Module 1: Healthcare Systems and Settings Flashcards
1
Q
roles and responsibilities of CMA
A
- administrative: greeting pts, answering phones
- clinical duties: obtaining med history, explaining Tx/procedures, drawing lab tests
2
Q
medical doctor (MD)
A
- allopathic
- Dx, Tx, Rx
3
Q
osteopathic providers (DO)
A
- similar to MD
- osteopathic manipulative therapy
4
Q
nurse practitioners (NP)
A
- Dx, Rx
- training beyond RN degree, lots of clinical experience
- preventative care
5
Q
physician assistants (PA)
A
- under the direction and supervision of MD or DO
- make clinical decisions, responsible for variety of services
6
Q
medical laboratory technician
A
- diagnostic testing on body fluids
- under supervision of medical technologist
7
Q
medical receptionist
A
- check pt in/out, phones, filing, faxing
8
Q
occupational therapist
A
- assist pts with conditions disabling them developmentally, emotionally, mentally, or physically
9
Q
pharmacy technician
A
- assist pharmacists
- tasks not requiring expertise or judgement of pharmacists
10
Q
pharmacy technician
A
- assist pharmacists
- tasks not requiring expertise or judgment of pharmacists
11
Q
physical therapist
A
- assist pts in regaining mobility, strength, ROM
12
Q
radiology technician
A
- imaging equipment to assist in Dx and Tx
13
Q
professionalism in CMAs
A
- appropriate dress
- phone use
- punctuality
- boundary respect
- motivation
- work ethic
- integrity
- accountability
- flexibility
- open mindedness
14
Q
scope of practice
A
- duties that can be delegated based on education, training, and experience
- state regulations and specific office policies
15
Q
standard of care
A
- degree of care expected in particular circumstance or role
16
Q
how much department of labor projects medical assistant field will grow from 2014 to 2024
A
23%
17
Q
average occupation growth
A
7%
18
Q
CPT
A
- certified phlebotomy technician
- additional credential
19
Q
CET
A
- certified EKG technician
- additional credential
20
Q
CBCS
A
- certified billing and coding specialist
- additional credential
21
Q
CEHRS
A
- certified electronic health records specialist
- additional credential
22
Q
certified health coach or patient navigator
A
- directs pt through health care system, organize care, provide resources
- may have chronic disease focus
- additional credential
23
Q
licensure
A
- state regulated
- mandatory for physicians
- CMA not required to be licensed
24
Q
how licensure is accomplished
A
- examination: state board exam
- reciprocity: recognize requirements from other state
- endorsement: graduates of med school
25
certification
- generally optional
- may be required to administer meds, perform phlebotomy, enter prescription into CPOE
- continuing education to keep current
26
advantages of certification
- increased initial job placement
- higher wages
- career advancement opportunities
27
health care delivery
- organization of individuals, establishments, and resources to deliver health care services and meet health needs of specific populations
28
affordable care act
- promoted newer healthcare systems and payment models
- move from reimbursement structure to value of care model
29
accountable care organizations (ACO)
- group of physicians, hospitals, and other health care providers
- voluntary care to Medicare pts
- shares savings with Medicare programs if spends money wisely
30
capitation
- pt assigned monthly payment based on age, race, sex, lifestyle, medical history, benefit design
- payment tied to expected usage
- partial/blended: only specific services are paid on basis of capitation
31
global budget
- fixed total amount paid annually for all care
- participating providers determine how money is spent
- limit increase in healthcare costs
- include quality component
32
health maintenance organization (HMO)
- medical center/group of providers give preventative and acute care
- require referrals, precertification, preauthorization
33
patient centered medical home (PCMH)
- PCP coordinates Tx
- pt receives care in a way they can understand
34
pay for performance
- reimbursement model compensates providers only if they meet quality and efficacy standards
35
preferred provider organization (PPO)
- more flexible than HMO
- doesn't need PCP, referrals
- providers in network cost less
36
general practitioner (GP)
- general medicine
- acute and chronic illness
- preventative care and education to pts
- holistic approach
37
family practitioner
- general medicine
- care for whole family (newborn to adult)
- familiar with range of disorders/diseases
