patient is having multiple tests
57
Wave Scheduling
3 or 4 patients are scheduled every half hour and are seen in the order in which they arrive at the office

CCMA (School Edition) (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions