Module 1A: Foundational Knowledge Flashcards
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
MA Scope of Practice
The MA works under the supervision of a provider and performs tasks allowed by states and provider approval
does not include the practice of medicine
Certification
Verification by an outside agency that an employer is following established guidelines and standard of care providing the highest quality of care for their patients
MA Responsibilities
Administrative Duties:
- Scheduling patient appointments
- Patient registration (demographics, payer information, compliance forms)
- Updating and working in patient records
- Sending claims to insurance
- Collecting patient responsibility amounts (copays, coinsurance, deductible)
Clinical Duties:
- Collecting and processing lab specimens
- Performing diagnostic testing (EKG, spirometry)
- Preparing and cleaning examination rooms
- Preparing the patient for evaluation and procedure
- Measuring vital signs
- Preparing medications and administering immunizations
Doctor of Medicine (MD)
Scientific focus on diagnosis and treatment of medical conditions
Doctor of Osteopathic Medicine (DO)
- Holistic approach to medicine
- Training on osteopathic manipulative treatment
Physician Assistants (PA)
Practices medicine under the direction and supervision of a licensed MD or DO, but they can make clinical decisions.
Nurse Practitioners (NP)
Provide basic patient care services, including diagnosing and prescribing medications for common illnesses. NPs must work under the supervision of a physician, but in some states, they can practice independently.
Registered Nurse (RN)
Must complete more schooling in the form of an associate degree, diploma graduate, or baccalaureate degree. They, too, must pass a state board examination to be licensed. Due to the more intensive training, RNs have a much broader scope of practice than LPNs. RNs can work in clinical settings, public health agencies, administrative capacities, and educational settings.
Licensed Practical Nurse (LPN)
Must be licensed in their state. Typically, one year of schooling through an accredited program, along with passing a state board examination, is required to obtain an LPN license. LPNs are somewhat limited in their scope of practice, as the role is designed to be assistive. They can measure vital signs, administer some medications, and perform clinical care such as wound care. Often, the role of an LPN is to observe patients, recording and reporting on status changes.
Medical Laboratory Technicians
Perform diagnostic testing on blood, bodily fluids, and other specimens under the supervision of a medical technologist
Medical Receptionists
Check patients in and out, answer phones, schedule appointments, and perform other administrative tasks
Occupational Therapists
Assist patients who have conditions that disable them developmentally, emotionally, mentally, or physically.
OT helps the patient compensate for the loss of functions and rebuild to a functional level.
Pharmacy Technicians
May perform routine medication dispensing functions that do not require the expertise or judgment of a licensed pharmacist. Pharmacy technicians must work under the direct supervision of a pharmacist
Physical Therapists
Assist patients in improving mobility, strength, and range of motion often impaired by an accident, injury, or disease.
Radiology Technicians
Use various imaging equipment to assist the provider in diagnosing and treating certain diseases
Endorsement
The process of a state/territory granting a license to an applicant who is licensed in good standing at the equivalent designation in another jurisdiction.
Reciprocity
Agreement or arrangement that allows resident licensees of one reciprocal state to obtain a license in another reciprocal state.
Licensure
Regulated by state statutes through the medical practice acts.
- accomplished by examination, reciprocity, or endorsement
Certification
Generally optional, but some states require official education and training for a medical assistant to administer medication or perform phlebotomy procedures.
- Must be maintained to stay current. This ensures that medical assistants have the most up-to-date information about the medical field and provides validity to the overall profession.
NHA Certification Validity
Those certified through NHA have a valid certification for two years and must either retake the certification exam or complete 10 hours of continuing education to renew.
Inpatient Care
Occurs while the patient is admitted to a hospital or facility
Ambulatory Care
Any care received in an outpatient facility
- primary care clinics
- specialty care clinics
- home health
- mobile health units
- hospice
Primary Care Clinics
Outpatient care settings where patients are seen for routine type visits, including wellness checks, prevention counseling, chronic conditions, medication management, and minor acute needs
Specialty Care Clinics
Outpatient facilities where patients who have complex or severe diseases and conditions are seen for routine visits by doctors who specialize in a specific disease or condition
Home Health
Types of care provided to those who cannot leave their home easily.
It must be prescribed and overseen by a provider, typically a primary care provider (PCP).
