CMAA Review Information for 2024

HIPPA Privacy Officer keeps track of

who is viewing patient's protected health information

What review will be performed 60 to 90 days after the start of MAA's employment?

Probationary period review

Fraud is

when you alter notes in a patients record to justify medical necessity

Information on Encounter form:

• Basic patient information (e.g., name, age, and patient ID number)

• Medical health history, including previously treated illnesses.

• List of doctors involved in patient care.

• Patient assessment and course of treatment.

• Signature of the doctors involved in patient care.

Medical Record number should be placed on

the encounter form

Encounter form does not include _ such as debit or credit balance

patient balances

If coworker is posting on social media about a celebrity patient report it to

practice administrator

Which of the following tiers of violation for HIPAA includes a minimum fine of $50,000?

Tier 4

Which of the following is an example of protected health information?

Email address PHI types include name; geographical identifiers; phone and fax numbers; email address; Social Security number; medical record number; account number; certificate/license number; vehicle identifiers; device identifier and serial numbers; web uniform resource locators (URLs); internet protocol (IP) address number; biometric identifiers, including finger, retinal, and voice prints; full-face photographic images; and any other comparable images, including photo ID, and any other unique identifying number, characteristic, or code.

The _ was created to protect electronic personal health information by implementing integrity controls and physical and technical safeguards.

HIPAA Security Rule

Why are audit controls important to the medical organization?

Audit controls are an important feature of safeguarding PHI because they are used to ensure appropriate access to and use of PHI.

Other than using a screen saver, what other cybersecurity safeguards would medical staff use to ensure electronic records protection?

Password rules, screen visors, mobile device usage policies. Workstations can become more secure by implementing restricted access, screen visors, restricted data transfer, and the removal/reuse of electronic media. A variety of administrative safeguards may be implemented to protect electronic medical records.

The _ primarily focused on removing restrictions for preexisting conditions, removing lifetime limitations, and ensuring the patient a choice of provider.

Patients' Bill of Rights aka Patient Care Partnership

The Patient's Bill of Rights includes

rules regarding consent, the right to go to a medical specialist, the right to keep the same physician or be seen by another physician, the right to a second opinion, medical record ownership, the right to refuse treatment, and ADA compliance.

Scope of practice

refers to a specific set of standards that a medical professional may perform within the limits of the medical license, registration, and/or certification. Each state has different regulations regarding the scope of practice for medical professionals.

New patient is new to the organization or is returning after an absence of

3 years

Types of appointments:

Comprehensive, Complete Annual Physical Exam, Follow up or Urgent

Status Barrier

perceiving only those in higher positions as being important

If patient dies how long does provider have to keep medical records according to HIPAA

2 years for malpractice they must be kept 7 years.

How long can patients account be delinquent for payment before it should be sent to collections

90 to 120 days

The nervous system coordinates the body's

functions

What is a medical scribe

personal assistant to physician performing documentation in the EHR

What finds common billing errors before a claim is sent to the insurance company?

Claims Scrubber finds common billing error

Ketosis is an expected finding in a patient with diabetes mellitus.

an expected finding in a patient with diabetes

An ACO (accountable care organization) involves

groups of health care providers working together to coordinate high quality patient care for Medicare recipients.

CPT codes are

numbers only not letters or decimal points with numbers afterwards.

Condition of swayback is

Lordosis

Dyskinesia

painful movement in the body or body part. Kinesi/o = movement

GERD =

Gastroesophageal reflux disease = heart burn

Abbreviation PO is correct to used to represent _ when writing prescriptions.

by mouth

Indemnity insurance plan =

allows the patient to see the provider of their choice, with no regard to a network and requires 20% payment from the patient after the deductible has been met.

Laboratory orders

can be sent from the provider to another entity via the electronic health record

ADAAA (Americans with Disabilities Act Amendments Act of 2008)

prohibits discrimination based on disability

Account aging =

process of determining how long specific account balances have been outstanding

Credit balance=

a negative number on a patient's account and indicated an overpayment has been made.

Claim Scrubber =

Finds common billing errors before a claim is sent to the insurance carrier.

Encoder Software =

Used to improve coding accuracy and billing performance.

Coordination of Benefits =

Insurance companies contain this provision to avoid overlapping payments.

Patients Occupation =

is necessary to confirm a patient's demographics

Genetic Engineering =

can be an ethical issue because it involves manipulation of genetic material (DNA) in cells to produce a specific outcome in hereditary traits.

