NHA CCMA Certification Review Flashcards

Comprehensive vocabulary flashcards generated from the NHA Certified Clinical Medical Assistant (CCMA) study guide covering insurance terms, controlled substance schedules, clinical procedures, anatomy, legal/ethical topics, and infection control.

Advance Beneficiary Notice (ABN)

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

Allowed Amount

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

Copayment

An amount of money that is paid at the time of medical service based on the patient's insurance policy benefits.

Coinsurance

A policy provision in medical insurance where the policyholder and the insurance company share the cost of covered losses in a specified ratio, such as $80:20$.

Deductible

A specific amount of money a patient must pay out of pocket before the insurance carrier begins paying for services.

Explanation of Benefits (EOB)

A statement from the insurance carrier detailing what services were paid, denied, or reduced in payment, including amounts applied to deductibles, coinsurance, and allowed amounts.

Remittance Advice (RA)

An explanation of benefits sent to the provider from the insurance carrier containing payment details for multiple patients, electronic fund transfers, or checks used to post payments.

Participating Provider (PAR)

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

Schedule I Controlled Substances

Illegal substances with a high potential for abuse and no approved medical use in the United States, including heroin, mescaline, LSD, and cannabis.

Schedule II Controlled Substances

Substances with high potential for abuse leading to severe physical or psychological dependence, requiring handwritten prescriptions with no refills and secure locked storage.

Schedule III Controlled Substances

Substances with moderate to low potential for physical and psychological dependence (e.g., ketamine, anabolic steroids), requiring a handwritten prescription refillable up to $5$ times in $6$ months.

Schedule IV Controlled Substances

Substances with a low potential for abuse and dependence (e.g., diazepam, alprazolam), refillable $5$ times in $6$ months and eligible for phone refills.

Schedule V Controlled Substances

Substances containing limited quantities of certain narcotics used for antidiarrheal, antitussive, or analgesic purposes, refillable $5$ times in $6$ months.

Superior (Cranial)

Anatomical direction meaning above or closer to the head.

Inferior (Caudal)

Anatomical direction meaning below or closer to the feet.

Anterior (Ventral)

Anatomical direction meaning toward the front of the body.

Posterior (Dorsal)

Anatomical direction meaning toward the back of the body.

Medial

Anatomical direction meaning closer to the midline of the body.

Lateral

Anatomical direction meaning further away from the midline of the body.

Proximal

Anatomical direction meaning closer to the trunk of the body.

Distal

Anatomical direction meaning farther away from the trunk.

Superficial

Anatomical term meaning closer to the surface of the body.

Deep

Anatomical term meaning farther from the body's surface.

Planes of the Body

Anatomical divisions including the sagittal plane, coronal plane, and transverse plane.

Body Cavities

Internal body spaces that contain and protect organs, including cranial, spinal, thoracic, abdominal, and pelvic cavities.

Body Quadrants

The four abdominal regions used for clinical description: Right Upper Quadrant (RUQ), Left Upper Quadrant (LUQ), Right Lower Quadrant (RLQ), and Left Lower Quadrant (LLQ).

Nine Body Regions

Anatomical grid division of the abdomen consisting of right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right iliac, hypogastric, and left iliac regions.

Rule of Nines

A standardized system used to estimate the total body surface area percentage affected by burns.

Sinoatrial (SA) Node

The pacemaker of the heart that generates electrical impulses initiating the cardiac cycle.

Atrioventricular (AV) Node

The gatekeeper of the heart's electrical conduction system that receives electrical impulses from the SA node.

Homeostasis

The state achieved when the body's systems and biological processes maintain stability and balance in response to external environmental changes.

Systolic Pressure

The blood pressure reading recorded when the first sharp tapping sound (Korotkoff phase I) is heard as blood surges into the artery.

Diastolic Pressure

The blood pressure reading noted when the last Korotkoff sound (phase V) disappears completely and blood flows freely.

Hypertension

A clinical condition defined by a blood pressure reading of $140/90\,\text{mm Hg}$ or higher.

Prehypertension

A blood pressure reading between $120$ and $139\,\text{mm Hg}$ systolic, or $80$ to $89\,\text{mm Hg}$ diastolic.

P Wave

An EKG waveform representing atrial depolarization or contraction.

QRS Wave

An EKG waveform representing ventricular depolarization or contraction.

T Wave

An EKG waveform representing ventricular repolarization or relaxation.

U Wave

An EKG waveform representing repolarization of the bundle of His and Purkinje fibers.

Chest Lead Placement

Systematic placement of precordial EKG leads V1 through V6 across specified intercostal spaces and anatomical lines.

Wandering Baseline

An EKG tracing artifact caused by poor electrode connection, lotions, or oils on the skin.

Interrupted Baseline

An EKG tracing artifact characterized by a break in the signal, usually related to a disconnected or broken lead wire.

Medical Asepsis

Clean technique aimed at reducing the number of microorganisms and prohibiting their growth after leaving the body, primarily protecting the healthcare worker.

Surgical Asepsis

Sterile technique aimed at eliminating all microorganisms before entering the body during invasive procedures, primarily protecting the patient.

Sanitization

The first step in cleaning medical equipment, reducing microbes to a lower level using friction or ultrasonic sound waves prior to disinfection or sterilization.

Disinfection

The process of destroying pathogens on surfaces or equipment using chemical agents (such as glutaraldehyde or a $1:10$ bleach solution).

