Textbook Chapter 1 Key Terms

Question 1

AHCCCS

Answer 1

• 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.

Question 2

APC

Answer 2

• Ambulatory Patient Classification

- Medical services that can be delivered in outpatient facilities.

Question 3

Case Manager

Answer 3

-The person who coordinates medical services on behalf of a patient in a MCO.

Question 4

Certification

Answer 4

• Evidence that an individual has mastered fundamental competencies in a particular technical areas (like phlebotomy).
• May be required for employment and licensing.

Question 5

CLIA ‘88

Answer 5

• Clinical Laboratory Improvement Amendments of 1988
• Federal Law regulating all laboratory testing sites using standards by the Center for Medicare and Medicaid Services (CMS).

Question 6

CMS

Answer 6

• 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.

Question 7

Communication Barriers

Answer 7

• Biases or personalized filters that are major obstructions to verbal communications.
• Language Limitations; Cultural Diversity; Emotions; Age; Hearing Loss; Etc

Question 8

CPT

Answer 8

• 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.

Question 9

Exsanguinate

Answer 9

-To remove all blood.

Question 10

HIPAA

Answer 10

• 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.

Question 11

HMO

Answer 11

• Health Maintenance Organization
• A Third Party Payer
• A Managed Care Organization where group practices are reimbursed on a prepaid, negotiated and discounted basis.

Question 12

ICD-9-CM

Answer 12

• 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.

Question 13

IDS

Answer 13

• 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.

Question 14

Kinesics

Answer 14

-The study of non-verbal communication.

Question 15

Kinesic Slip

Answer 15

-A mismatch of verbal and non-verbal messages.

Question 16

MCO

Answer 16

• 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.

Question 17

Medicaid

Answer 17

• 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

Question 18

Medicare

Answer 18

• 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

Question 19

MLS

Answer 19

• 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.

Question 20

PHI

Answer 20

• 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)

Question 21

PHS

Answer 21

• 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.

Question 22

Phlebotomy

Answer 22

-Incision into the vein for the purpose of drawing blood.

Question 23

Polycythemia

Answer 23

• 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).

Question 24

PPO

Answer 24

• 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).

Question 25

Primary Care

Answer 25

-Care by a general physician who assumes ongoing responsibility for maintaining his or her patients’ health.

Question 26

Proxemics

Answer 26

• 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.

Question 27

Reference Laboratories

Answer 27

• 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.

Question 28

Secondary Care

Answer 28

-Care provided by a physician (specialist) who can perform out-of-the-ordinary procedures in outpatient facilities.

Question 29

Tertiary Care

Answer 29

-Highly complex care and therapy services from practitioners in a hospital or overnight facility.

Question 30

Third-Party Payer

Answer 30

• An insurance company or government program that pays for healthcare on behalf of a patient.
• HMOs; PPOs; MCOs; Medicaid; Medicare