- primary concern is preventative care
- most often chosen
38
internist
- general medicine
- comprehensive care of adults
- often chronic conditions
- also common illness and preventative care
- need broad understanding of body
39
allergist
- disorders/diseases of immune system
- reactions to medications and food, anaphylaxis, autoimmune disease, asthma
40
anesthesiologist
- manage pain or use sedation during surgical procedures
41
cardiologist
- Dx and Tx heart and blood vessel conditions
42
dermatologist
- skin conditions
43
endocrinologist
- hormonal and glandular conditions
- diabetes pts
44
gastroenterologist
- GI tract
45
gynecologist
- female reproductive system, fertility disorders
46
hematologist
- blood
- anemia, leukemia, lymphoma
47
hepatologist
- liver, biliary tree, gallbladder, pancreas
48
neonatologist
- newborns
49
nephrologist
- care and Tx of kidneys
50
obstetricians
- care of women during and after pregnancy
51
oncologist
- care of Tx of pts with cancer
52
ophthalmologist
- eye conditions
53
orthopedist
- bones, joints, muscles, tendons, ligaments
54
otolaryngologist
- ear, nose, throat
55
neurologist
- nervous system
56
pathologist
- body tissues/fluids to Dx or Tx conditions
57
pediatricians
- infant to adolescent care
58
psychiatrist
- mental disorders and conditions
59
radiologist
- use xray, ultrasound, nuclear medicine, CT, MRI to detect abnormalities
60
urologist
- urinary tract disorders
61
urgent care
- ancillary service
- alternative to ED
- cost less, shorter wait, conveniently located, flexible hours, offer walk ins
62
laboratory services
- ancillary service
- diagnostic testing on specimens to conclude Dx
63
diagnostic imaging
- ancillary service
- xray, ultrasounds, MRI, CT
- further Dx condition
64
occupational therapy
- ancillary service
- assist pts with conditions disabling them developmentally, physically, emotionally, mentally
- compensate for loss of function
65
physical therapy
- ancillary service
- pts regain mobility, strength, ROM
- often after accident, injury, disease
66
acupuncture
- alternative therapy
- pricking skin with needles to relieve pain
- treat physical, mental, emotional conditions
67
chiropractic
- alternative therapy
- Dx and Tx mechanical disorders of musculoskeletal system, often spine
68
energy therapy
- alternative therapy
- clearing cellular memory through human energy field
- promotes health, balance, relaxation
- idea of connection between physical, mental, emotional, states of life
69
dietary supplements
- alternative therapy
- vitamins, minerals, herbs, other botanicals
70
advance beneficiary notice (ABN)
- form provided to pt when provider believes Medicare won't cover service
71
allowed amount
- max insurance will pay for service
72
copayment
- paid at time of medical service
73
coinsurance
- policyholder and insurance company share cost in ratio
- 80:20
74
deductible
- specific amount pt must pay before insurance begins paying
75
explanation of benefits (EOB)
- statement from insurance detailing what was paid, denied, or reduced
76
participating provider (PAR)
- providers who agree to write off difference between amount charged and approved fee from insurance
77
Medicare
- over 65
- part A (hospitalization)
- part B (routine medical office visits)
78
Tricare
- dependents of military personnel treated at expense of federal government
79
CHAMPVA
- surviving spouses and children of veterans who died as result of service related disabilities
80
Medicaid
- medically indigent
- cost sharing program between federal and state govs
81
workers compensation
- protects wage earners against loss of wages and cost fo care resulting from occupational accident/disease as long as employee is not proven negligent
82
managed care
- umbrella term for plans providing health care in return for scheduled payments and coordinated through network of providers/hospitals
83
examples of private insurance plans
- Blue Cross Blue Shield
- Aetna
- United Healthcare
84
America's oldest and largest system of independent health insurers
Blue Cross Blue Shield
85
CMS 1500
- form for insurance claims
- 33 blocks in 3 sections
- maintained by National Uniform Claim Committee (NUCC)
- new versions approved by Office of Management and Budget (OMB)
86
direct billing
- providers submits insurance claims directly to carrier electronically
87
clearinghouse submissions
- providers submit all insurance claims and clearinghouse sends to each company
88
time period Medicare and Medicaid claims must be filed
no later than 12 months after date of service
