Module 1 Flashcards
Certification
Verification by an outside agency that an employer is following established guidelines and standards of care and providing the highest quality of care for their patients
Capitation
A managed care method of monthly payments to the provider based on the number of enrolled patients, regardless of how many encounters a patient may have during the month
Health Maintenance Organization (HMO)
A medical insurance group that provides coverage of health care services for a period of time and a fixed annual fee
STRICT, LESS EXPENSIVE, NEED REFERRAL
Patient-Centered Medical Home (PCMH)
A partnership between a patient and their care team in which total health is the focus and not just a single condition. A health care team consists of a provider (Physician, Nurse Practitioner, Physician Assistant), CMAA, CCMA, Nurses, and Pharmacist
Preferred Provider Organization (PPO)
A network of physicians, other health care practitioners, and hospitals that have joined together to contract with insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee.
Managed Care
System used by private and public insurance plans that controls health care cost and improves preventive care for its patients by having contracts with providers and medical organizations. The three types of managed care plans are health maintenance organization (HMO), Preferred provider organization (PPO), and point of Service (POS)
Scope of Practice
A specific set of standards that a medical professional may perform within the limits of the medical license, registration, and/or certification
Common Roles and Responsibilities of Medical Assistants
Clinical/Administrative Duties
Health Care Licensure
Regulated by state statutes through the medical practice act.
Pay for Performance
You pay employees based on how well they perform their duties.
Global Budget
Allow policymakers to directly constrain total health care spending by paying providers a lump su8m for all services they deliver
ACOS | Accountable Care Organizations
Groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve
Allopathic
A system in which medical doctors and other healthcare professionals, treat symptoms and diseases using drugs, radiation, or surgery
Ambulatory
People walking in to receive care
CPOE | Computerized Physician Order Entry
Designed to replace a hospital’s paper-based ordering system
