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CCMA (School Edition) > Insurance/ Basic Knowledge > Flashcards

Insurance/ Basic Knowledge Flashcards

1
Q

Define Scope of Practice

A

Describes the procedure, actions, and process that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional training, licensure, or certificate

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2
Q

What is within the Medical Assistants Scope of Practice?

A
  • Educating patients on how to take their medication
  • Health promotion of the patient
  • Performing an EKG
  • Taking a patient’s vitals
  • Performing a urinalysis and a throat culture
  • Patient education
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3
Q

What is outside the Medical Assistants Scope of Practice?

A
  • Diagnosing a patient
  • Administering Narcotics
  • Interpreting lab results
  • Pathogenic identification
  • Performing an Arterial Blood Gas (ABG)
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4
Q

Assult

A

Open threat of bodily harm against another person

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5
Q

Battery

A

An action that causes bodily harm

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6
Q

Fraud

A

Deception with the intent to deprive another person of his/ her rights

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7
Q

Invasion of Privacy

A

Intruding on a patient’s private affairs, or disclosure of private information

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8
Q

Malpractice

A

The negligent delivery of professional services

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9
Q

Negligence

A

The failure to do something that a reasonably prudent individual would do under similar circumstances

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10
Q

Spousal Abuse/ Intimate Partner Abuse

A

Provide a list of organizations within the local community that can assist with the situation

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11
Q

Tort

A

A civil wrong committed against a person or property

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12
Q

Chain of Custody

A

In legal context, refers to the chronological documentation showing the paper trail, custody, control, transfer, analysis, and disposition of physical or electronic evidence

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13
Q

Clinical Laboratory Improvement Amendments (CLIA)

A

Sets quality standards and issues certificates for human clinical laboratories

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14
Q

Health Insurance Portability and Accountability Act (HIPAA)

A

The right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the privacy rule

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15
Q

Two main purposes of HIPAA

A
  • To provide continuous health insurance coverage for workers who lose or change their job
  • To reduce the administrative burdens and cost of healthcare by standardizing the electronic transmission of administrative and financial transactions and protecting the patient’s personal medical info and confidentiality
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16
Q

The Joint Commission

A

Regulates that correctly identifying patients is crucial to improving patient safety

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17
Q

Occupational Safety and Health Administration

A

Federal agency that oversees and regulates safety in the workplace

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18
Q

Quality Control (QC)

A

Promotes accurate test results

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19
Q

True/ False: Always ask patients to confirm their full name and DOB

A

True

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20
Q

Implied Consent

A

Extending arm for phlebotomy

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21
Q

Informed Consent

A

Informing the patient of the risk, possible outcomes, and alternative therapies

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22
Q

Written Consent

A

Must have a patient’s signature to perform the procedure

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23
Q

Patient’s Bill of Rights

A

A list of guarantees for those receiving medical care

24
Q

Problem Oriented Medical Record (POMR)

A

Should always be filled out in chronological order

25
Q

Centers for Medicare and Medicaid Services (CMS-1500)

A

Basic standard claim form used by health care professionals to request reimbursement for services provided to patients

26
Q

Encounter Form (Superbill)

A

An itemized for of services submitted to insurance carriers for reimbursements of rendered services

27
Q

Release Information Form

A

Allows a patient access to his own medical records and allows the patient control over to whom those records are released

28
Q

Preferred Provider Organization (PPO)

A

Managed care organization of providers, hospitals, and other healthcare providers who agreed with an insurer or a third-party administrator to provide health care are reduced rates to the insurer’s or administrator’s clients

29
Q

Medicaid

A

Provides health insurance for the medically needy

30
Q

Medicare

A

Federal insurance plan that generally covers those over the age of 65

31
Q

Tricare

A

Healthcare for military personnel and their dependents to receive care from civilian providers at the expense of the federal government

32
Q

Workers’ Compensation

A

Wage replacement and medical benefits for those injured on the job

33
Q

Advance Beneficiary Notice (ABN)

A

Waiver of liability is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service

34
Q

Coinsurance

A

An amount a policyholder is financially responsible for according to their insurance policy

35
Q

Copay

A

A specified sum of money based on the patient’s insurance policy benefits due at the time of service

36
Q

Deductible

A

Specific amounts of money a patient must pay out-of-pocket before the insurance carrier begins paying for services in a calendar year

37
Q

Explanation of Benefits (EOB)

A

A statement detailing what services were paid, denied, or reduced in payment by the patient’s insurance company

38
Q

Preauthorization

A

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary

39
Q

Precertification

A

The process of obtaining eligibility, certification, or authorization and collecting information from the health plan prior to inpatient admissions and selected ambulatory procedures and services

40
Q

Referral

A

The process of directing or redirecting to a medical specialist or agency for definitive treatment

41
Q

Verification of Eligibility

A

Important to confirm how a patient will pay for services

42
Q

Diagnosis Code

A

Medical necessity

43
Q

CPT

A

Current Procedural Terminology (5-digit code)

44
Q

International Classification of Diseases (ICD)

A

Each diagnostic and procedural code allows for submission of services for reimbursement from insurance companies and to provide statistical data for research studies

45
Q

What does the first character mean for ICD Coding?

A

Main term when searching in the alphabetical index

46
Q

What does the second and third character mean for ICD Coding?

A

Numeric Codes

47
Q

What does the fourth, fifth, sixth, or seventh character mean for ICD Coding?

A

Being either alphabetical or numeric

48
Q

Modifier

A

Indicates one procedure was used multiple times on a patient

49
Q

Advance Booking

A

Making an appointment for a patient in advance

50
Q

What does clustering mean in terms of scheduling?

A

Seeing patients on the same day at the same time

51
Q

Double Booking

A

2 patients are given the same appointment time

52
Q

How do you deal with Hard of Hearing or Deaf Patients?

A

Get an interpreter

53
Q

How to deal with a Late Provider?

A

Offer to reschedule a patient’s appointment if the provider is late

54
Q

New Patient (NP)

A

A patient who has not been seen by the provider before r who has not been seen in 3+ years is considered a new patient for coding and billing purposes

55
Q

No Show (NS)

A

Patients who have missed their scheduled appointment

56
Q

How do you schedule tests?

A

Schedule the least invasive test first if a patient is having multiple tests

57
Q

Wave Scheduling

A

3 or 4 patients are scheduled every half hour and are seen in the order in which they arrive at the office

CCMA (School Edition) (2 decks)

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