Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
CMAA Exam
| Term | Definition |
|---|---|
| patient-centered medical home (PCMH) | most common outpatient model consists of healthcare team that collectively takes responsibility for a patient's comprehensive care decreases costs and provides proactive preventive care |
| collaborative care (integrated care) | uses a team-based approach to integrate primary care with mental and behavioral health providers |
| accountable care organizations (ACOs) | hospitals, providers, and specialists who form groups that deliver collaborative care to patients often preventive care and screenings shown to prevent errors, avoid duplications example of true coordination of care and reduces cost for patients |
| hospice | care for terminally ill patients |
| home health care (HHC) | wide range of skilled medical and support services that are given in home, usually after a hospital stay example: post-partum care |
| mobile health unit | specialized vehicles that go to locations where healthcare may not be available example: urban and rural populations with vulnerable populations |
| certified medical administrative assistant (CMAA) | communicates that patient is checked in and ready to move forward to exam room or treatment area provides administrative support including answering phones, make appts, check patients in and out, collect copays |
| certified clinical medical assistant (CCMA) | takes patients to exam room or treatment area and documents chief complaint and current status of progress trained for clinical and administrative duties |
| registered nurses (RNs) | health care professionals who are licensed by the state to provide and coordinate patient care |
| licensed practical nurses (LPNs) | provide healthcare to patients who are sick, injured, or in need of checkups are licensed but supervised by providers and RNs |
| nurse practitioners (NPs) | diagnoses illnesses, conduct physical exams, order and interpret tests, develop treatment plans, and prescribe medications |
| physician associates/assistants (PAs) | licensed healthcare providers that work interdependently with physicians to diagnose illnesses, conduct physical exams, order and interpret tests, develop treatment plans, and prescribe meds |
| primary care providers (PCPs) | include physicians, NPs, PAs diagnose and treat illnesses, injuries, and disorders, prescribe meds, make treatment plans, and answer patients questions |
| electronic claims submission | billing application submits claims for reimbursements third-party payments and adjustments are posted patient payments are posted statements are itemized and receipts are generated |
| billing management | monitors payments billed and received each month report allows for opportunity for practice to analyze trends of reimbursement info has to be timely, there are deadlines |
| patient eligibility verification | eligibility is verified when appointment is made and services are provided, process is automated |
| payment tracking | tracks claim submissions to third-party payers, claim status, and when payment is being sent to provider payments often made by direct deposit |
| a-fib | atrial fibrillation |
| amt | amount |
| ecg | electrocardiogram |
| etoh | ethanol |
| po | orally |
| prn | as needed |
| superior | above; toward head |
| inferior | below; toward feet |
| anterior | front of body |
| posterior | back of body |
| midline | divides body equally down the middle |
| lateral | side |
| medial | middle |
| axial | head, neck, vertebral column |
| appendicular | upper and lower extremities |
| saggital plane | left and right of body |
| coronal plane | divides anterior and posterior |
| transverse plane | divides superior and inferior |
| therapeutic communication | based between patient and healthcare provider to improve patient's wellbeing |
| verbal communication | oral or written communication |
| nonverbal communication | body language |
| passive communication | avoiding expressing feelings or thoughts when communicating with them, be assertive and firm (not aggressive) while other person feels heard |
| aggressive communication | hostile or argumentative and believe their thoughts are the only ones that matter best approach is to remain calm, empathetic, and assist in resolving the issue |
| passive-aggressive communication | presents calm and relaxed. but are upset and frustrated remain calm, practice patience, and assist without aggression |
| manipulative communication | do whatever they need to get their way remain calm and firm |
| assertive communication | most effective being firm, using appropriate body language, clearly stating facts as well as solutions everyone feels heard |
| compliance | following mandated laws, policies, standards and guidelines |
| laws | obligation imposed by authority to protect patients, providers, and property may lead to punishment |
| regulations | rules or orders issued by executive authority or regulatory agency of government with force of law |
| guidelines | written reccomendations of policy |
| policies | written documents that specify responsibilities among boards, management, and medical staff |
| standards | criteria and practices established by authority as rules for measuring value, extent, or quality |
| medical law | explains rights and responsibilities of medical providers and patients |
| contracts | legally binding agreements between parties |
| malpractice | treatment by medical professional that doesn't follow standards of care |
| centers for medicare and medicaid services (CMS) | ensures standards in federally funded medical programs are followed include medicare, medicaid, state children's health insurance program (SCHIP), TRICARE, veterans health admin, and Indian Health Service |
| medicare fraud | submitting false claims for payment, receiving incentives for services or devices that are federally funded, making inappropriate referrals |
| medicare abuse | any practice that may result in unnecessary costs ot medicare |
| Tier 1 HIPAA violation | unknowingly committing a violation |
| Tier 2 HIPAA violation | reasonable cause, a violation the covered entity should be aware of but couldn't avoid |
| Tier 3 HIPAA violation | willful neglect, an attempt has been made to correct the violation |
| Tier 4 HIPAA violation | willful neglect, no attempt has been made to correct |
| block scheduling | grouping similar patient conditions and specific times |
| modified wave | patients scheduled in 15 minute time period |
| time-specific/streaming | scheduled at designated time |
| wave scheduling | schedule 2-3 patients during a designated hourly time period |
| HMO | insurance group that provides coverage of healthcare services for a period of time and fixed annual fee Example is Blue Cross |
| PPO | network of physicians, healthcare practitioners, and hospitals that have joined together to contract with insurance companies, employers, or other organizations to provider for subscribers for a discounted fee examples are United Health and Humana |
| utilization management review | ensures patient has appropriate referral, precert, preauth, or predetermination |
| precertification | finding out if service is covered by patient's plan |
| predetermination | determining the payer's reimbursement amount for service |
| preauthorization | finding out if payer considers a service medically necessary based on patient's condition |
| contractural adjustment | used by third-party payer when there's a difference between billed amount and allowed amount |
Created by:
aslayton