Health Care fundementals

Question 1

Which healthcare professionals practices medicine under the direction and supervision of a licensed MD or DO?

Answer 1

Physician Assistant (PA)

Question 2

What does a Medical Doctor do?

Answer 2

Diagnosis illness, provides treatments, performs procedures, writes prescriptions. Uses drugs or surgery

Question 3

What does an Osteopathic provider do?

Answer 3

Uses modern medicine, techniques and surgical procedures and osteopathic manipulative therapy

Question 4

What does nurse practitioners do?

Answer 4

Diagnose prescribe medication, focuses on preventative, care and disease prevention

Question 5

What does a physician Assistant do? 

Answer 5

Practices medicine under the direction and supervision of a licensed MD or DO. Able to make clinical decisions

Question 6

What does a medical laboratory technician do?

Answer 6

Performs testing on blood, body, fluids, and other specimens

Question 7

What does a pharmacy technician do?

Answer 7

Assist pharmacist with duties

Question 8

What does a Radiology technician do?

Answer 8

Uses imaging equipment to assist providers in diagnosing and treating diseases

Question 9

What is the definition of Professionalism?

Answer 9

Skills, behavior, and appropriate judgment that represents the best qualities of a person in a specific profession

Question 10

List Appropriate dress and hygiene

Answer 10

Avoid perfumes and colognes
Conservative make up
Clean, and polished nails at a reasonable length 

Question 11

What is Punctuality?

Answer 11

Arriving to work on time and having good time management

Question 12

What is integrity?

Answer 12

Being honest, having strong, moral principles 

Question 13

What is accountability?

Answer 13

Being responsible for your own actions

Question 14

What is flexibility?

Answer 14

Adjust to schedule changes, assist, others, works as a team, never say “that’s not my job”

Question 15

What is open mindedness as a medical assistant?

Answer 15

Trying new things, increase skills, open to discussions and listening

Question 16

General vs Specialty services

Answer 16

General providers are able to access a wide range of symptoms, diagnose and build treatment plans, while specialty providers access more specific sets of symptoms, diagnosis, and conditions

Question 17

Accountable care organizations (ACO)

Answer 17

Groups of physicians, hospitals, and care providers come together, voluntarily to provide quality care to Medicare patients

Question 18

Patient centered medical home (PCMH)

Answer 18

Care delivery module primary care provider coordinates treatments to make sure Patients receives required here.

Question 19

Health, maintenance organization (HMO)

Answer 19

Plan contracts with groups of providers and facilities, preventative, and acute care for patients- HMOs require referrals to specialist and pre-certification and preauthorization for hospital admissions, outpatient procedures, and treatments

Question 20

Preferred provider organization (PPO)

Answer 20

PlantHouse more flexibility than an HMO. Patient is not required to have a PCP, I can go directly to a specialist without referrals. In network and out of network providers.

Question 21

Long term care, nursing homes, and assisted living

Answer 21

Residence required healthcare on a regular basis
Frail, elderly and disabled 

Question 22

Hospice care

Answer 22

Patience with less than six months to live terminal condition

Question 23

Palliative care

Answer 23

Only relieving pain

Question 24

Ambulatory (Walk in)

Answer 24

Physicians offices/clinics
Urgent care centers
Hospital/emergency departments
Surgical centers 

Question 25

Which healthcare delivery module requires referrals to specialist

Answer 25

Health maintenance organization/HMO

Question 26

What healthcare delivery module provides care to Medicare patients

Answer 26

Accountable care organizations (ACO)

Question 27

What are the two insurance fundamentals?

Answer 27

Government and private plans

Question 28

Government plans include:

Answer 28

Medicare, which is patients over 65 and older

Medicaid, which is medically indigent/low income 

TRICARE, which is active duty services and family members

(CHAMPVA ), Veterans affairs

Question 29

Private plans include:

Answer 29

Group

individual
- Examples, Blue Cross, Humana, Aetna, CIGNA

Question 30

Electronic submission of claim is submitted by:

Answer 30

Direct billing- Insurance, carrier, and last provider to submit directly to the insurance company electronically.

Clearinghouse- Allows provider to submit all insurance claims using software, clearinghouse audits, source claims and send them to the appropriate insurance company.

Must be sent timely – for medical and Medicaid claims, invoice cannot exceed 12 months from service