Exam Prep #4 Flashcards
Patient Care Coordination and Education
Organization of patient care activities and the sharing of information with all parties concerned with a patient’s care to achieve safer and more effective care. To meet patient’s needs and preferences while delivering high-quality, high-value health care.
Care Coordination
A provision of health services to individuals, families, and their communities by at least 2 health providers who work collaboratively with patients and their caregivers to accomplish shared goals.
Team Based Patient Care
What are 2 common healthcare delivery models?
Patient Centered Medical Home (PCMH) and Accountable Care Organization (ACO)
An approach to delivering high quality, cost effective primary care. Coordinates patient care across the health system is called?
Patient Centered Medical Home
The movement of a patient from one setting of care to another. Including hospitals, ambulatory primary care practices, ambulatory specialty care practices, long-term care facilities, home health, and rehabilitation facilities.
Transition of Care
A law that reformed the Medicare payment system. Incorporates quality performance measurements into payments with the goal of creating an equitable payment system for physicians.
Medicare Access and CHIP Reauthorization Act
Learning by hearing and listening. Remembering things you have heard or by the way things sound is called?
Auditory Learning
When you manipulate or touch material to learn. Needs to see the action and then perform it back. What kind of learning is this?
Kinesthetic Learning
Learning by visualizing images, graphics, colors, and maps to communicate ideas and thoughts.
Visual Learning
List 3 different scheduling methods.
- Wave scheduling
- Modified scheduling
- Double-Booking
Scheduling methods that allows 3 patients to be scheduled at the same time in the order that they arrive.
Wave Scheduling
Scheduling methods that allows 2 patients to arrive at a scheduled time and the third to be scheduled 30 minutes after.
Modified Wave
Scheduling method where 2 patients are scheduled at the same time to see the same provider. Allows for a patient with an acute illness to be seen when no time is available.
Double-Booking
Lists the steps for paper record filing.
- Conditioning
- Releasing
- Indexing and coding
- Sorting
- Storing and filing
Scheduling new patients require which factors of information?
- Full name
- Address
- DOB
- Phone number
- Insurance info
- SSN
- Emergency contacts
What are 3 basic filing methods
- Alphabetic
- Numeric
- Subject filing
A federal law that sets national standards to protect medical records and confidential patient information.
HIPAA
Gives individuals the right to access and request amendments to their medical records.
The Privacy Act of 1974
HIPAA security rule requires measures to safeguard electronic protected information to ensure its _________, _________, and _________.
Confidentiality, integrity, and security.
Explanation of benefits sent to the provider from the insurance carrier. Contains multiple patients and providers as well as electronic fund transfer information or check for payment. Used to post payment to patient accounts.
Remittance Advice
Also known as a waiver or liability. A notice a provider should give patients before you receive a service if your provider has a reason to believe Medicare will not pay for the services.
Advanced Beneficiary Notice (ABN)
A 7 number character, alphanumeric code. Each code begins with a letter, and that letter is followed by 2 numbers.
ICD-10-CM
A 7 number character, alphanumeric code. Each code begins with a letter, and that letter is followed by 2 numbers.
ICD-10-PCS
Used to document procedures and technical services based on services by providers in outpatient settings.
CPT Codes and Modifiers
Group codes and descriptions that represent procedures, supplies, products, and services not covered by the CPT coding system. Update every year. Used for Medicaid and Medicare insurance plans.
HCPCS
How long do regular, urgent, and STAT referrals take?
Regular take 3 to 10 days, urgent are 24 hours, STAT are immediately.
Define account balance.
Total balance on the account
What are credit and debit?
Debit is negative, credit is positive.
Define accounts receivable.
Amounts owed to the provider for services.
Define accounts payable.
Money owed by a business to its supplies shown as a liability on company balances.
Define assets.
Objects or property of an individual or organization that is subject for debts.
Communication that refers to work with numbers, facts, and data. Little emphasis of feelings.
Analytical Communication
Communication by looking at the big picture but can be confusing if the approach is too broad.
Intuitive Communication
Communication where it is taken by an organized approach with detailed plans. Uses step by step methods to solve problems.
Functional Communication
Communication that uses emotional language. Deeply cares about what people think and feel. Good listeners and are able to resolve conflicts.
Personal Communicator
Recognize defense mechanisms such as.
- Denial
- Regression
- Projection and Displacement
- Repression
- Sublimation
What are the 4 types of laws.
- Civil Law
- Criminal Law
- Administrative Law
- Tort Law
The law that pertains to persons, things, and relationships that develop among them. Applied to medical malpractice cases.
Civil Law
Deals with punishment of people and entities that break laws. Involves behaviors and can be construed as offenses against the public, society, or the state. Convictions result in a fine or imprisonment.
Criminal Law
Form of decisions, rules, and regulations, and orders created by administrative agencies under direction of the federal government to carry out duties. Responsible for protecting civil rights, privacy, and safety of its citizens.
Administrative Law
What are 2 classifications of Tort Law?
Intentional and Negligence
An act that is illegal and causes physical or monetary harm to another. Considered intentional.
Malfeasance
Act that is lawful, but performed in an unlawful, illegal or injurious manner.
Misfeasance
Failure to behave with the level of care that someone would have exercised under the same circumstance.
Negligence
Failure to do something that one is legally responsible to do. An intentional failure upon one’s legal or moral duty in a situation.
Nonfeasance
Enacted to decrease the growth in health care spending in the U.S. and to help provide more affordable health insurance.
Affordable Care Act
Makes employers accountable for providing a safe and healthy environment for employees through training, outreach, education, and assistance.
OSHA
Gives patients rights over their health information and sets rules and limits on who can look at and receive patient’s private information.
HIPAA
Signed on February 17, 2009, to promote the adoption of health information technology. Addresses the privacy and security concerns associated with the electronic transmission of health information through several provisions that strengthen civil and criminal enforcement of the HIPAA rules.
The Health Information Technology for Economic and Clinical Health Act (HITECH)
Regulates the manufacture and distribution of controlled substances including narcotics, depressants, and stimulants. CSA classifies medications into 5 schedules.
Control Substances Act
Forbids discrimination against any applicant or employee who could perform a job regardless of a disability. ADA
Americans with Disabilities Act
A federal law that requires certain employees to give time off to employees for familial or medical reasons.
Family Medical Leave Act (FMLA)
Help healthcare organizations position for the future of integrated care, strengthen patient safety and quality of care, improve risk management and risk reduction.
The Joint Commission Accreditation
The discipline concerned with what is morally good and bad, right and wrong is called what?
Ethics
Set of accepted behaviors and values that a person is expected to possess in a particular organization or profession is called?
Professional Ethics
Consist of sets of requests that patients put in writing for their provider, family, and other health care professionals to carry out surrounding end of life medical treatment.
Medical Directives
A legal document that states what procedures that a patient would want, which one’s they refuse and under what conditions such as dialysis, blood transfusions and DNR orders.
The Living Will
A legal document in which you name a person to be a proxy (agent) to make all your health care decisions if you are unable to do so.
Durable Power of Attorney
An order that demands no sort of life saving mechanisms if the heart or breathing stops (CPR, AED).
DNR
Helps describe your wishes for health care (not an advance directive). Addresses specific medical orders and wishes in an emergency such as whether to use CPR.
POLST
The legal process when a person allows an organ of their own to be removed and transplanted to another person.
Organ tissue and donation
A complaint can be filed by mail, fax, email, or OCR Complaint Portal. T/F?
True
