#1 NHA CCMA: Professionalism and Healthcare Systems

What areas does professionalism encompass in a health care organization?

Professionalism encompasses behaviors, appearance, communication (voice tone, attitude, word selection, and written communication), work ethic, and relationships.

Why is professionalism vital in a health care setting?

Because it must be present in all aspects of the environment to maintain trust, respect, and effective care among team members and patients.

How does a medical assistant contribute to professionalism in health care?

The MA provides the first patient interaction, making it important to maintain a professional manner with a positive attitude, which helps establish trust and respect.

What factors contribute to a professional presence?

Factors include a strong work ethic, positive demeanor, politeness, willingness to assist, cooperation, time management, and appropriate dress and personal boundaries.

What is the primary setting and function of a medical assistant (MA)?

MAs primarily work alongside providers in outpatient or ambulatory settings, performing both clinical and administrative duties.

What are common administrative duties of a medical assistant?

Administrative duties include scheduling appointments, patient registration, updating patient records, sending insurance claims, and collecting patient payments like copays and deductibles.

What clinical duties can a medical assistant perform?

Clinical duties include collecting lab specimens, performing EKGs and spirometry, preparing exam rooms and patients, measuring vital signs, and administering immunizations.

How is the MA’s role evolving in health care?

MAs now also support patient navigation and care coordination, helping patients understand their care plan and assisting with referrals and scheduling.

What is the scope of practice for a medical assistant?

It includes duties assigned based on their education, training, and experience, and must follow state regulations and employer policies.

Can a medical assistant practice medicine?

No, medical assistants cannot practice medicine or perform duties for which they are not trained or certified.

What factors determine a medical assistant’s scope of practice?

Factors include state medical board regulations, organizational policies, and the MA’s level of training.

How did the medical assistant profession develop?

Initially, MAs were hired for administrative tasks; by 1956, a formal association was created, and in 1978, the U.S. Department of Education recognized the profession.

What are some additional certifications a medical assistant can obtain?

Certifications include CMAA, CPT, CET, CBCS, and CEHRS.

What is the difference between licensure and certification?

Licensure is a state-mandated legal requirement for providers like MDs and DOs, while certification is a voluntary credential that validates competency for MAs.

Do medical assistants need to be licensed?

Not in all states, but some require licensing for certain procedures like x-rays or EKGs.

What are the benefits of certification for MAs?

Certification can improve job placement, increase wages, and provide career advancement opportunities.

How is certification maintained?

Through continuing education and following the certifying organization’s recertification guidelines.

What education and licensing is required to become a physician?

Physicians complete 4 years of college, 4 years of medical school, residency (2–7 years), and pass all 3 parts of the USMLE.

What are the differences between MDs and DOs?

MDs use allopathic medicine, while DOs also use osteopathic manipulative therapy in addition to traditional medicine.

What is the role of a physician assistant (PA)?

PAs must work under a licensed physician but can make clinical decisions and typically specialize in a field.

What is the role of a nurse practitioner (NP)?

NPs provide basic patient care, including diagnosing and prescribing, and may work independently in some states.

How do LPNs and RNs differ?

LPNs provide basic care and work under supervision, while RNs have more education, a broader scope, and can work in leadership and education roles.

Who are considered allied health professionals?

Roles include medical lab technicians, receptionists, OT/PT professionals, pharmacy technicians, and radiology technicians.

What is the difference between inpatient and outpatient care?

Inpatient care requires hospital admission, while outpatient care is provided without overnight stays.

What is the role of primary care clinics?

They offer routine wellness, chronic condition management, medication management, and minor acute care.

What is specialty care?

Care provided by doctors specializing in specific diseases or body systems, typically for more complex health issues.

What is home health care?

Time-limited skilled care delivered at home for patients who are temporarily homebound, often after hospitalization.

What are mobile health units?

Vehicles equipped to deliver health care services to underserved areas, especially useful for outreach and vaccination.

What is hospice care?

End-of-life care focused on comfort for terminal patients, provided outpatient or inpatient as needed.

What is a Patient-Centered Medical Home (PCMH)?

A care model where the PCP leads an interprofessional team to deliver coordinated, holistic care.

What is telehealth?

Health care services provided virtually, often through video calls, to increase access and reduce in-person exposure.

How do MAs assist with telehealth visits?

