Textbook Chapter 1 Key Terms Flashcards
1
Q
AHCCCS
A
- Arizona Healthcare Cost Containment System
- A reimbursement program available only in Arizona.
- Physician Groups must win annual contracts to serve residents.
- Patients choose providers by open annual enrollment.
2
Q
APC
A
- Ambulatory Patient Classification
- Medical services that can be delivered in outpatient facilities.
3
Q
Case Manager
A
-The person who coordinates medical services on behalf of a patient in a MCO.
4
Q
Certification
A
- Evidence that an individual has mastered fundamental competencies in a particular technical areas (like phlebotomy).
- May be required for employment and licensing.
5
Q
CLIA ‘88
A
- Clinical Laboratory Improvement Amendments of 1988
- Federal Law regulating all laboratory testing sites using standards by the Center for Medicare and Medicaid Services (CMS).
6
Q
CMS
A
- Center for Medicare and Medicaid Services
- A federal organization which set standards for laboratory practices including the Procedural Coding System (PCS) and the ICD-10-PCS.
7
Q
Communication Barriers
A
- Biases or personalized filters that are major obstructions to verbal communications.
- Language Limitations; Cultural Diversity; Emotions; Age; Hearing Loss; Etc
8
Q
CPT
A
- Current Procedural Terminology Codes
- Developed by the AMA in the 1960’s to help provide a standardized terminology.
- Used in physician billing, and other healthcare settings.
- ICD-10-PCS replaced the CPT in 2013 for inpatient settings; CPT still used for outpatient providers.
9
Q
Exsanguinate
A
-To remove all blood.
10
Q
HIPAA
A
- Health Insurance Portability and Protection Act
- Law passed in 1996 to regulate patient privacy and safeguard of Protected Health Information (PHI).
- Requires that consent must be provided in writing to a Healthcare Worker (HCW) before disclosing the patient’s medical information.
11
Q
HMO
A
- Health Maintenance Organization
- A Third Party Payer
- A Managed Care Organization where group practices are reimbursed on a prepaid, negotiated and discounted basis.
12
Q
ICD-9-CM
A
- International Classification of Diseases, Ninth Revision, Clinical Modification.
- Used by healthcare providers as a standard coding system for diagnoses.
- Groups together similar diseases and operations.
- Replaced by ICD-10-CM.
13
Q
IDS
A
- Integrated Healthcare Delivery System
- A healthcare provider made up of associated medical facilities that furnish coordinated services from pre-birth to death.
- Includes hospitals, subacute care facilities, ambulatory surgery centers, physician practices, outpatient clinics and skilled nursing facilities (SNFs).
- More cost effective than utilizing separate healthcare organizations and focuses on holistic coordinated care.
14
Q
Kinesics
A
-The study of non-verbal communication.
15
Q
Kinesic Slip
A
-A mismatch of verbal and non-verbal messages.
16
Q
MCO
A
- Managed Care Organization
- A complete network of medical services.
- Services are reimbursed by the number of enrollees served, not by number of services provided.
- Hopes to reduce the total cost of care while maintaining patient satisfaction.
17
Q
Medicaid
A
- Federal and state program which provides medical assistance to low income americans.
- Enacted in 1965
- Recipients must meet eligibility requirements.
- Covers inpatient, outpatient, diagnostic services, skilled nursing facilities, home healthcare and physician services.
- A Third-Party Payer
18
Q
Medicare
A
- Federally funded entitlement program which provides healthcare to people over the age of 65 and to the disabled.
- Enacted in 1965.
- Individuals earn Medicare through employment and is financed through social security, payroll deductions and co-payments.
- Part A provides for hospital services.
- Part B provides supplementary medical insurance (SMI) and is optional.
- A Third-Party Payer
19
Q
MLS
A
- Medical Laboratory Scientist (also Medical Technologist)
- Performs all level of laboratory medical testing; reports results; performs quality control; evaluates new procedures; and conducts preventative maintenance or equipment troubleshooting.
- Has a Bachelor’s Degree and additional studies or experience in the clinical laboratory settings.
- States may require licensing.
20
Q
PHI
A
- Protected Health Information
- Individually identifiable health information that is transmitted by electronic media; maintained in any medium described in the definition of electronic media or transmitted or maintained in any other form or medium.
- Protected by the Health Insurance Protection and Portability Act of 1996 (HIPPA)
21
Q
PHS
A
- Public Health Service
- Part of the Department of Health and Human Services (HHS).
- Promotes, protects and advances the nation’s physical and mental health.
- Sponsors and administers programs for the development of health resources, disease control and prevention and drug abuse.
- Provides services for little or no charge.
22
Q
Phlebotomy
A
-Incision into the vein for the purpose of drawing blood.
23
Q
Polycythemia
A
- A disorder involving overproduction of red blood cells (RBCs).
- Treated with phlebotomy techniques.
- RBC levels monitored by the Hematocrit Test (HCT, Crit, or H&H).
24
Q
PPO
A
- Preferred Provider Organizations.
- A Third-Party Payer
- Independent groups of physicians or hospitals that offer services to employers at discounted rates.
- Evolved in Managed Care Organizations (MCOs).
25
Q
Primary Care
A
-Care by a general physician who assumes ongoing responsibility for maintaining his or her patients’ health.
26
Q
Proxemics
A
- The study of an individual’s concept and use of space.
- Part of Non-Verbal Communication.
- It may be necessary to enter a patient’s “personal space” and must be handled in the correct manner as not to make the patient feel threatened, insecure or out of control.
27
Q
Reference Laboratories
A
- Large independent laboratories that receive and test specimens from many different facilities.
- Can provide routine or specialized testing with a fast turnaround time (TAT) and reduced cost.
28
Q
Secondary Care
A
-Care provided by a physician (specialist) who can perform out-of-the-ordinary procedures in outpatient facilities.
29
Q
Tertiary Care
A
-Highly complex care and therapy services from practitioners in a hospital or overnight facility.
30
Q
Third-Party Payer
A
- An insurance company or government program that pays for healthcare on behalf of a patient.
- HMOs; PPOs; MCOs; Medicaid; Medicare
