Healthcare Systems & Settings Exam Flashcards
Diagnose illness, provide treatments, perform procedures, and write prescriptions
Medical doctors
Do osteopathic manipulative therapy (OMT) to treat patients
Osteopathic providers (DO’s)
Advanced training beyond RN degree, extensive clinical experience, diagnose and treat common illness, and focus on preventive care
Nurse practitioners
Practice medicine under MD or DO, advanced degree
Physician assistant
Diagnostic testing on blood under supervision of medical technologist
Medical laboratory technicians
Check patients in and out, answer, phones, perform feeling, faxing, and other tasks
Medical receptionist
HMO
Health maintenance organization
PPO
Preferred provider organization
ACO
Accountable care organization (capitation)
PCMH
Patient centered medical home (global budget, pay for performance)
-provides lower costs to plan members
-requires a referral from a PCP to to see specialist
-requires pre-authorization for surgery
HMO
-provides lower cost of plan members
-less restrictions to see specialist
-can go out of network providers, but will cost more
PPO
Provider network sharing financial and medical responsibility for coordinated patient care, for Medicare patients, ACA (In hopes of limiting unnecessary spending)
Accountable care organizations (ACO)
Payment to physician per patient, per time period in advance, and incentives avoiding costly procedures based on demographics
Capitation (full or partial)
Primary care provider (PCP) coordinates treatment for patient to ensure they receive necessary care (patient centered)
(PCMH) patient centered medical home
Physicians receive fixed payments for patient care, encouraging, cost-effective treatment choices based on in individual factors
Global budget
Providers paid for meeting, quality and efficiency criteria
Pay for performance
Appropriate dress, personal phone use, punctuality, and respect for boundaries
Professionalism
Lifelong goals
Intrinsic Motivation
Driven by outside forces, short and less fulfilling
Extrinsic motivation
Integrity, accountability, flexibility, and open mindness
Work ethic
Delegated to medical assistance, work under supervision
Scope of pratice
The degree of care or competence expected in a particular circumstance or role
Standard of care
What can MA not do?
Diagnosed, treat, or instruct patients to take course of action
What are the types of insurances?
Medicare, Medicaid, TRICARE, SCAMPVA, Worker’s Compensation, and private insurance plans
Covers patients 65+ by part A (hospitalization) or part B (routine office visits)
Medicare
Provides health insurance to low income individuals
Medicaid
Allows dependents of military personal to receive treatment from civilian providers
TRICARE
Covers surviving spouses and dependent children of veterans who died as a result of their service
CHAMPVA
Covers the cost of medical, resulting from a job injury or accident
Worker’s Compensation
Medical coverage purchased directly by an individual
Private insurance
Maximum amount and insurance company will pay for a procedure or service
Allowed amount
Amount of money paid by the patient for service or prescription
Copayment
Patient and insurance company share the cost in a specified ration, such as 80/20
Coinsurance
specific amount of money a patient must pay out-of-pocket before the insurance carrier begins paying
Deductible
Amount of money paid by the patient (usually money/per paycheck) to have medical insurance, cost often shared between employer and employee
Premium
Statement from the insurance company detailing what was paid, denied, reduced, etc
Explanation of benefits
Provider agrees to write off the difference between the amount charge and the approved fee established by the insurance company
Participating provider
organization that individual is qualified to perform job to professional standards (non-governmental agency/association)
Certification
Granting of the title or licensed by board that gives you permission to practice chosen profession (wear pin), usually bored or governmental association
Registration
General duties include?
Communicating and educating patients, patient navigator, and maintain medical records
Administrative duties include?
Scheduling appointment, handling correspondence or billing, medical transcript, and answering telephones
Clinical duties include?
Performing diagnostic test, recording, vital signs, history, administrating, medications allowed, and assist with minor surgery phlebotomy
Laboratory duties include?
Performing CLIA wave tests, collecting and preparing laboratory specimens, teaching patients to collect specific specimens
Medical assistant duties include?
General, administrative, clinical, and laboratory
Greeting, and correspondence cell phone calls
Administrative roles of a medical assistant
Medical history, explaining treatment, drawing labs, immunization prep
Clinical roles of medical assistant
Providers of medical or health services, individually, or as organizations, that furnish, bill for, or are paid for services or products
Healthcare providers
Are considered allopathic providers and are the most widely recognized type of doctor. They: diagnose, provide treatments, perform procedures, and write prescriptions.
