Section 2 Administrative Medical Assisting Flashcards
What is any condition that could affect the health or safety of an employee, either immediately or through long-term exposure called?
Workplace hazard
What is any event that can cause injury or damage to a group of people called?
Disaster
What type of waste material has the potential to carry disease?
Biological
What type of waste contains substances such as germicides, cleaning solvents, and pharmaceuticals?
Chemical
What type of waste contains or is contaminated with liquid or solid radioactive material
Radioactive
What applies scientific information and data regarding human body mechanics to the design of objects and overall environments for human use.
Ergonomics
What is coordination of body alignment, balance, and movement called
Proper body mechanics
What is any accident, medical error, or unusual occurrence called?
An incident
What is a preventable negative effect of care called?
A medical error
What is the process of gathering and evaluating information about the services provided and comparing this information with an accepted standard referred to as a benchmark called?
Quality assurance (QA)
What is illegally obtaining and using another persons personal identifiying information, usually for financial gain, called?
Identity theft
What is using stolen personal information to obtain medical goods and services called?
Medical Identity Theft
What are patients who do not keep their appointment and do not call to reschedule called?
No-shows
What codes are services provided?
CPT codes
What codes are for diagnoses?
ICD-10-CM codes
What are the purposes of closing procedures?
Ensure security of premises and to prepare in advance for the next day
What is the time span each day that a medical office is open for business called?
Office hours
What is the length in time the average patient spends in the medical office called?
Cycle time
What is a benefit of specified time scheduling?
It helps prevent a large backlog of waiting patients
What is the drawback of specified time scheduling?
Some patients might not provide enough information about their medical problems to schedule an appropriate appointment length
What scheduling type has all patients told to come in at the beginning of the hour and are seen in the order in which they arrive?
Wave scheduling
What is the grid that shows the availability of each physician, as well as periods if time that are not available for appointments called?
The appointment matrix
What are illnesses or injuries patients suddenly experience and require treatment but may not be life threatening called?
Acute conditions
What is sorting or grouping patients according to seriousness or their condition called?
Triage
What is the EHR?
The electronic health record
What is the AHRQ
The agency for healthcare research and quality
What is the ONC
The office for the national coordination for health information technology
When was HITECH passed?
2009
What is HITECH
The health information technology for economic and clinical health
What does the EHR do?
It manages medical records of patients and can network with offices of other providers to share information
What does practice management system (PMS) do?
It manages administrative functions
What does “if it wasn’t documented it, wasnt done” refer to?
The medical record
What does SOAP mean
Subjective
Objective
Assessment
Plan
What does SOMR mean
Source-Oriented Medical Record
What record pertains to patients who have been seem within the past three years and are currently being treated?
Active records
What record pertains to patients who have not been seen within the past three years or time period determined by office policy?
Inactive records
What record pertains to patients who have actively terminated their contract with the physician
Closed records
What are the three file storage types
Vertical, Lateral, Movable
What is designed to meet special needs and may be color coded
File folders
What is used to separate files in drawers or shelves?
Divider guides
What are placards that indicate a file has been removed called?
Out-guides
What identifies what is in the file and are used as special alerts?
Labels
What are commonly used filing systems?
Alphabetic, Numeric, and Subject matter
What is the process of gathering and organizing information called?
Collating
When did hospital insurance coverage begin and what was it known as?
1929, Blue cross plan
When did insurance begin as disability income insurance?
In the mid-1800s
When did insurance companies issue first individual disability and illness policies?
Around 1890
Who was the first group policy giving comprehensive benefits offered by and when
Massachusetts health insurance of Boston, 1847
When did employee benefit plans become popular?
In the 1940s and 1950s
When did government programs begin to cover healthcare costs?
The 1950s and 1960s
When did the federal government enact medicare and medicaid?
1965
What federal program is designed for older adults?
Medicare
What federal program is targeted to low-income families
Medicaid
What allowed the use of federal funds and policy to promote health maintenance organizations, which provide managed care to patients?
HMO act of 1973
When were diagnosis related groups implemented by medicare to help control spending
1980s
When were most Americans with health insurance in managed care plans?
