NHA CCMA Exam 2022 Study Flashcards

Flashcards for vocabulary and key concepts from the NHA CCMA Exam 2022 study notes.

Advance Beneficiary Notice (ABN)

A form provided to the patient when the provider believes Medicare will probably not pay for services received.

Allowed Amount

The maximum amount a third-party payer will pay for a particular procedure or service.

Copayment

A small fixed fee paid by the patient at the time of an office visit.

Coinsurance

A provision under which both the insured and the insurer share the covered losses, typically 80:20.

Deductible

Specific amount of money a patient must pay out of pocket before the insurance carrier begins paying.

Explanation of Benefits

A form created by the insurance company to explain what charges were covered, denied, or need more documentation based on the claims submitted.

Participating provider (PAR)

Providers who agree to write off the difference between the amount charged by the provider and the approved fee.

Medicare

A federal program of health insurance for persons 65 years of age and older.

Tricare

U.S. government health insurance plan for all military personnel.

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.

Managed Care

An umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care.

CMS-1500 form

Standard insurance form used by all government and most commercial insurance payers.

CMS-1500 Section 1

Carrier Block: contains the address of the insurance carrier.

CMS-1500 Section 2

Patient/insured section: contains information about the patient or insured.

CMS-1500 Section 3

Physician/Supplier Section: contains information about the physician or supplier.

Supine Position

Lying flat on the back.

Dorsal Recumbent Position

Lying flat on the back with knees bent.

Sims' Position

Lying on the left side with the right knee and thigh drawn up.

Knee-elbow position

Lying on the knees with the upper body resting on the elbows.

Fowler's Position

Sitting up at a 45-90 degree angle.

Lithotomy Position

Lying on the back with legs raised and feet in stirrups.

Epidural Injection

Injection into the epidural space of the spine.

Intra-arterial Injection

Injection into an artery.

Intra-articular Injection

Injection into joint space.

Intradermal Injection

Injection into the skin.

Intramuscular Injection

Injection into a muscle.

Intraosseous Injection

Injection into the bone marrow.

Intraperitoneal Injection

Injection within the peritoneal cavity.

Intrapleural Injection

Injection into the pleural space.

Intrathecal Injection

Injection into the subarachnoid space.

Fat soluble vitamins

Vitamins A, D, E, K.

Water Soluble vitamins

Vitamins B1, B2, B3, B6, Folate, B12, Pantothenic acid, biotin, C.

Erikson's stages of psychosocial development

Trust vs. mistrust; autonomy vs. shame and doubt; initiative vs. guilt; industry vs. inferiority; identity vs. role confusion; intimacy vs. isolation; generativity vs. stagnation; integrity vs. despair.

Grief Cycle

Denial, anger, bargaining, depression, acceptance.

Sagittal Plane

Divides the body into left and right portions.

Coronal Plane

Divides the body into front and back portions.

Transverse Plane

Horizontal division of the body into upper and lower portions.

Right Upper Quadrant (RUQ)

Contains the right lobe of liver, gallbladder, right kidney, portions of stomach, small and large intestine.

Left Upper Quadrant (LUQ)

Contains the left lobe of liver, stomach, pancreas, left kidney, spleen, portions of large intestine.

Right Lower Quadrant (RLQ)

Contains cecum, appendix, right ovary and tube, right ureter, right spermatic cord.

Left Lower Quadrant (LLQ)

Contains parts of the small and large intestines, left ovary, and left ureter.

Epigastric Region

Located above the stomach.

Umbilical Region

Located around the navel.

Hypogastric Region

Located below the stomach.

Right Hypochondriac Region

Right lateral region just below the ribs.

Left Hypochondriac Region

Left upper region below the rib cartilage.

Right Lumbar Region

Right middle region near the waist.

Left Lumbar Region

Left middle region near the waist.

Right Iliac Region

Right lateral region near the groin.

Left Iliac Region

Left lateral region near the groin.

Chain of Infection

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host.

Wheezing

Difficult breathing with a high-pitched whistling or sighing sound during expiration.

Rales

Crackles; wet crackling noise in lungs.

Rhonchi

Loud rumbling sounds heard on auscultation of bronchi obstructed by sputum.

kg -> lbs conversion

1 kg = 2.2 lbs.

Trendelenburg position

Lying on the back with legs elevated.

Intradermal needle gauge

27-28 gauge.

Intradermal Needle Length

3/8 in.

Subcutaneous Needle Gauge

25-26 gauge.

Subcutaneous Needle Length

1/2 to 5/8 inch.

Intramuscular Needle gauge

20-23 gauge.

Intramuscular Needle Length

1-3 inches.

Smaller the higher the needle gauge number, the ___ the diameter.

The smaller the diameter.

Precertification

A process required by some insurance carriers to prove medical necessity before performing a procedure.

EMR

Electronic medical record.

Suffix

Word ending.

Prefix

A syllable or word that comes before a root word.

Pancreas

Organ involved in digestion and endocrine functions.

Thymus

Organ involved in endocrine and immune functions.

Upcoding

Fraudulent practice of billing higher procedural codes than actually performed.

Usual Fee

Fee for a service charged by a provider for most patients.

Customary Fee

Fee typically charged for a service in a particular geographic area.

Reasonable Fee

Generally accepted fee for an exceptionally difficult service.

Capitation

Payment system used by managed care plans based on per capita amount.

Phantom Billing

Billing for services not performed.

Who do you report to for fraud?

Office of Civil Rights (OCR).

Secretary of Health and Human Services

The head of the U.S. Department of Health and Human Services.

Who do you report to for unsecured HPI?

U.S. Department of Health and Human Services (HHS).

HHS

U.S. Department of Health and Human Services.

CMS

Centers for Medicare and Medicaid Services.

OSHA

Occupational Safety and Health Administration.

Red Cross

An international organization for medical care during disasters.

Legal Aid Society

Provides free or low-cost legal assistance.

TJC

The Joint Commission Organization, establishing standards for health facilities.

NAACLS

National Accrediting Agency for Clinical Laboratory Sciences.

ACS

American Cancer Society.

AHA

American Hospital Association.

Accountable Care Organization (ACO)

A network of providers managing quality and cost of care for patients.

Patient-Centered Medical Home (PCMH)

Model of care providing comprehensive and timely patient care.

ACO vs PCMH

ACO is value-based, PCMH is care delivery model involving collaboration.

Cluster Scheduling

Scheduling similar appointments together at a specific time.

Wave Scheduling

Scheduling multiple patients to arrive at the same time.

Open Scheduling

Patients are seen on a first come first serve basis.

Fahrenheit to Celsius Conversion Formula

(F-32)/1.8.

Fomite

A physical object that transmits infectious agents.

Vector (medical)

An animal that carries a disease.

Sanitization

Removal of pathogens to meet public health standards.

Sterilization

Process that destroys all microbial life.

Disinfection

Process that eliminates many microorganisms from objects.