Healthcare Fundamentals Flashcards
What do MAs have to know?
- different specialties
- other health professionals
- healthcare delivery models
- basic insurance
What do medical doctors do?
- diagnosis illness
- provides treatments
- performs procedures
- writes prescriptions
What do osteopathic providers (DO) do?
- uses modern medicine techniques and surgical procedures
What do nurse practitioners do?
- diagnose
- prescribe medications
- preventative care and disease prevention
What do physician assistants do?
- practices medicine under the direction and supervision of a MD or DO
- can make clinical decisions
What do medical laboratory technicians do?
test blood, body fluids and other specimen
What does a pharmacy technician do?
helps phamacists
What do radiology technicians do?
- uses imaging equipment to assist providers in diagnosing and treating diseases
What is integreity?
honesty
What is accountability?
responsible for your own actions
What is flexibility?
ability to adjust to schedule changes
What is open-mindedness?
try new things
- open to discussions and listen
What are general providers?
able to assess a wide range of symptoms
- diagnose and build treatment plans
What are specialist providers?
assess more specific sets of symptoms, diagnoses, conditions
What are general practitioners?
medical doctors who treat acute and chronic illnesses and provide preventative care and health education
What are internists?
diagnosing and treating chronic conditions
- offers treatment for common illnesses and preventative care
What do cardiologists do?
specialized in heart and blood vessel conditions
What do dermatologists do?
specializes in skin conditions
What do endocrinologists do?
specialize in hormonal and glandular conditions
- diabetes
- thyroid
What do gastroenterologists do?
specializes in gastrointestinal tract diseases
- stomach, intestines, esophagus, liver, pancreas, colon, rectum
What do gynecologists do?
specialize in female reproductive system
What do nephrologists do?
specialize in kidney care and disorders
What do obstetricians do?
care for women during and after pregnancy
What do oncologists do?
specialize in cancer treatments
What do ophthalmologists do?
specialize in eye conditions
What do orthopedists do?
specialize in bones, joints, muscles, tendons, and ligaments
What do otolaryngologists/otorhinolaryngologists do? (ENT)
specializes in ear, nose, throat
What is an accountable care organization? (ACO)
groups of physicians, hospitals, and care providers who come together voluntarily to provide quality care to Medicare patients
What is a patient-centered medical home? (PCMH)
care delivery model
- PCP coordinates treatment to make sure patients receive required care
What is a health maintenance organization? (HMO)
connects groups of providers and facilitates preventative and acute care for patients
- requires referrals to specialists and precertification and preauthorization for hospital admissions, outpatient procedures, and treatments
What is a preferred provider organization? (PPO)
patient isn’t required to have a PCP
- can go directly to a specialist without referrals
What type of care are nursing homes and assisted living?
long-term care
- requires healthcare on a regular basis
- frail, elderly, disabled
What is hospice care?
patients with less than 6 months to live
- terminal conditions
What is palliative care?
relieving pain
What is ambulatory care? Give examples.
walk in places
- physician offices/clinics
- urgent care centers
- hospitals/emergency department
- surgical centers
What is Medicare? Who is it for?
government insurance plan
- Part A: hospitalization
- Part B: medical office visits
- Part D: medications
- patients 65+
Who is medicaid for?
medically indigent or low income
Who is tricare for?
active duty service and family members
Who is CAMPVA for?
veterans affairs
What are some examples of private individual insurance plans?
- blue cross/shield
- humana
- aetna
- cigna
What are examples of private insurance plans?
group
individual
worker’s compensation
What is an allowed amount?
maximum amount insurance will pay for a procedure or service
What is a copay?
a set amount of money that is paid by the patient at the time of service
What is coinsurance?
policyholder and insurance carrier share costs
What is a deductible?
amount of money paid out of pocket before insurance carrier begins paying
What is the CMS-1500 form used for?
invoice insurance and government plans
- sent electronically to insurance companies and government plans
What is direct billing?
insurance carrier allows provider to submit directly to insurance company electronically
What is clearinghouse?
allows provider to submit all insurance claims using software
- audits, sorts, and sends claims
When should Medicare and Medicaid claims be electronically submitted?
invoice cannot exceed 12 months from service
What is managed care?
medical plans that provide health care in return for preset schedules payments coordinated through a network of providers and hospitals
What is osteropathic?
medical care based on how the musculoskeletal system affects other body parts and using various manipulative methods along with conventional medical, pharmacological, and other therapeutic procedures
What is professionalism?
skills, behavior and appropriate judgment that represent the best qualities of a person in a specific profession
What is work ethic?
a set of values based on the moral virtues of hard work and diligence