The mid-1990s
When was it when individuals and companies paid for about half the health care received in United States; government paid for other half through Medicare, Medicaid, other programs
1995
Estimated how many americans have no health insurance?
31 million
About what percent of americans have health insurance through employee-sponsored plans?
About 60%
When did congress pass the patient protection and affordable care act?
2010
What is the person who owns the insurance policy known as?
Member, subscriber, insured, or policyholder
What is the process to determine patients eligibility called?
Verification of benefits
What does, patient is qualified to recieved benefits under policy provisions, called?
Eligibility
What are family members covered under an insurance policy called?
Dependants
What is the amount the policyholder pays to the insurance carrier to purchase a commercial health insurance policy called?
Premium
What is the health care providers list of charges for each service they provide called?
The fee schedule
What are fee schedules currently organized by?
Type of service and current procedural terminology CPT code
What is the charge on providers fee schedule called?
Usual charge
What is the amount that insurance companies consider to be appropriate fee?
Allowed amount
What is the amount patients must pay to provider for health care services before health insurance benefits begin to pay?
Deductible
What are the fixed dollar amounts that patients pay at time of service called?
Copayments
What is the fixed percentage of charges that patients pay called?
Coinsurance
What is a form that patients sign when medical offices bill their insurance that authorized insurance companies to pay benefits directly to provider called?
The assignment of benifits
What does any condition a patient was diagnosed with or treated for before beginning coverage with a new insurance plan refer to?
Preexisting conditions
What does a claim that was processed and found to be ineligible for payment refer to?
A denied claim
What type of HMO has providers that treat both HMO patients and non-HMO patients?
Open-panel HMO
What type of HMO has physicians who see only patients of a specific HMO?
Closed-panel HMO
What is a HMO?
A health maintenance organization
What are PPOs
Preferred provider organizations
Three major sources of private health insurance
Group health plans, self insured, individual insurance
What is coverage for employees who have been covered under group insurance and leave emplyment called
COBRA coverage
When did the Health Insurance Exchange start?
2014
What government insurance is for active duty and retired service personnel and their families?
TRICARE
What government insurance is for veterans with service-related disabilities?
CHAMPVA
What is coverage for employees for job-related injuries called?
Workers compensation
What payes for injuries sustained because of an automobile accident?
Automobile personal injury protection (PIP)
What is part A of medicare coverage
Part A : hospital insurance
What is part B of medicare coverage
Part B : Provider coverage
What is part C of medicare coverage?
Part C : medicare advantage
What is part D of medicare coverage?
Part D : prescription drug
What suppliments medicare coverage to fill “gaps” in part A and part B coverage?
Medigap (MG) plans
What does “Locum Tenes” mean?
Latin for place holder
What type of workers compensation claim is because a worker was injured and treated by physician, but no time was lost from work?
A nondisability (ND) claim
What type of workers compensation claim is because a worker is able to return to previous or modified work at a later time?
Temporary disability (TD) claim
What workers compensation claim is because no further improvement is expected and worker is unable to return to work?
Permanent disability (PD) claim
What entitles eligible employees of covered employers to take unpaid leave for specified family and medical reasons?
Family medical leave act (FMLA)
In the situation where spouses or partners are covered by eachothers policy, who is the primary and who is the secondary policy?
Primary: patients policy
Secondary: spouse or partners policy
In the situation where children are covered by policies of both parents, married, who is the primary and who is the secondary policy?
Primary: policy of older parent
Secondary: policy of younger parent
In the situation where children are covered by policies of both parents, married, who share the same birthday, which policy is primary and which is secondary?
Primary: policy in force longer
Secondary: policy in force for less time
In the situation where children are covered by policies of two biological parents and one stepparent, who is the primary and secondary policy?
Primary: custodial parent
Secondary: stepparents policy
Tertiary: noncustodial parents policy
What is a NPI
National Provider Identifier
What is the uniform billing format used for medical claims?
CMS-1500 claim form
What is the standard form for dental claims?