They schedule visits, verify patient information, help with connection setup, and may gather patient history during the call.

What are patient portals?

Online platforms allowing patients to access health records, test results, and communicate securely with providers.

What is the MA’s role in patient portals?

Uploading patient information, helping patients enroll, and explaining portal functionality.

What is the fee-for-service model?

A system where providers bill separately for each medical service provided.

What is value-based care?

A model that focuses on patient outcomes, satisfaction, cost reduction, and provider well-being rather than service volume.

What are capitation-based models?

Providers are paid a set amount per patient per month, regardless of how often the patient receives care.

What is a Health Maintenance Organization (HMO) plan?

Contracts with a specific medical center or group of providers to offer preventive and acute care, usually requiring referrals to see specialists and prior authorization for procedures and hospitalizations.

What is a Preferred Provider Organization (PPO) plan?

Offers more flexibility than an HMO by allowing patients to see specialists without referrals and to use out-of-network providers, though at a higher cost than in-network providers.

What is a Point-of-Service (POS) plan?

Combines elements of HMO and PPO plans, allowing patients to self-refer to specialists and not requiring a primary care provider, with costs varying based on whether the provider is in or out of network.

What do general practitioners (GPs) do?

They treat a wide range of illnesses and emphasize preventive care using a holistic approach.

How are family practitioners different from internists?

Family practitioners treat patients of all ages, while internists typically focus on adult care and chronic condition management.

When is a specialist needed?

When a condition goes beyond the expertise of a primary care provider.

What are ancillary services in health care?

Services such as urgent care, labs, diagnostic imaging, physical therapy, and occupational therapy provided alongside standard care.

What is acupuncture?

A therapy that involves inserting needles into the skin to treat pain and other conditions.

What is chiropractic medicine?

A method of diagnosing and treating musculoskeletal issues through spinal adjustments.

What are dietary supplements?

Products that contain ingredients like vitamins, minerals, and herbs used for their nutritional or therapeutic effects.

What does a cardiologist treat?

diseases and conditions of the heart and blood vessels.

What does a dermatologist specialize in?

diagnosing and treating conditions related to the skin.

What does an endocrinologist manage?

patients who have hormonal and glandular disorders, such as diabetes.

What types of conditions does a gastroenterologist treat?

diseases of the gastrointestinal tract and digestive organs.

What does a hematologist focus on?

blood disorders and related issues.

What does an immunologist treat?

disorders of the immune system, such as autoimmune diseases.

What conditions does a nephrologist manage?

diseases and conditions affecting kidney function.

What is the focus of a neurologist?

conditions of the brain and nervous system.

What kind of care does an oncologist provide?

diagnoses and treats patients who have cancer.

What does an ophthalmologist specialize in?

eye diseases and performs eye surgeries.

What is the role of an orthopedist?

treats conditions of the musculoskeletal system, including bones, joints, and muscles.

What does an otolaryngologist (ENT specialist) do?

treats disorders of the ear, nose, and throat.

What conditions does a pediatrician treat?

specializes in the medical care of infants, children, and adolescents.

What does a psychiatrist do?

diagnoses and treats mental, emotional, and behavioral disorders and can prescribe medications.

What is the role of a pulmonologist?

treats diseases and conditions of the lungs and respiratory system.

What conditions does a radiologist interpret and manage?

specializes in diagnosing diseases and injuries using medical imaging techniques like X-rays, CT scans, and MRIs.

What does a rheumatologist focus on?

treats autoimmune diseases and disorders of the joints and soft tissues, such as arthritis and lupus.

What kind of care does a urologist provide?

treats conditions of the urinary tract and male reproductive system.

What does an obstetrician do?

specializes in pregnancy, childbirth, and postpartum care.

What is the role of a gynecologist?

treats disorders and conditions specific to the female reproductive system.

What is managed care in the health care system?

provides medical services in return for preset scheduled payments and coordinates care through a defined network of providers and hospitals.

How does capitation work in health care?

a payment model where patients are assigned a per-member, per-month payment based on factors like age, race, sex, lifestyle, and medical history, regardless of how often the patient receives care.

What is the purpose of partial or full capitation models?

incentivize providers to avoid high-cost procedures and tests by tying payments to expected usage; in partial models, only specific services are paid based on capitation.