Medical doctor (MD)
Complete requirements that are similar to this of MDs to graduate and practice medicine. They: diagnose, provide treatments, perform procedures, and write prescriptions along with using osteopathic manipulative therapy in treating patients
Osteopathic providers (ODs)
Provide basic patient care, including diagnosing and prescribing medication’s for common illnesses. They require advanced, academic training beyond the registered nurse are in degree and have an extensive amount of experience generally nurse practitioners focus on preventative care and disease prevention.
Nurse practitioner (NP)
Practices medicine under the direct supervision of a licensed MD or DO. Additionally, are able to make clinical decisions and a responsible for variety of services.
Physician assistant (PA)
Another term for conventional, or western, medical practices, and systems of health
Allopathic medicine
A form of medical practice that provides all the benefits of conventional allopathic medicine, including prescription, drugs, and surgery, and emphasizes the interrelationship between the structure the function of the human body.
Osteopathic medicine
Individuals with training and responsibilities that support, supplement, and assist the professional functions of physicians
Allied health personnel
Check patients in and out, answer, phones, and perform filling, faxing, and other task
Medical receptionist
Assist patients who have developed conditions that disable them developmentally, emotionally, mentally, or physically
Occupational therapist
Assist pharmacist with preparation and administration of medications, and perform receptionist and billing duties
Pharmacy technician
Assist persons with musculoskeletal problems. Focuses on restoring function and preventing disability. Do not require the expertise or judgment of a licensed pharmacist.
Physical therapist
Good qualities of medical assistant
Professionalism, appropriate dress, punctuality, work, ethic, integrity, etc.
Duties a medical profession is allowed to carry out based on job description, training, and qualifications
Scope of practice
Giant blood screening, building administration, and vital science lab
Duties of a MA
The degree of care that a reasonably prudent person should exercise under the same or similar circumstances. Cannot put beliefs or feelings into work. Must treat each patient with the same care.
Standard of care
Same day in an out patient care
Ambulatory care
MA credentials
CPT, CET, CCS, CEHRS
Process of electronica data entry a provider instructions for treatment
Computerized physician order entry (CPOE)
Providing more Americans with access to affordable health insurance, improving the quality of healthcare and health insurance, regulating the health insurance industry, and reducing healthcare spending in the US
Affordable care act
Insurance method that focuses on prevention of disease requires referrals for specialist, pre-certification for hospitals, and outpatient procedure treatments
HMO, health maintenance organization
A link of institutions and healthcare professions that together take on the responsibility of delivering coordinated care
Healthcare delivery system
More flexible, does not need primary care provider, can go directly to specialist without referrals
Preferred provider, organization, PPO
Able to service a wide range of symptoms, diagnosis and conditions using variety of resources
General medicine
Treat acute and chronicle illnesses, take hass to look approachable, biological psychological social aspects
General practitioner (GP)
Aftercare to the whole family from newborn to elders, use preventative care
family practitioner
Provide comprehensive care for adults, often diagnosed and treat chronic long-term conditions
Internist
Assess a more specific set of symptoms diagnosis, and conditions
Specialty medicine
Specialize in heart and blood vessels
Cardiologist
Specialize in conditions of the skin
Dermatologist
Specialize in stomach, intestines, esophagus, liver, pancreas, colon and rectum
Gastroenterologist
Specialize in female reproductive system, and fertility disorders
Gynecologist
Specialize in the liver, biliary tree, gallbladder, and pancreas
Hepatologist
Specialize in kidney care
Nephrologist
Specialize in pregnancy, labor and delivery OB/GYN
Obstetrician
Specialize in tumors/cancer
Oncologist
Specialize in bones, joints, muscles, tendons, ligaments
Orthopedist
Specialize in body, blood, urine, and other body fluids
Pathologist
Specialize in x-rays, ultrasounds, MRIs, CT
Radiologist
A doctor or specialist who studies the diseases of the urinary system
Urologist
Provide convenience for your patience
Ancillary services
Alternative emergency department shorter, waiting time and flexible hours
Urgent care
X-rays, ultrasounds, and MRIs, CT
Diagnostic imaging
MRI
Magnetic resonance imaging
CT
Computed tomography
EKG
Electrocardiogram
EEG
Electroencephalogram
Assisting patients regarding mobility, improving strength, and range of motion
Physical therapy
Alternative therapies examples
Acupuncture, Chiropractic, Energy Therapy, Dietary Supplements
Provides healthcare and return for pre-CERT scheduled payments and coordination care, defined network of providers in hospitals
Managed care
Americans oldest and largest system of independent health insurance
Blue Cross Blue Shield
Examples of private insurance plans
Blue Cross Blue Shield, United healthcare was once Aetna
Health insurance claim form
CMS1500 form
