Module 1 - Health Care Systems/Settings Flashcards
Primary role of medical assistant
Work alongside a provider in outpatient or ambulatory setting. Might be cross-trained to perform administrative and clinical duties.
Role of medical doctors (MD)
“Allopathic” providers, most widely recognized type.
Diagnose illnesses, provide treatments, perform procedures such as surgical interventions, write prescriptions.
Role of osteopathic providers (DO)
Complete requirements similar to those of MDs
In addition to using modern medicine and surgical procedures, use osteopathic manipulative therapy (OMT) in treating their patients
Role of nurse practitioners
Provide basic patient care services including diagnosing and prescribing medications for common illnesses.
Require advanced academic training beyond the RN degree and have extensive amount of clinical experience.
Generally focus on preventive care and disease prevention
Role of physician assistants
Practice medicine under the direction and supervision of a licensed MD or DO.
Able to make clinical decisions are are responsible for a variety of services
Role of medical laboratory technicians
Perform diagnostic testing on blood, bodily fluids, and other specimens under the supervision of a medical technologist
Role of medical receptionist
Check patients in and out, answer phones, perform filing faxing, and other tasks
Role of occupational therapist
Assist patients who have developed conditions that disable them developmentally, emotionally, mentally, or physically
Role of pharmacy technician
Assist pharmacists with duties that do not require the expertise or judgement of a licensed pharmacist
Role of physical therapist
Assist patients in regaining their mobility and improving their strength and range of motion
Role of radiology technicians
Use various types of imaging equipment to assist the provider in diagnosing and treating certain diseases
Professionalism - appropriate dress
Good personal hygiene and appropriate work attire.
Avoid perfumes and colognes.
Conservative makeup and clean nails.
Professionalism - personal phone use
Take personal phone calls and text messages during scheduled work breaks or lunch hours.
If a phone must be carried, put on vibrate. Step into hall or break area if a call must be taken.
Professionalism - punctuality
Arrive to work in timely manner, perform all assigned duties each day.
Good time-management skills - prioritize tasks and arrange schedules to perform all necessary duties efficiently and effectively.
Professionalism - respect for boundaries
Respect personal space for patients and coworkers, provide effective communication when interrupting it
Professionalism - motivation
Intrinsic motivation comes from within and focuses on lifelong goals.
Extrinsic motivation is physical and driven by outside forces.
Extrinsic motivation is more short-lived and less fulfilling
Professionalism - work ethic
A set of values based on the moral virtues of hard work and diligence.
Always display initiative, be reliable, assist others, be present and ready to work.
Professionalism - integrity
The quality of being honest and having strong moral principles.
Honesty, truthfulness, equal treatment of all patients.
Professionalism - accountability
Being responsible for one’s own actions. Being able to explain and answer questions relating to their actions
Professionalism - flexibility
Being able to acclimate to a wide variety of situations. Staff must be flexible enough to adjust to schedule changes for all patients.
Staff members are willing to assist each other when workloads are uneven. Never say “that’s not my job”
Professionalism - open-mindedness
Willingness to try new things and be considerate of others ideas. Listens to opponents in a discussion
Scope of practice for medical assistants and variables
Must be trained or in some cases certified to perform certain duties. Cannot diagnose, treat, or instruct patients to take any course of action
Variables include regulations and policies issued by state medical boards, the specific organizational policies of the medical office
Licensure vs certification
Licensure is regulated by state, issued upon graduation. Mandatory for physicians and controlled by a state board of medical examiners. May be accomplished by examination, reciprocity, or endorsement
Certification is generally optional for medical assistants, but some states require official education and training to administer medication or perform phlebotomy procedures. Additionally the government may require certification in order to enter prescriptions into the computerized physician order entry CPOE program.
To keep certification a medical assistant must perform continuing education units
Delivery model - Accountable care organizations (ACOs)
Groups of physicians, hospitals, and other health care providers that coordinate care to Medicare patients.
Share savings it achieves for the Medicare program
Delivery model - Capitation (partial or full)
Patients are assigned a per-member, per-month payment based on age, race, sex, lifestyle, medical history, benefit design. Rates are tied to expected usage.
Providers have an incentive to help patients avoid high-cost procedures and tests to maximize their compensation
Delivery model - Global budget
Fixed total dollar amount paid annually for all care, providers determine how the money is spent.
Limits the level and rate of increase of health care cost.
Delivery model - Health maintenance organization (HMO)
Contracts with a medical center or group of providers to provide preventive and acute care for the insured person.
