CCMA module 1

Capitation

A managed-care payment method in which a provider receives a set payment per enrolled patient, usually per month, regardless of how many times the patient receives care.

Certification

Verification by an outside agency that a person or organization meets established standards, guidelines, and quality requirements.

Controlled Substances Act

A federal law that divides regulated substances into five schedules based mainly on their medical use, safety, and potential for abuse or dependence.

Fee-for-Service

A health care payment system in which providers are paid separately for each service they perform.

Health Maintenance Organization (HMO)

A managed-care insurance plan that generally uses a network of providers, emphasizes preventive care, and usually requires patients to choose a primary care provider and obtain referrals for specialists.

Managed Care

A health care system designed to control costs and improve quality and preventive care through contracts with networks of providers and medical organizations.

Three main types of managed care

HMO, PPO, and POS.

Nutrition

The study of food, nutrients, and the substances in food that help the body grow, recover from illness, and stay healthy.

Patient-Centered Medical Home (PCMH)

A team-based approach to care in which the patient and health care team work together to focus on the patient's total health rather than just one condition.

PCMH health care team

May include a physician, nurse practitioner, physician assistant, medical assistants, nurses, pharmacists, therapists, psychologists, and other health professionals.

Point of Service (POS)

A managed-care plan that combines characteristics of HMOs and PPOs and usually offers lower costs when patients use providers within the plan's network.

Preferred Provider Organization (PPO)

A network of physicians, other health care practitioners, and hospitals that contract with insurers or employers to provide care at negotiated or discounted rates.

Scope of Practice

The specific tasks and procedures a health care professional is legally permitted to perform based on education, training, licensure, registration, certification, state law, and employer policy.

Telehealth

The remote or virtual delivery of health care services using technology.

Value-Based Plan

An insurance or payment model in which reimbursement is influenced by the quality of care and patient health outcomes rather than simply the number of services provided.

Administrative duties of a Medical Assistant

Greeting patients, scheduling appointments, answering telephones, handling correspondence, managing records, and performing other office responsibilities.

Clinical duties of a Medical Assistant

Obtaining medical histories, taking vital signs, providing patient education, assisting with examinations, performing permitted laboratory tests, preparing patients, and preparing or administering medications when allowed.

Medical Assistant scope of practice

MAs must work within their training, certification, state laws, employer policies, and provider supervision; what an MA is allowed to do can vary by state and workplace.

Factors affecting an MA's scope of practice

State laws, licensing and certification rules, education and training, employer policies, provider delegation, and the type of medical facility.

Additional certifications an MA can obtain

Examples include certified medical administrative assistant, certified phlebotomy technician, certified EKG technician, certified billing and coding specialist, and certified electronic health records specialist.

Licensure

Government-granted legal authority that allows a person to practice a profession after meeting required education, examination, and other standards.

Certification

A credential usually awarded by a professional organization showing that an individual has met specified education or examination standards.

Licensure vs. certification

Licensure is government authorization to legally practice; certification is generally a professional credential showing competence in a specific field.

NHA certification renewal

NHA certifications are generally renewed every 2 years.

NHA continuing education requirement

Generally 10 continuing education credits are required during each 2-year certification period.

Primary Care Clinic

An outpatient setting that provides routine health care such as wellness visits, preventive care, screenings, chronic disease management, and treatment of minor acute conditions.

Specialty Care Clinic

An outpatient facility where patients receive care for a specific body system, disease, or medical specialty.

Home Health

Health care provided in a patient's home, such as nursing, physical therapy, occupational therapy, or speech therapy, usually for a specific period while the patient needs assistance.

Mobile Health Unit

A vehicle or portable health care facility that brings medical services to populations that may have difficulty accessing traditional health facilities.

Hospice

End-of-life care focused on comfort, symptom relief, quality of life, and support rather than curing a terminal illness.

Patient-Centered Medical Home model

A group of health professionals works together with the patient at the center of care, often coordinated by a primary care provider.

