Module 1: Health Care System Flashcards
Roles and Responsibilities
Medical Assistant
Medical Personnel are Ultimately Responsible for Care/Well-Being of their Patients
administrative: greeting, correspondence, answer phones
clinical: medical history, explaining treatments/procedures, drawing labs, prep/give immunizations
Screen Patients Before Provider, Help Allied Health Services
Where: Hospital, Ambulatory Care Center, Home Health Agency, Hospice, Medical Office
Administrative and Clinical Duties
Medical Assistant
Health Care Providers
Greetings, Handling Correspondence, Answering Telephones
Responsible for Clinical Task: Medical Histories, Explaining Treatment, Drawing Labs, Prep/Admin Shots
Medical Doctors (MD)
allopathic providers
Health Care Providers
Diagnose Illnesses, Provide Treatments, Perform Procedures (surgical, interventions, and write prescriptions)
Osteopathic Providers (DOs)
similar to MD
Health Care Providers
Addition to Modern Medicine, Surgical Procedures, Use Osteopathic Manipulative Therapy (OMT)
Nurse Practitioners
below MD and beyond RN
Health Care Providers
Provide Basic Patient Care Services (diagnosing, prescribing medications), Focus on Preventive Care/Disease Prevention
Physician Assistants
supervised by MD or DO
Health Care Providers
Able to Make Clinical Decisions/Be Responsible for Variety of Services
Medical Laboratory Technicians
under supervision of medical technologist
Allied Health Personnel
Perform Diagnostic Testing
(blood, bodily fluids, other specimens)
Medical Receptionists
works for provider
Allied Health Personnel
Check Patients In & Out, Answer Phones,
Perform (filing, faxing, other tasks)
Occupational Therapists
Allied Health Personnel
Assist Patients Who Have Developed Conditions that Disable Them
Developmentally, Emotionally, Mentally, Physically
Pharmacy Technicians
Allied Health Personnel
Assist Pharmacists with Duties that DO NOT require expertise or judgement of a licensed pharmacist
Physical Therapists
Allied Health Personnel
Assist Patients in regaining their Mobility/Improving their Strength/Rang of Motion
Radiology Technicians
Allied Health Personnel
Use Various typed of Imaging Equipment to Assist the Provider in Diagnosing/Treating Certain Diseases
Professionalism
skills, behavior, appropriate judgment that represent best qualities of person in a specific profession
Exhibit Courteous, Conscientious, Businesslike Manner
Dependability, Initiative, Flexibility, Confidentiality, Good Attitude
Appropriate Dress
good personal hygiene, appropriate work attire, avoid perfumes, wear make up conservatively, keep nails clean
clothing should be comfortable/fit, no facial piercings, visible tattoos
Work Ethic
A set of values based on the moral virtues of hard work and diligence
Scope of Practice
Delegated clinical and administrative duties consistent with education, training, and experience
Standard of Care
Degree of care or competence expected in a particular circumstance or role
CPT
Additional Credentials
Certified Phlebotomy Technician
CET
Additional Credentials
Certified EKG Technician
CBCS
Additional Credentials
Certified Billing and Coding Specialist
CEHRS
Additional Credentials
Certified Electronic Health Records Specialist
CHC or PN
Additional Credentials
Certified Health Coach
Patient Navigator
Computerized Physician Order Entry
CPOE
Process of electronic data entry of provider instructions for treatment
Accountable Care Organizations
ACOs
Health Care Delivery Model
Groups of physicians, hospitals, other health care providers together voluntarily provide high-quality care to Medicare patients. ACO succeeds delivering high-quality care/spending health care dollars wise, share in savings achieves Medicare program
Capitation
(partial or full)
Health Care Delivery Model
patients assigned per-member, per-month payment based on age, race, sex, lifestyle, medical history, benefit design. payment rates tied expected usage regardless how often patients visits, like bundled payment models, providers incentive to help avoid high-cost procedures/tests max compensation, under partial/blended-cap models, only specific types/cat services paid basis of capitation
Global Budget
Health Care Delivery Model
fixed total dollar amount paid annually all care, providers determine how money spent, limit level/rate increase health care cost, typically include quality component
Health Maintenance Organization
HMO
Health Care Delivery Model
plan contacts medical center/group of providers to preventive/acute care for insured peron. HMOs require referrals speciaists precertification/preauthorization hospital admissions, outpatient procedures, treatments
Patient-Centered Medical Home
PCMH
Health Care Delivery Model
primary care provider coordinates treatment to insure patients receive required care when/where they need it, in way they can understand
Pay for Performance
Health Care Delivery Model
reimbursement model compensates providers only if they meet certain measures quality/efficiency, generating quality benchmark measures connects provider reimbursement directly quality care provide