Home health is not used on an ongoing basis for a patient but is ordered for a set period based on an acute event, usually hospitalization. The service is complete when the goals are reached.
Types:
- PT
- OT
- SLP
- Skilled Nursing
Mobile Health Units
These units bring health care to the communities that most need it and may otherwise lack access to the services provided. Teams working in a mobile health unit are equipped with means of transportation that allow for the setup and use of specialized medical equipment.
Hospice
End-of-life care focused on comfort rather than curative efforts. Patients can qualify for hospice care if they have a terminal illness at the end stage.
It can be delivered as outpatient or inpatient care.
Patient-Centered Medical Home (PCMH)
A care delivery model in which a PCP coordinates treatment to ensure patients receive the required care when and where they need it and in a way they can understand.
The PCMH is a team-based approach to health care in which a provider leads an interprofessional team to work collaboratively and effectively for their patients.
Encompasses all aspects of care, from prevention and wellness education to acute illness and chronic disease management to end-of-life care.
Telehealth
Health care delivered virtually, most commonly via video call
Prevents patients from coming in contact with communicable diseases, provides convenience, and allows patients in rural areas to obtain specialty care where it may not have been offered before.
Telehealth Appropriate
- Follow-up on medication adjustments
- Chronic condition review and discussion
- Patient education
- Evaluation of minor or common rashes and skin concerns
- Follow-up on new medical equipment, such as a CPAP machine
- Discussion of lab results
In-Person Evaluation Needed (NOT Telehealth Appropriate)
- Diagnostic testing, such as imaging or lab work
- New pain symptoms
- Physical examination
MAs Role in Telehealth Visits
Scheduling: gather or confirm the patient’s email address, ensure the link has been sent, and review instructions
Participating in the actual visit (just like in person): gathering a history, verifying medication and pharmacy information, setting an agenda, and following up with the patient on the next steps, such as referral or diagnostic testing coordination.
Patient Portals
The patient-facing aspect of the EHR where patients can view their personal health information, such as test results, visit notes, and patient education materials (ex: MyChart)
MAs Role in Patient Portals
May be responsible for uploading information to the portal, as well as assisting the patient with enrolling and getting set up with an account.
Fee for Service
System used by private insurance companies and not-for-profits in which insurance carriers determine the allowed charge either by a fee schedule or through service benefits that define covered services but not necessarily the exact payments.
*Main system of US healthcare
Every examination, medical service, test, and procedure has an associated procedural code and charge. These charges are managed through the provider’s medical billing department and sent to the insurance (or directly to the patient) for payment.
- The primary benefit of this model is that patients only pay for services they use. The risk of this model is that it can lead to unnecessary visits, tests, and procedures for the profit of those providing care.
Value-Based Plans
Insurance coverage that changes the amount of reimbursement based on health outcomes of patients and the quality of the service they received.
* the health care system is increasingly moving toward
The goals of value-based care are summarized in the Quadruple Aim.
- Improved patient outcomes
- Improved patient satisfaction
- Lower cost
- Health care professional well-being
Rather than costs being determined by each service, the cost is more holistic. This model prioritizes prevention and early intervention over complex intervention to prevent unnecessary downstream costs.
Managed Care
An umbrella term for private and public insurance plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals.
3 types of managed care plans:
- health maintenance organization (HMO)
- preferred provider organization (PPO)
- point of service (POS)
Health Maintenance Organization (HMO)
This plan contracts with a medical center or group of providers to provide preventive and acute care for the insured person for a period of time and a fixed annual fee.
HMOs generally require referrals to specialists, as well as precertification and preauthorization for hospital admissions, outpatient procedures, and treatments.
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.
These plans have more flexibility than HMO plans. An insured person does not need a PCP and can go directly to a specialist without referrals. Although patients can see providers in or out of their network, an in-network provider usually costs less.
Point of Service (POS)
A type of managed care health insurance plan that is based on lower medical costs in exchange for more limited choice.
POS plans allow a great deal of flexibility for patients. They can self-refer to specialists and do not need an assigned PCP. Like PPO, the cost depends on whether the providers they see are within the plan’s panel.
Capitation
A managed care method of monthly payments to the provider based on the number of enrolled patients, age, race, sex, lifestyle, medical history, and benefit design, regardless of how many encounters a patient may have during the month.