Generally require referrals to specialists, pre-certification and preauthorization for hospital admissions, outpatient procedures, and treatments
Delivery model - Patient-centered medical home (PCMH)
A primary care provider coordinates treatment to make sure patients receive the required care when and where they need it, and in a way they can understand
Delivery model - Pay for performance
Compensates providers only if they meet certain measures for quality and efficiency
Delivery model - Preferred provider organization (PPO)
More flexible than HMO, an insured person doesn’t need a PCP, can go to specialists without referrals. In-network providers usually cost less, although both are allowed
General practitioners (GPs)
Medical doctors who treat acute and chronic illnesses and provide preventive care and health education to patients. Often has holistic approach with consideration of biological, psychological, and social aspects relevant to the care of each patient’s illness
Family practitioners
Offer care to the whole family, from newborns to older adults. Familiar with a range of disorders and diseases. Preventive care is primary concern
Internists
Provide comprehensive care of adults, often diagnosing and treating chronic, long-term conditions. Offer treatment for common illnesses and preventive care. Must have a broad understanding of the body and its ailments to be able to diagnose conditions and provide treatment
Allergists
Evaluate disorders and diseases of the immune system
Includes reactions to medications/foods, anaphylaxis, autoimmune disease, asthma
Anesthesiologists
Manage pain or use sedation during surgical procedures
Cardiologists
Specialize in diagnosing and treating diseases or conditions of the heart and blood vessels
Dermatologists
Specialize in conditions of the skin
Endocrinologists
Specialize in hormonal and glandular conditions. They often work with patients who have diabetes mellitus.
Gastroenterologists
Specialize in managing diseases of GI tract: stomach, intestines, esophagus, liver, pancreas, colon, and rectum
Gynecologists
Specialize in the female reproductive system and fertility disorders
Hematologists
Deal with blood and blood-producing organs, often work with patients who have anemia, leukemia, and lymphoma
Hepatologists
Specialize in the study of body parts such as liver, biliary tree, gallbladder, pancreas
Neonatologists
Specialize in the care of newborns
Nephrologists
Specialize in kidney care and treating diseases of the kidneys
Obstetricians
Specialize in the care of women during and after pregnancy
Oncologists
Specialize in the treatment and care of patients who have cancer
Opthalmologists
Specialize in eye conditions
Orthopedists
Specialize in bones, joints, muscles, tendons, and ligaments
Otolaryngologists
Specialize in ear, nose, and throat
Neurologists
Specialize in the nervous system
Pathologists
Specialize in body tissues, blood, urine, and other body fluids to diagnose or treat medical conditions
Pediatricians
Specialize in newborn, infant, child, and adolescent health care
Psychiatrists
Specialize in mental disorders and conditions
Radiologists
Specialize in the use of x-rays, ultrasound, nuclear medicine, computed tomography, MRI to detect abnormalities throughout the body
Urologists
Specialize in disorders of the urinary tract
Urgent care
Provides and alternative to the emergency department. Costs less, have a shorter wait time, are conveniently located. Flexible hours and offer walk-in appointments
Laboratory services
Perform diagnostic testing on blood, body fluids, and other types of specimens to conclude a diagnosis for the provider
Diagnostic imaging machines
Machines such as x-ray equipment, ultrasound machines, magnetic resonance imaging, and computerized tomography take images of body parts to further diagnose a condition
Occupational therapy
Assists patients who have conditions that disable them developmentally, emotionally, mentally, or physically. Helps patient compensate for loss of functions and rebuild to a functional level
Physical therapy
Assists patients in regaining mobility and improving strength and range of motion, often impaired by an accident, injury, or as a result of disease
Acupuncture
Pricking the skin or tissues with needles to relieve pain and treat various physical, mental, and emotional conditions
Chiropractic medicine
diagnoses and treats mechanical disorders of the musculoskeletal system, particularly the spine
Energy therapy
Calm method of clearing cellular memory through the human energy field promoting health, balance, and relaxation. Centered on the idea of connection between the physical, emotional, and mental states of life found in various holistic healing techniques
Dietary supplements
Contain one or more dietary ingredients including vitamins, minerals, herbs, or other botanicals. A plant or part of a plant is used for its flavor, scent, or potential therapeutic properties
Insurance terminology - Advance beneficiary notice (ABN)
A form provided to the patient when the provider believes Medicare will probably not pay for services received
Insurance terminology - Allowed amount
The maximum amount a third-party payer will pay for a particular procedure or service
Insurance terminology - Copayment
An amount of money that is paid at the time of medical service
Insurance terminology - Coinsurance
A policy provision frequently found in medical insurance whereby the policyholder and the insurance company share the cost of covered losses in a specified ratio, such as 80:20
Insurance terminology - Deductible
A specific amount of money a patient must pay out of pocket before the insurance carrier begins paying
Insurance terminology - Explanation of benefits
A statement from the insurance carrier detailing what was paid, denied, or reduced in payment; also contains information about amounts applied to the deductible, coinsurance, and allowed amounts
Insurance terminology - Participating provider (PAR)
Providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer
Medicare
Generally covers patients age 65 and older by Part A (hospitalization) or Part B (routine medical office visits) benefits
Tricare
Authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government
CHAMPVA
covers surviving spouses and dependent children of veterans who died as a results of service-related disabilities
Medicaid
provides health insurance to the medically indigent population through a cost-sharing program between federal and state governments for those who meet specific eligibility criteria
Managed care
an umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals
Workers compensation
protects wage earners against the loss of wages and the cost of medical care resulting from an occupational accident or disease as long as the employee is not proven negligent
CMS-1500 Form
Used by most health care payers for claims submitted by a provider or supplier.
Has 3 sections:
Section 1 - Carrier Block
Section 2 - Patient/Insured Section
3 - Physician/Supplier
A medical assistant must know how to properly fill it out
