CCMA Exam Review Flashcards

Flashcards covering key foundational knowledge, basic science, clinical patient care, patient care coordination and education, administrative assisting, communication and customer service, medical ethics and law, and core knowledge as it pertains to the CCMA exam.

What are the clinical and administrative tasks performed by Medical Assistants?

Scheduling, answering phones, obtaining patient histories, patient pre and post procedure education, phlebotomy, processing specimens, assisting the provider during exams, injections, etc.

What is the role of Medical Doctors (MDs)?

Diagnose and treat patients based on findings during exams or from labs and other diagnostic tests, perform surgery, and write prescriptions

What type of therapy do Osteopathic providers (DOs) incorporate in their treatment?

Osteopathic Manipulative Therapy (OMT)

What are some professionals considered as Allied Health Professionals?

Medical laboratory technicians, Medical receptionists, Pharmacy technicians, Physical therapists, Radiology technicians

Define 'Scope of Practice' for a Medical Assistant.

The MA will only perform duties they have received proper education and training to be able to complete.

Name some advanced credentials an MA can obtain.

Certified phlebotomy technician (CPT), Certified EKG technician (CET), Certified billing and coding specialist (CBCS), Certified electronic health records specialist (CEHRS), Certified health coach or patient navigator

What is licensing in healthcare and who regulates it?

Regulated by the state for MD’s, DO’s, Chiropractors after they have completed their degree.

What is certification in healthcare?

Achieved upon completion of education and training and passing a certification exam and varies by state.

What does 'fee-for-service' mean in healthcare?

Insurance reimbursement based on the fee charged and the service provided.

Who does Medicare provide insurance for?

The elderly, permanently disabled, and end-stage renal disease

Who is Medicaid intended to provide insurance for?

Low-income individuals and families

Who is TRICARE insurance provided by the government for?

The dependents of active military personnel

What is a Health Maintenance Organization (HMO)?

It limits testing by requiring the patient’s PCP to approve of further visits or testing to be done by another provider by requesting the HMO to provide a referral

What is a Preferred Provider Organization (PPO)?

Providers that are contracted with the insurance and have agreed to accept designated fees for services rendered and have a financial incentive for patients to use providers in the network

What are examples of 3rd Party Payers?

Insurance companies (BC/BS, Aetna, UHC), Governmental agencies (Medicare, Medicaid, Tricare), Employers

What is Capitation?

This is a fixed payment per patient given to providers by a managed care group (HMO”S) for providing care to patients enrolled in the managed care plan

Define 'Generalist' practitioner.

Physicians that provide preventative care to patients as well as treat acute and chronic diseases

What is the main focus of an Internist?

Comprehensive care for chronic, long-term diseases and conditions, although they will also treat common illnesses and help with preventative care

What conditions do Allergists diagnose and treat?

Disorders of the immune system- specifically allergies or adverse reactions caused by medications, food, and airborne allergens, anaphylaxis, asthma, and problems related to autoimmune disorders

What services do Anesthesiologists provide?

Sedation and pain management to patients during surgical procedures

What system do Endocrinologists diagnose and treat diseases and conditions of?

Endocrine system, such as glandular conditions, hormone problems, and diabetes

What does a Gynecologist diagnose and treat?

Diseases and conditions of the female reproductive system and infertility

What does a Hematologist diagnose and treat?

Diseases and conditions of blood and blood-producing organs

What does a Neonatologist diagnose and treat?

Diseases and conditions of newborns as well as providing specialized care

What does an Oncologist do?

Diagnose, treat, and care for cancer patients

What does an Ophthalmologist diagnose and treat?

Diseases and conditions of the eye (can perform surgery)

What does an Otolaryngologist diagnose and treat?

Diseases and conditions of the ears, nose, and throat

What does a Psychiatrist diagnose and treat?

Diseases and conditions of the mind such as depression, schizophrenia, PTSD, etc… And can prescribe medications

What does a Radiologist aid in diagnosing and treating?

Diseases and conditions using X-ray, MRI, CT, Ultrasound, and Nuclear medicine

What are ancillary services in healthcare?

These are healthcare services that support the primary physician

Provide some examples of ancillary services.

Urgent care, Laboratory services, Diagnostic imaging, Occupational therapy, Physical therapists

Provide examples of alternative therapies.

Acupuncture, Chiropractic, Energy therapy, Dietary supplements

What is Primary insurance?

Insurance to whom the insurance claim must be sent first

What is Secondary insurance?

Insurance that covers an individual in addition to primary insurance

Why is coordination of benefits important?

This is the term used for the rules the insurance companies use to coordinate insurance payments. It can vary by State.

If a child is covered with insurance by both parents, how do you determine primary insurance?

You will bill the insurance of the parent whose birthday comes first in the calendar year as the primary insurance (Birthday rule)

Define 'Deductible' in insurance terms.

Payment by member each calendar year before health insurance pays for any services

What is the 'Allowed amount'?

This is the maximum amount the Third-party payor will pay for particular services

What is an Explanation of Benefits (EOB)?

This is a statement from the insurance company to the patient that explains what was paid to the physician, hospital, etc.

What is a Participating Provider (PAR)?

This is the physician that agrees to accept patients with insurance and “write-off” the difference between the amount charged and the approved fee established by the insurer

Who does Medicare provide insurance for?

People 65 and older, people with end-stage renal disease, or permanent disability

State Children’s Health Insurance Program (SCHIP)

Established in 1997 for children and provided to low-income families

Who is TRICARE insurance coverage for?

Active duty military personnel, their spouses and dependents

Who is CHAMPVA insurance coverage for?

Spouses and dependents of military personnel permanently disable in the line of duty

What does worker’s compensation insurance cover?

Employees for injuries and diseases that occurred as a result of their job

What is an HMO (Health Maintenance Organization)?