The American dental association standard form (ADA)
What are the two major sections of the CMS-1500 claim form
Patient and insured information
(Items 1-13)
Physician or supplier information
(Items 14-33)
What are items 1-13 on the CMS-1500 claim form
Patient and insured information
What are items 14-33 on the CMS-1500 claim form
Physician or supplier information
Who maintains and updates the CMA-1500 form?
The national uniform claim committee (NUCC)
When was the most recent form of the CMS-1500 claim form effective?
April 2014
What is the standard format for electronic claims?
837P
What form is used by inpatient hospitals?
UB-04 claim form (837I)
What are boxes 1-41 for in a UB-04 claim form?
Patient information
What are boxes 42-49 for in a UB-04 claim form?
Billing information
What are boxes 50-65 for in a UB-04 claim form?
Payer information
What are boxes 66-81 for in a UB-04 claim form?
Diagnosis and procedure information
Under ________, all routine and sick care is paid out-of-pocket.
Catastrophic care
________ is a real-time, moving X-ray image, usually viewed on a monitor.
Fluoroscopy
________ codes identify billable services provided to patients.
Procedure
When coding a patient’s diagnosis, medical assistants should use the version of ICD-10-CM that ________.
Was in affect on the patients date of service
Historically, diagnosis coding was used to track the ________.
Study of disease and cause of death
ICDA-8 was published for clinicians in ________?
1965
Everything that is done during a patient’s medical visit, ordered over the telephone, or discussed with a patient over the phone or e-mail must be ________?
Documented
Which factor prevents diagnosis coding from being performed at the highest level of certainty?
The medical record is incomplete or inaccurate
Coding of procedures and diagnoses must be supported by the ________ in the patient record.
Documentation
Category ________ codes help in collecting data and tracking performance.
II
Health care providers must establish a fee schedule, which lists their charge for each service they provide and is usually organized by ________.
CPT code
The ICD-10-CM coding manual contains over ________ codes.
70,000
Which is the most restrictive type of health care plan?
HMO
The ________ plan should include the physician’s statement of what is wrong with the patient, the plan to care for the problem, and options presented to the patient, as well as any instructions given to the patient.
Diagnosis and treatment
Supplemental insurance for an Alzheimer’s patient would be which type of coverage?
Disease-specific
In the Tabular List, the ________ code, or parent code, has a description written on the left and starts with a capital letter.
Standalone
Non-fraudulent billing practices are called ________.
Abuse
CPT codes do not have a decimal point, and the description is found ________.
To the right
The ________ mandates the approved code sets for all covered entities, such as a medical office, which handle claims related to health care services.
Health Insurance Portability and Accountability Act (HIPAA)
________ is illegal and can cause denial of claims and fines.
Unbundling
CPT codes are divided into three categories under the _______?
Tabular list
________ are organizations that pay for health care services on behalf of the patient.
Third party payers
The ________ section of the POMR contains information about physical examinations, the patient history, and the results of baseline laboratory or diagnostic procedures.
Database
In ________, Congress passed legislation that made financial incentives available for EHR implementation.
2009
________ cabinets are used to file documents such as patient records, tax records, insurance policies, and canceled checks.
Fireproof
The main reason for the services provided is known as the ________ diagnosis.
First-listed
Disease-specific assessments can be found in which category?
Category II
How are foreign names indexed in alphabetic filing?
Indexed as one unit
________ coding refers to reporting several codes to fully describe a condition.
Multiple
To obtain precertification for a patient to receive a prescribed procedure, the medical assistant contacts the ________.
Patients insurance carrier
________ codes describe services performed for patients.
Procedure
Process of assigning alphanumeric characters to represent diagnoses, procedures, and services a physician provides to patients
Medical coding
a diagnosis accompanied by a term such as possible, probable, suspected, rule out, or working diagnosis; also called a qualified diagnosis
Uncertain diagnosis
Within an ICD-10-CL manual, a level of code numbers having a three-character entry ________
Category
In an ICD-10-CM manual, a table within the index listing external causes of diseases and injuries; follows the table of drugs and chemicals in most manuals
Index to external causes
Within an ICD-10-CM manual, a level of code numbers having a four- or five- character entry
Subcategory