Agents of Indirect Transmission

Intermediate mechanisms that transmit pathogens, consisting of living organisms (vectors) or inanimate objects (fomites).

Assault

An instance in criminal law where an individual threatens to cause harm to another person.

Battery

Intentional touching or use of force against an individual in a harmful manner without consent.

Plaintiff

The individual who files a lawsuit to initiate legal action.

Defendant

The person being sued or accused of a crime in a court of law.

Subpoena

A written court order commanding an individual to appear in court to give evidence.

Deposition

A formal sworn statement made by a witness or defendant prior to trial promising to tell the truth.

Malfeasance

Performance of an unlawful, wrongful act by a healthcare worker (e.g., performing a procedure on the wrong patient).

Misfeasance

Performance of a lawful action in an illegal or improper manner (e.g., performing a procedure on the correct patient, but doing so incorrectly).

Nonfeasance

Failure to perform a task, duty, or legal obligation that one is required to perform (e.g., waiting to treat a patient until it is too late).

Negligence

Failure to do something that a reasonable person of ordinary prudence would do, or doing something that such a person would not do.

Living Will

A legal document detailing desired or refused medical treatments (e.g., DNR, dialysis, organ donation) under specific end-of-life conditions.

Durable Power of Attorney for Health Care

A legal document naming a health care proxy to make medical decisions when the patient is unable to do so.

Patient-Centered Medical Home (PCMH)

A care delivery model coordinated through the primary care provider to provide centralized, comprehensive, and accessible team-based care.

Preauthorization

A process required by insurance carriers in which the provider obtains permission prior to performing specific procedures, services, or specialist referrals.

Precertification

A process required by insurance carriers where the provider must prove medical necessity prior to performing a procedure, hospitalization, or expensive diagnostic test.

Tympanometry

A diagnostic procedure recording movement of the tympanic membrane using air pressure changes to detect middle ear fluid or infection.

Audiometry

A hearing test measuring perception of tones in decibels ($\text{dB}$) and frequency in hertz ($\text{Hz}$).

Cryosurgery

A surgical procedure exposing tissues to extreme cold via liquid nitrogen to destroy abnormal cells.

Medicare

generally covers patients aged 65 and older by Part A (hospitalization) or Part B (medical office visits) benefits

Tricare

authorizes dependents of military personnel to receive treatment from civilian providers and military facilities.

CHAMPVA

covers surviving spouses and dependent children of veterans who died as a result of service-related disabilites

Medicaid

provides health insurance to medically indigent population through cost-sharing program between federal and state governments for those who meet eligibility criteria

Managed Care

plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals

Workers compensation

protects wage earners against loss of wages and cost of medical care resulting from an occupational accident or disease as long as employee is not proven negligent

CMS-1500 Form is?

for claims submitted by a provider or supplier with 33 blocks divided into 3 sections

Section 1 of CMS-1500 Form

Carrier Block contains address of insurance carrier and is located at the top of the form

Section 2 of CMS-1500 Form

Patient insurance section contains information about the patient or insured through boxes 1 - 13

Section 3 of CMS-1500 Form

Physician/Supplier Section with information about the physician or supplier in boxes 14 -33

epidural route is in

epidural space (spine)

intra-arterial is in

arteries to break up clots

intra-actricular is

within a joint space

intradermal is in

skin of upper chest, forearms, upper back

intramuscular (IM) is in

deltoid, vastus lateralis, ventrogluteal muscles

intraosseous is in

bone marrow

intraperitoneal is in

peritoneal cavity (abdomen)

intrapleural is in

pleural space (lungs)

intrathecal is in

subarachnoid space (brain)

intravenous (IV) is in

major veins, most often in arms or hands

subcutaneous is

under skin of abdomen, anterior thighs, etc.w

which routes permit CCMAs to administer

intradermal, intramuscular, and subcutaneous

water soluble vitamins are

B1, B2, B3, B6, folate, B12, panthothenic acid, biotin, and C

erikson’s stages of psychosocial development mnemonic

My (mistrust) Sweet (shame) Girl (guilt) in (inferiority) Red (role confusion) is (isolation) Selling (stagnation) Drinks (despair)

5 stages of grief

denial → anger → bargaining → depression → acceptance

apathy

a lack of interest

conversion

transformation of an anxiety into physical symptom with no cause (getting a headache every time i see my ex with his new wife)

intellectualization

analysis of a situation with facts and not emotions

introjection

adoption of the thoughts or feelings of others (my dad says i should be more assertive so im gonna stand up for myself)

Purkinje fibers cause

the ventricles to contract and pump blood into pulmonary artery and aorta

Chain of infection

Infectious agent → reservoir host → portal of exit → mode of transmission → portal of entry → susceptible host

conditions for growth

Moisture, warmth, oxygen, food, and time

Heart Rates for:

Newborn (birth to 1 month) :

Infant (1 month to 12 months):

Toddler (1 to 3 years):

Preschool (3 to 5 years):

School-age (6 to 15 years):

Adult (older than 15):

120 to 160/min

80 to 140/min

80 to 130/min

80 to 120/min

70 to 100/min

60 to 100/min

newborns respiratory rate vs adults

30 to 50/min vs 12 to 20/min

to calculate height…

divide inches by 12 (62 inch/12 = 5 ft 2 inch)