Telehealth appropriate uses

Medication adjustment follow-ups, stable chronic-condition follow-ups, patient education, minor concerns that can be evaluated remotely, and follow-up regarding medical equipment.

When an in-person visit is needed

When diagnostic testing, a physical examination, evaluation of new or serious symptoms, procedures, imaging, or hands-on assessment is required.

Role of the MA in virtual visits

Help patients access the visit, provide instructions, collect or review information, prepare the patient and provider, and assist with the virtual appointment.

Patient Portal

A secure online system connected to the health record that allows patients to view health information and communicate with the health care office.

MA role with the patient portal

Help patients enroll or log in, provide instructions, answer basic questions, assist with uploading information, and encourage appropriate portal use.

Fee-for-Service health care model

Providers and medical facilities bill for individual services performed; more services generally produce more reimbursement.

Value-Based health care model

Providers are rewarded for quality, efficiency, prevention, and positive health outcomes rather than simply performing more services.

Managed Care health care model

Insurance plans contract with provider networks to control costs and coordinate patient care.

Capitation health care model

A provider receives a set amount of money per enrolled patient for a given period, regardless of the exact amount of care used.

HMO characteristics

Usually requires an in-network PCP, referrals to specialists, and use of network hospitals and providers except in emergencies; often has lower costs.

PPO characteristics

Usually does not require a PCP or specialist referral, allows greater provider choice, and permits out-of-network care at a higher cost.

POS characteristics

Combines HMO and PPO features; patients may select a PCP and can usually use out-of-network providers but pay more.

Quadruple Aim of health care

Improve patient experience, improve population health, reduce health care costs, and improve the well-being or work life of health care providers.

General Practitioner / Primary Care Provider

A physician who treats acute and chronic conditions, provides preventive care and health education, and considers biological, psychological, and social aspects of health.

Family Practitioner

A physician who provides preventive and medical care to patients across the lifespan, from newborns and children to adults and older adults.

Internist

A physician who specializes in comprehensive care of adults, including diagnosing and treating common illnesses and chronic or complex conditions.

Allergist

A physician specializing in allergies, asthma, and allergic reactions.

Anesthesiologist

A physician who administers anesthesia, manages pain, and monitors patients before, during, and after procedures or surgery.

Cardiologist

A physician who diagnoses and treats diseases of the heart and cardiovascular system.

Dermatologist

A physician who diagnoses and treats conditions of the skin, hair, and nails.

Endocrinologist

A physician who diagnoses and treats disorders involving hormones and the endocrine system.

Gastroenterologist

A physician who diagnoses and treats diseases of the gastrointestinal or digestive tract.

Gynecologist

A physician specializing in the female reproductive system.

Hematologist

A physician who diagnoses and treats diseases of the blood and blood-forming tissues.

Hepatologist

A specialist who diagnoses and treats diseases of the liver and related organs such as the biliary system.

Neonatologist

A physician who specializes in the care of newborns, especially premature or critically ill babies.

Nephrologist

A physician who specializes in kidney diseases.

Obstetrician

A physician specializing in pregnancy, childbirth, and postpartum care.

Oncologist

A physician who diagnoses and treats cancer.

Ophthalmologist

A physician who provides medical and surgical care for the eyes.

Orthopedist

A physician specializing in the musculoskeletal system, including bones, joints, muscles, ligaments, and tendons.

Neurologist

A physician who diagnoses and treats disorders of the brain, spinal cord, nerves, and nervous system.

Otolaryngologist

A physician specializing in conditions of the ear, nose, and throat; also called an ENT.

Pediatrician

A physician specializing in the medical care of infants, children, and adolescents.

Psychiatrist

A physician who specializes in mental and behavioral health disorders and can prescribe medication.

Radiologist

A physician who interprets medical imaging to detect, diagnose, and sometimes treat abnormalities or diseases.

Urologist

A physician specializing in the urinary tract in both males and females and the male reproductive system.

