Module 1 Terms CCMA

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17 Terms

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adverse reactions

Unwanted or undesired effects that are possibly related to taking a medication, usually secondary to the main effect of the medication.

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capitation

A managed care method of monthly payments to the provider based on the number of enrolled patients, regardless of how many encounters a patient may have during the month.

3
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certification

Verification by an outside agency that an employer is following established guidelines and standards of care and providing the highest quality of care for their patients.

4
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Controlled Substances Act

Statute that identifies all regulated substances into one of five schedules depending on potential for abuse.

5
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fee for service

System used by private insurance companies and not-for-profits in which insurance carriers determine the allowed charge either by a fee schedule or through service benefits that define covered services but not necessarily the exact payments.

6
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health maintenance organization (HMO)

A medical insurance group that provides coverage of health care services for a period of time and a fixed annual fee.

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managed care

System used by private and public insurance plans that controls health care cost and improves preventive care for its patients by having contracts with providers and medical organizations. The three types of managed care plans are health maintenance organization (HMO), preferred provider organization (PPO), and point of service (POS).

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nutrition

The field of study focused on food and the substances in food that help people grow, recover from illnesses, and stay healthy.

9
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patient-centered medical home (PCMH)

A partnership between a patient and their care team in which total health is the focus and not just a single condition. A health care team consists of a provider (physician, nurse practitioner, physician assistant), CMAA, CCMA, nurses, and pharmacist.

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Physician's Desk Reference (PDR)

Reference book that provides a guide to prescription medication information.

11
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point of service (POS)

A type of managed care health insurance plan that is based on lower medical costs in exchange for more limited choice.

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preferred provider organization (PPO)

A network of physicians, other health care practitioners, and hospitals that have joined together to contract with insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee.

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scope of practice

A specific set of standards that a medical professional may perform within the limits of the medical license, registration, and/or certification.

14
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side effects

A secondary reaction to the one intended.

15
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telehealth

The virtual delivery of health care services remotely.

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therapeutic effects

The helpful effect that the provider is hoping will help the patient to feel better.

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value-based plan

Insurance coverage that changes the amount of reimbursement based on health outcomes of patients and the quality of the service they received.