NHA CCMA Study Notes

w/in scope of practice

• educating pxts on how to take meds

• health promotion of pxt

• perform EKG

• take pxt’s vitals

• perform urinalysis

• perform throat culture

• pxt education

outside scope of practice

• diagnose pxt

• administer narcotics

• interpret lab results

• pathogenic ID

• performing arterial blood gas (ABG)

assault

open threat of bodily harm vs another person

battery

action that causes bodily harm

fraud

deception w/intent to deprive another person of their rights

invasion of privacy

intruding on pxt’s private affairs/disclosure of private info (entering pxt’s room w/o knocking or permission)

malpractice

negligent delivery of professional services

negligence

failure to do something that a reasonably prudent individual would do under similar circumstances

spousal abuse/intimate partner abuse

provide list of organizations w/in local community that can assist in the situation

T/F: report suspected child abuse to the provider and don’t confront pxt

true

tort

civil wrong committed vs. person/property

chain of custody

legal context refers to chronological documentation showing paper trail, custody, control, transfer, analysis&disposition of physical/electronic evidence and evidence must be sealed in front of pxt

clinical laboratory improvement amendments (CLIA)

sets quality standards+issues certificates for human clinical labs

health insurance portability+accountability act (HIPAA)

right to inspect, review+receive copy of medical records+billing records held by health plans+health care providers covered by privacy rule

HIPAA purpose

1. provide continuous health insurance coverage for workers who lose/change their job

   1. reduce administrative burdens+cost of healthcare by standardizing electronic transmission of administrative+financial transactions+protects pxt’s personal medical info and confidentiality

the joint commission (TJC)

regulates that correctly ID’ing pxts is crucial to improving pxt safety

occupational safety+health administration (OSHA)

federal agency that oversees+regulates safety in workplace where training provided @no cost to employee

quality control (QC)

promotes accurate test results

pxt ID (ensure pxt safety)

• always ask pxts to confirm full name+DOB

  • never confirm pxt’s name by speaking name+DOB to them

implied consent

• extending arm for phlebotomy

• remove clothing for medical procedure/exam

informed consent

informing pxt of risk, possible outcomes+alt therapies

written consent

must have pxt’s signature to perform procedure

pxts’ bill of rights

list of guarantees for those receiving medical care

• pxts have right to copy of medical records

• guarantees fair treatment

• autonomy over medical decisions+many more rights

problem oriented medical record (POMR)

should always be filled out in chronological order

pxts have right to view medical records @any time

• info contained w/in medical record belongs to pxt

• physical form where info housed belongs to author

encounter form/superbill

itemized form of services submitted to insurance carriers for reimbursement of rendered services, also used to check pxts out after office visit

release of information form

allows pxt access to his own medical records+allows pxt control over to whom those records

preferred provider organization (PPO)

managed care organization of providers, hospitals+other health care providers who have agreed w/an insurer/3rd party administrator to provide health care @reduced rates to the insurer’s/administrator’s clients

medicaid

provides health insurance for medically needy

medicare

federal insurance plan that generally covers those >65+considered entitlement bc those covered have paid into the system thru payroll tax

tricare

healthcare for military personnel+their dependents to receive care from civilian providers @expense of federal gov

workers’ compensation

wage replacement+medical benefits for those injured on the job

advance beneficiary notice (ABN)

waiver of liability, a notice a provider should give before you receive a service if the provider has reason to believe Medicare won’t pay for the service, pxt responsible for paying the bill

coinsurance

amt policyholder financially responsible for according to their insurance policy and policyholder must meet specified amt before insurance company will pay their portion

copay

specified sum of $ based on pxt’s insurance policy benefits due @time of service

deductible

specific amts of $ pxt must pay out-of-pocket b4 insurance carrier begins paying for services in a calendar year

explanation of benefits (EOB)

statement detailing what services were paid, denied/reduced in payment by pxt’s insurance company

preauthorization

decision by health insurer/plan that a health care service, treatment plan, prescription drug/durable medical equipment is medically necessary

precertification

process of obtaining eligibility, certification/authorization+collecting info from health plan prior to impatient admissions+selected ambulatory procedures+services

referral

process of directing/redirecting to medical specialist/agency for definitive treatment

verification of eligibility

b4 you provide care, important to confirm how pxt will pay for services, equally important to verify pxt’s insurance eligibility b4 providing any care

CPT

current procedural terminology

ICD

international classification of diseases

• each diagnostic+procedural code allows 4 submission of services 4 reimbursement from insurance companies+to provide statistical data 4 research studies

ICD: 1st character

main term when searching in alphabetical index

ICD: 2nd+3rd characters

numeric codes

ICD: 4th, 5th, 6th/7th characters

alphabetic/numeric

modifier

indicates 1 procedure was used multiple times on pxt

advance booking

making appt for pxt in advance

clustering

seeing pxts on same day @same time

double booking

2 pxts given same appt time

hard of hearing/deaf pxts

get interpreter

late provider

offer to reschedule pxt’s appt if provider late

new pxt (NP)

pxt who hasn’t been seen by provider b4/who hasn’t been seen in 3/more years considered a new pxt for coding+billing purposes

no show (NS)

pxts who’ve missed their scheduled appt

tests

schedule least invasive test 1st if pxt having multiple tests

wave scheduling

3 or 4 pxts scheduled every 0.5 hr+seen in order in which they arrive @office

aerophagia

swallowing air