Ancillary Service

A supportive health care service that helps diagnose, treat, or rehabilitate patients but is not usually the patient's primary source of medical care.

Urgent Care

A walk-in medical service for illnesses or injuries that require prompt attention but are not usually life-threatening; often has extended hours and lower costs than an emergency department.

Laboratory Services

Diagnostic testing performed on blood, urine, body fluids, or other specimens to help providers diagnose or monitor disease.

Diagnostic Imaging

Use of technologies such as X-rays, ultrasound, CT, and MRI to create images of the body and assist with diagnosis.

Occupational Therapy

Therapy that helps people regain or develop the ability to perform activities needed for daily living, school, work, or independence.

Physical Therapy

Therapy that helps improve mobility, strength, flexibility, balance, and range of motion after injury, illness, or disability.

DO / MD

A physician educated and licensed to diagnose disease, prescribe medication, perform procedures, and provide medical treatment.

Typical physician education

Usually about 4 years of undergraduate education, 4 years of medical school, followed by residency training that varies by specialty.

Physician Assistant (PA)

A licensed medical professional who practices medicine as part of a physician-led or collaborative health care team and may diagnose conditions, order tests, prescribe medications, and treat patients depending on state law.

Typical PA education

Usually a bachelor's degree followed by an accredited PA graduate program, commonly about 2 to 3 years.

Nurse Practitioner (NP)

An advanced practice registered nurse who can assess patients, diagnose conditions, order tests, prescribe medications, and provide treatment according to state law.

Typical NP education

First becomes an RN and then completes graduate-level nurse practitioner education; some states allow independent NP practice.

Licensed Practical Nurse (LPN)

Provides basic nursing care, monitors patients, takes vital signs, assists with daily care, and administers some medications under appropriate supervision.

Registered Nurse (RN)

Provides and coordinates patient care, performs assessments, administers medications, provides health education, and carries out treatments.

Medical Laboratory Technician

Performs diagnostic laboratory testing on blood, body fluids, tissues, and other specimens under laboratory standards.

Medical Receptionist

Checks patients in and out, answers phones, schedules appointments, handles records, and performs administrative office duties.

Occupational Therapist

Helps patients with physical, mental, emotional, or developmental conditions improve their ability to perform everyday activities.

Pharmacy Technician

Assists pharmacists with medication preparation, dispensing, inventory, prescriptions, and other pharmacy operations but does not perform duties requiring the professional judgment of a pharmacist.

Physical Therapist

Assesses and treats movement problems and helps patients improve mobility, strength, balance, flexibility, and range of motion.

Radiologic Technologist / Radiology Technician

Uses imaging equipment to obtain diagnostic images that assist providers in diagnosing and treating disease.

Complementary Care

Health practices used together with conventional medical care; they may or may not involve medication.

Acupuncture

A complementary therapy involving insertion of very thin needles into specific points of the body to stimulate nerves and tissues and help manage certain symptoms such as pain.

Chiropractic Care

A form of care focused mainly on the musculoskeletal system, particularly the spine, using manipulation and other techniques to improve function and reduce certain types of pain.

Energy Therapy

A complementary practice based on the idea of influencing or balancing a person's energy field to promote relaxation or well-being.

Dietary Supplement

A product containing vitamins, minerals, herbs, amino acids, or other substances intended to supplement the diet.

Nutrient

A substance the body needs for energy, growth, repair, regulation, and normal cellular activities.

Five factors MyPlate considers when personalizing a food plan

Age, sex, height, weight, and physical activity level.

Water in the human body

Water makes up roughly 50–80% of the human body depending on factors such as age and body composition.

General daily water recommendation

About 2–3 liters per day is a commonly used general range, although individual needs vary.

Functions of water

Transports nutrients and oxygen, removes waste, regulates body temperature, supports blood and body fluids, and helps maintain fluid balance.

Water balance

The body must balance water intake with water output through urine, sweat, breathing, and other losses.

Protein

Complex molecules made of amino acids that are used to build and repair tissues and perform many body functions.