NHA CCMA Study Guide

A set of flashcards to help review key concepts from the NHA CCMA study guide.

What is an Advance Beneficiary Notice (ABN)?

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

What does 'Allowed amount' refer to in insurance terminology?

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

Define copayment in terms of medical billing.

An amount of money that is paid at the time of medical service.

What is coinsurance?

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

What is a deductible in health insurance?

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

What is an Explanation of Benefits (EOB)?

A statement from the insurance carrier detailing what was paid, denied, or reduced in payment.

What does a Participating Provider (PAR) agree to do?

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

What are the two primary parts of Medicare?

Part A (hospitalization) and Part B (routine medical office visits) benefits.

What is Medicaid designed to do?

Provides health insurance to the medically indigent population through a cost-sharing program between federal and state governments.

What is the purpose of the CMS-1500 Form?

Used for claims submitted by a provider or supplier to health care payers.

Describe the supine position in medical examinations.

Lying flat on the back with the knees bent.

In the medication schedules, what substances are classified in Schedule I?

Substances with a high potential for abuse and no approved medical use, such as heroin and LSD.

How are Schedule II substances characterized?

High potential for abuse, considered dangerous, and can lead to psychological or physical dependence.

What distinguishes Schedule III substances from others?

They have a moderate to low potential for physical and psychological dependence.

What is the federal Controlled Substances Act (CSA)?

A law that regulates the manufacture and distribution of controlled substances.

What is the typical adult normal blood pressure range?

100/60 to 140/80 mm Hg.

What is homeostasis?

The body's systems and biological processes maintain stability and balance.

What is the purpose of the chain of infection?

Identify the connection between the infectious agent, reservoir host, portal of exit, mode of transmission, portal of entry, and susceptible host.

What is the average heart rate for an adult over 15 years old?

60 to 100 beats per minute.

What are the two types of circuits blood flows through in the body?

Systemic and pulmonary circulation.

What are the two primary laws that govern the handling of health information in the United States?

HIPAA and the HITECH Act.

What is the role of the Medical Assistant in patient intake?

To gather patient history, perform vital sign checks, and document important information.

What is 'upcoding' in medical billing?

Coding for more than what was performed, leading to potential fraud and legal issues.

What are the elements required for a valid contract in healthcare?

Mutual assent, consideration, capacity, and legality.