Like bundled payment models, providers are incentivized to help patients avoid high-cost procedures and tests to maximize their compensation. Under partial- or blended-capitation models, only specific types or categories of services are paid based on capitation.
General Health Care Services
- General Practitioners (GPs): Medical doctors who treat acute and chronic illnesses and provide patients with preventive care and health education.
- Family practitioners: offer care to the whole family, from newborns to older adults. They are familiar with a range of disorders and diseases. However, preventive care is their primary concern.
- Internists: provide comprehensive care for adults, often diagnosing and treating chronic, long-term conditions. They also offer treatment for common illnesses and preventive care. Internists may focus on pediatric or adult medicine rather than provide care across the lifespan.
Specialty Health Care Services
Used when a disease or diagnosis escalates beyond the area of expertise of a PCP. Specialists are providers focused on diagnosing and treating diseases and disorders of specific body systems.
MAs in Specialty Care
Medical assistants can interact with specialists by managing and coordinating referrals from primary care offices and directly supporting the specialist provider.
Allergist
Evaluates disorders and diseases of the immune system, including adverse reactions to medications and food, anaphylaxis, problems related to autoimmune disease, and asthma
Adverse Reactions
Unwanted or undesired effects that are possibly related to taking a medication, usually secondary to the main effect of the medication.
Anesthesiologist
Manages pain or administers sedation medications during surgical procedures
Cardiologist
Diagnoses and treats diseases or conditions of the heart and blood vessels
Dermatologist
Diagnoses and treats skin conditions
Endocrinologist
Diagnoses and treats hormonal and glandular conditions; often works with patients who have diabetes
Gastroenterologist
Manages diseases of the GI tract (stomach, intestines, esophagus, liver, pancreas, colon, and rectum)
Gynecologist
Diagnoses and treats internal reproductive system and fertility disorders
Hematologist
Diagnoses and treats blood and blood-producing organs, patients who have anemia, leukemia, and lymphoma
Hepatologists
Studies and treats diseases related to the liver, biliary tree, gallbladder, and pancreas
Neonatologist
Provides care of newborns, specifically those who are ill or premature
Nephrologist
Manages diseases and disorders of the kidney and its associated structures
Obstetrician
Provides care of patients during and after pregnancy
Oncologist
Treats and provides care for patients who have cancer
Ophthalmologist
Diagnoses and treats diseases and conditions of the eye
Orthopedist
Treats injuries and diseases of the bones, joints, muscles, tendons, and ligaments
Neurologist
Treats diseases and disorders of the brain and nervous system
Otolaryngologist
Treats diseases and conditions of the ear, nose, and throat
Pediatrician
Manages newborn to adolescent health
Psychiatrist
Diagnoses and treats mental disorders and conditions
Radiologist
Uses and interprets imaging to detect abnormalities in the body
Urologist
Manages disorders of the urinary tract
Ancillary Services
Providing ancillary services in the provider’s office adds convenience for patients and increases revenue for the organization.
Ancillary services meet a specific medical need for a particular population.
- Urgent care
- Laboratory services
- Diagnostic imaging
- PT and OT
Urgent Care
Provides an alternative to the emergency department. They cost less, have a shorter wait time, and are often conveniently located. Most have flexible hours and offer walk-in appointments. They are appropriate to use for non-life-threatening acute injuries and illnesses.
Laboratory Services
Perform diagnostic testing on blood, body fluids, and other specimens to conclude a diagnosis for the provider
Diagnostic Imaging
Machines such as x-ray equipment, ultrasound machines, magnetic resonance imaging (MRI), and computerized tomography (CT) take images of body parts to further diagnose a condition
Acupuncture
Involves pricking the skin or tissues with needles to relieve pain and treat various physical, mental, and emotional conditions.
Chiropractic Medicine
Diagnoses and treats pain and overall body function through spinal manipulation and alignment.
Energy Therapy
The calm method of clearing cellular memory through the human energy field, promoting health, balance, and relaxation. It centers on the connection between life’s physical, emotional, and mental states 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 (flowers, leaves, bark, fruit, seeds, stems, roots, amino acids) is used for its flavor, scent, or potential therapeutic properties.
