NHA CCMA National Exam Study Guide - Insurance, Coding, and Laws Section

Premium

Amount you pay monthly, quarterly, semiannually or annually to purchase different types of insurance

Deductible

the amount you pay before your health insurance starts paying for covered medical expenses

Coinsurance

the portion you pay once your deductible has been met, you will pay this percentage until you have reached your out-of-pocket maximum

Out-of-pocket maximum

The most money you will pay during a year for coverage. It includes deductibles, copayments, and coinsurance.

Medicare

A federal program of health insurance for persons 65 years of age and older by part A (hospitalization) or Part B (routine medical office visits) benefits

Tricare

authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government

CHAMPVA

covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities

Medicaid

Provides health insurance to the medically indigent population through a cost-sharing program between federal and state governments fo those who meet specific eligibility criteria

ICD-10-CM

uses 3 to seven characters used by facilities to code procedures (e.g. hospitals)

CPT codes

uses 5 characters. Used in outpatient settings.

Affordable Care Act (ACA)

providing more Americans with access to affordable health insurance, improving the quality of health care and health insurance, regulating the health insurance industry, and reducing health care spending in the US.

Occupational Safety and Health Administration (OSHA)

employers are accountable for providing a safe and healthful workplace for employees by setting and enforcing standards

Health Insurance Portability and Accountability Act (HIPAA)

gives patients rights over their health information and sets rules and limits on who can look at and receive patient's private information

Controlled Substances Act (CSA)

laws created to combat and control drug abuse

Title VII of the Civil Rights Act

prohibits an employer with 15 or more employees from discrimination on the basis of race, national origin, gender, or religion

Americans with Disabilities Act (ADA)

Act addresses rights of individuals with disabilities in employment and public accommodations.

Family and Medical Leave Act

FMLA is a federal law that requires certain employers to give time off to employees for familial or medical reasons

The Joint Commission (TJC)

improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.

Tort

an action that wrongly causes harm to an individual but is not a crime and is dealt with in civil court

intentional tort

A wrongful act knowingly committed.

Defamation of character

wrongfully hurting a person's good reputation

Slander

spoken/verbal defamation

Libel

written defamation

Common Law

A legal system based on custom and court rulings

malfeasance

performance of an unlawful, wrongful act

Misfeasance

The performance of a lawful act in an illegal or improper manner

Negligence

failure to perform a task, duty, or undertaking that one has agreed to preform or has a legal duty to preform

informed consent

a clear and voluntary indication of preference or choice, usually oral or written, and freely given in circumstances where the available options and their consequence have been made clear

Implied consent

voluntary agreement with an action proposed by another

fraudulent

relating to actions that purposely intend to deceive