This is insurance offered at a lower cost to the patient and requires the patient to choose a PCP (Primary Care Provider) who is an in-network provider to use specialists

What is CMS-1500?

This is the health insurance claim form used by the provider to the insurance supplier.

Where is the Carrier Block located on the CMS-1500 form and what does it contain?

Located at the top of the form, this section contains address of the insurance carrier as well as other insurance related questions

On the CMS-1500 form, what information is included in the Patient/Insured Section?

Information about the subscriber to the insurance (insured party- this is the person that that purchased (pays the premium) the insurance)

What is entered in Block 9 of CMS-1500 form?

This section is for the name of the Medigap patients (Medicare patients that have purchased a Medigap plan or supplemental

What are Physicians or Suppliers of Medical information supposed to include in Section 3 of the CMS-1500 form?

Boxes 14-33 are used for physicians and suppliers

What is included in Block 21 of the CMS-1500 form?

ICD-10 codes

What is included in Block 24D of the CMS-1500 form?

CPT or HCPCS codes for procedures, supplies, and service

What is included in Block 31 of the CMS-1500 form?

The provider’s signature or SOF (Signature on File)

Claims can be sent to a __ first, where the claim will be audited for errors or missing information, correct the errors then submit the claims to the insurance company

Clearinghouse

How quickly must Medicare and Medicaid claims be submitted?

Within 12 months of the date of service

What is the difference between superior and inferior positional terminology?

Superior (or cranial) means toward the head, while inferior (or caudal) means away from the head.

What is the difference between anterior and posterior positional terminology?

Anterior (or ventral) means the front side, while posterior (or dorsal) means the back side.

What does the term 'medial' refer to?

Toward the midline of the body

What does the term 'lateral' refer to?

Away from the midline of the body

Explain the difference between proximal and distal positional terminology.

Proximal means toward or nearest the trunk, while distal means away from or farthest from the trunk.

What is the Sagittal or Median plane?

Divides the body into left and right halves which may not be equal. Midsagittal is two equal halves.

What is the Coronal plane or Frontal plane (vertical)?

Divides the body into dorsal and ventral (back and front, or posterior and anterior) portions.

What is the Transverse plane or axial plane (lateral, horizontal)?

Divides the body into cranial and caudal (head and tail) portions.

Adrenergic

Constricts the lumen of a vessel (Epinephrine, vasopressin)

Antibiotic

Kills pathogens (Amoxicillin, Cipro, Keflex, Augmentin)

Define 'Anticoagulant'.

Decreases the clotting time (Coumadin, Ardeparin)

Define 'Hypnotic'.

Induces sleep (Dalmane, Ambien (aka-zolpidem tartrate))

Schedule I drugs

Drugs with no currently accepted medical use and a high potential for abuse.

Schedule II drugs

Drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence.

What are Schedule IV drugs defined as?

Drugs with a low potential for abuse and low risk of dependence

Schedule V drugs

Drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics.

Why is it important to check medication labels three times?

To verify the medication name, strength, and dose match the orders given by the physician

What are the seven rights of medication administration?

Right drug, Right dose, Right time, Right patient, Right route, Right technique, Right documentation

What is the Right Assessment?

Does the patient have any allergies to medications?

Why should a patient be monitored for 20 minutes after medication administration?

To watch for adverse effects to the drug and appropriate documentation must occur.

What type of information can be found in the Physician’s Desk Reference about medications?

Medications and how they are supplied and administered, side effects, dosage form, route, pictures of the drugs, and all names for the drug.

What are the essential nutrients?

Nutrients our body cannot make so we must ingest them (Certain proteins (essential amino acids))

What are the nonessential nutrients?

Nutrients our body can make

What is Basal Metabolism?

The amount of calories a person needs for energy to keep their body functioning at rest

If a 500 calorie a day deficit occurs, how much weight is expected to a patient lose per week?

1 pound

Water composes how much of our body?

Made up of 50% to 80%

What is Hyponatremia?

A medical condition where sodium levels are depleted in the body and can become very serious if the sodium level gets too low

What is one of dehydration's symptoms?

Fatigue

What are the Essential Amino acids?

Cannot be produced by the body

What are the Nonessential Amino acids?

The body can make these from essential amino acids and as proteins breakdown

Complete Protein

Animal proteins are considered complete proteins because they contain all 9 of the essential amino acids.

Incomplete Proteins

Plant based proteins do not contain all of the essential proteins, but do contain some of the nonessential proteins.

Omega-3 fatty acids are important for lowering the risk of what diseases?

Heart disease, depression, dementia, and arthritis.

Who is Jean Piaget?

Swiss psychologist who studied the basis for learning and development of the mind.

Who is Erik Erikson?

German-born American known for his theories on psychosocial development of human beings across a lifespan

Who is Abraham Maslow?

American psychologist, considered the founder of “humanist psychology”

According to Maslow's Hierarchy of Needs, what comes first?

Physiological needs

What comes after Safety Needs?

Love and belonging'

According to Maslow, what creates the Need for Self-Esteem?

Develop self-esteem people need to feel respected, valued and accepted by others.

Who is Elisabeth Kubler-Ross?

Developed the Five Stages of Death and Grieving

What is a stressor?

Anything that causes anxiety or stress (both good and bad things can cause stress).

What is an environmental stressor?

Air pollution, Sun exposure, Crowds, Cultural barriers (racial or ethnic, or body image discrimination), Fires, Floods, Tornadoes, Earthquakes, Hurricanes, War.

What are socioeconomic stressors?

Unemployment, Lack of sufficient food, water, and shelter, identity theft, retirement, economic changes, loss of job, home, or vehicle

How does exercise help with Mental Health?

Walking calms anxiety and improves mood