CMA study guide

ABN: Advance beneficiary notice

a form provided to patient when the provider believes medicare will not pay for their services.

Allowed amount

the maximum amount off a third party payer will pay for a particular procedure or service

Copayment

a fixed fee paid by the patient at the time of an office visit

Coinsurance

policy holder and insurance company share the cost of covered losses in ratio, 80% to 20%

Deductible

Amount you must pay before you begin receiving any benefits from your insurance company

Explanation of benefits

A statement from the insurance carrier detailing what was paid, denied, or reduced in payment; also contains information about amounts applied to the deductible, coinsurance, and allowed amounts

participating provider

A provider who signed a contract with insurance company and abide by certain rules and regulations set forth by that particular third-party payer.

Medicare

cover patients ages 65 and older by part a hospitalization or part b, routine medical visits benefit.

Tricare

military personnels receive treatments from providers paid by the federal government

CHAMPVA

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

Medicaid

A federal and state assistance program that pays for health care services for people with limited income and resources.

Managed Care

planted that provide healthcare for a fixed monthly schedule payment, instead of individual visits and coordinated care.

Worker compensation

Guarantees financial and medical assistance to workers injured on the job.

CMS-1500 form

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

suspine position

lying on back, facing upward

Sims position

a side-lying position with the lowermost arm behind the body and the uppermost leg flexed

dorsal recumbent position

patient is lying on the back, face up, with the knees bent

Knee-elbow position

A person resting on their knees and elbows.

Fowler's position

a semi-sitting position; the head of the bed is raised between 45 and 60 degrees

lithotomy position

lying on back with legs raised and feet in stirrups

Medication schedules

the federal Controlled Substances Act (CSA) created five schedules for controlled substances, according to their potential for abuse and addiction.

Medication schedule I

substances that have high potential for abuse and no approved medical use ( illegal and can't be prescribed) like heroin and also marjuana even if its legal.

Medication schedule II

substances that have high potential for abuse, considered dangerous and can lead to psychological or physical dependence. ( like morphone and fentanyl) providers must be given a handwritten prescriptions with no refills. ( providers must keep the medication in secured or locked)

Medication Schedule III

Includes substances that have moderate and low potential for physical and psychological dependence. providers must be given handwritten prescription and may refill five times in 6 months.

Schedule IV

substances that have low potential abuse and dependence. Like diazepam, zolpidem, alprazolam, patients may refill 5 times in 6 months, staff members may authorize refills over the phone.

Schedule V

Low potential for abuse, frequently describe to management mild pay, severe coughs, and diarrhea. Common medications refills 5 times in 6 months and staff may authorize refills over the phone.

Route: Epidural

Epidural space (spine) (injectable liquid)can't administered

Route: Intra-articular

Site: Joint space (injectable liquid) can't administered

Route: Intra-arterial

Site: Artery ( to break up clot) can't administered

Route: Intra-dermal

skin of the upper chest, forearms, upper back. ( Can administer)

Route: Intramuscular (IM)

deltoid, vastus lateralis, ventrogluteal muscles. (can administer)

Route: Intraosseous

injected into the bone marrow cavity ( can't admin.)

Route: Intraperitoneal

peritoneal cavity (abdomen) (can’t admin.)

Route: Intrapleural

pleural space (lungs) can

Route: Intratechal

subarachnoid space (brain) can’t admin.

Route: Intravenous (IV)

major veins, most often in the arms and hands or via central venous access devices

Route: Subcutaneous (SC)

under the skin of the abdomen, anterior thighs, upper outer arms, upper back (under the shoulder) can’t admin