Appeal Letter =

letter that identifies a denied claim and includes a statement from the provider detailing the medical reason for performing the procedure.

Pineal gland =

part of endocrine system it produces melatonin and regulates sleep patterns

No visit/appointment =

visit is scheduled for 30 to 40 minutes

Resource-based relative value scale (RBRVS) =

this establishes the units used to determine Medicare fee schedules based on overhead expenses, amount of work involved, and cost of malpractice insurance.

Write-off =

this indicates a balance that could not be collected due to bad debt or contractual discounts

Credit Balance =

A negative number on a patients account and indicates an overpayment has been made.

Which type of document should the MAA obtain to get reimbursement for a patient's office visit with a cardiology specialist who is a health maintenance organization (HMO) participant?

Referral from the patient's primary care provider

Scribe =

Professional tasked with entering data into the electronic health record as a patient's examination is being conducted.

Telemedicine =

Involves the use of technology to provide medical services, including diagnosis and treatment, to patients from a distance.

Probationary period review =

Review that will be performed 60 to 90 days after the start of employment.

Threshold =

The minimum number of supplies to be maintained based on average number of patients the practice sees in a day.

New Claim =

Submit this form is the CMAA feels a claim for was denied due to a coding error.

Accrual Accounting =

CMAA will use this process to ensure that two financial records agree.

Autonomy =

The patient has the right to make their own decisions regarding their health care. This is an ethical principle.

Needlestick Safety and Prevention Act =

Goal of OSHA to reduce the risk of exposure to bloodborne pathogens for health care workers.

Prescription pads =

Require secure storage upon delivery.

If a patient dies the provider should keep the medical record for

2 years

CAD =

coronary artery disease

Utilization Review Management =

purpose if to align the patient services with payer requirements. This is done not only to provide the appropriate care but also to ensure that services will be reimbursed.

After-visit summary =

Documents included is a summary of the current visit, follow-up appointments requested, referrals, and any instructions related to the patient care and condition.

Patient portal =

If the patient needs additional information about what happened during their visit provide it through the patient portal.

Patient should be given different _ to encourage payment at time of appointment.

forms of payment options

Patient demographics should be

updated with each visit or phone call to schedule an appointment.

All members of health care team have access to EHR based on their role in care.

Family members cannot with permission of the patient. All who request access will not be granted access without proper approval process.

All correspondence sent to a patient should include a copy that is uploaded to their medical record for documentation purposes and a paper trail.

Inventory, end-of-day reconciliation, and employee policies would not be uploaded to a patient's medical record.

Communicating with departments within the same practice should be done via _

• Business letters and faxes are more formal

• Memorandums inform may within the practice

electronic messaging

Equipment inventory =

keeping track of the equipment in the practice, including the date purchased, cost, and maintenance records.

Inventory control system is

a computerized system that will monitor usage and availability of supplies.

Opening office procedures

include turning off the answering service and reviewing messages received.

Make sure examination rooms are stocked.

CDC recommends having vision checked every _ to reduce the risk of fall.

2 years

A CMAA can _, but they CANNOT collect and process specimens.

complete the requisition lab slip for specimens

If patients health insurance sends request for protected health information the CMAA should

disclose the minimum amount of information necessary.

CMAA can disclose a patient's information without a signed authorization form the patient to the

Local Health Department

CMAA should label paper charts with the new EHR _ to avoid the creation of duplicate files during the transition from paper files to an electronic health record system (EHR)

patient identification number

An _ used silent mouth speech, gestures, and hand codes for each speech sound.

oral interpreter

Kinesthetic communication =

an example of this would be having the patient physically participate in the performance of the desired action.

If patient is hard of hearing

request an interpreter for the patient.

When a patients laboratory results are received the CMAA should

highlight the critical values and present them to the patient's provider for review.

Adduction

movement towards the midline of the body

Abduction

movement away from the midline of the body

If CMAA finds 2 charts that they suspect are for the same patient they should check the following identifiers =

patient's last name and date of birth.

Facility’s privacy officer

keeps track of who is viewing patient's protected health information.

CMAA should check patient's demographic information against the _

patient's driver's license

CMAA should verify a patient's CPT code for

obtaining preauthorization

Use _ to correlate procedures for a diagnosis and justify the necessity for medical services

procedure codes

The CMAA can use a speakerphone when listening to voicemail when the assistant

confirms the patients have left the office for the day.

HCPCS =

Healthcare Common Procedure Coding System for medications, supplies, and services not cartoon included in CPT. No letters or decimals.