NHA CCMA

Advance Beneficiary Notice (ABN)

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

Allowed Amount

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

Copayment

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

Coinsurance

A policy provision frequently found in medical insurance whereby 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.

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 (PAR)

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

Medicare

Generally covers patients age 65 and older by Part A (hospitalization) or Part B (routine medical office visits) benefits

Tricare

Authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government.

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 between federal and state governments for those who meet specific eligibility criteria.

Managed Care

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

Worker’s Compensation

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

CMS-1500 Form

CMS-1500 forms are submitted by healthcare providers or suppliers (like doctors, clinics, or medical offices) to insurance companies or other payers to request payment for services. To complete it, the medical assistant needs the patient’s and guarantor’s personal and insurance details, as well as information about tests, treatments, procedures, and billing. The CMS-1500 has 33 fields, organized into three sections.

CMS-1500 Section 1

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

CMS-1500 Section 2

Patient/Insured Section: Contains information about the patient or insured (if other than the patient); includes boxes 1-13

CMS-1500 Section 3

Physician/Supplier Section: contains information about the physician or supplier: includes boxes 14-33

Supine Position

Dorsal Recumbent Position

Sims Position

Knee-elbow position

Fowler’s Position

Lithotomy Position

Medication Schedules

Federal Controlled Substances Act (CSA) created five schedules for controlled substances, according to their potential for abuse and addiction. Only controlled substances are scheduled

Schedule I

Includes substances that have a high potential for abuse and no approved medical use in the US.

Schedule II

Includes substances that have a might potential for abuse, are considered dangerous, and can lead to psychological and physical dependence. Providers must give patients a handwritten prescription with no refills. In health care facilities, staff must keep these in a secure, locked cabinet or stage separate from other meds.

Schedule III

Includes substances that have a moderate to low potential for physical and psychological dependence. Providers must give patients a handwritten prescription. They may refill them five times in 6 months.

Schedule IV

Includes substances that have a low potential for abuse and dependence. Providers must sign prescriptions for these substances, and patients may refill them five times in 6 months. Staff members may authorize refills over a phone.

Schedule V

Includes substances that contain limited quantities of some narcotics, usually for antidiarrheal, antitussive, and analgesic purposes. Providers must sign prescriptions for these substances, and patients may refill them five times in 6 months. Staff members may authorize refills over the phone.

Household Value: 15 drops (gtt)

Apothecary value: 15-16 minims

Metric: 1 mL

Household Value: 1 teaspoon (tsp)

Apothecary value: 1 dram

Metric: 5 mL

Household Value: 1 tbsp

Apothecary value: 4 dram

Metric: 15 mL

Household Value: 1 fluid oz, 2 tbsp

Apothecary value: 8 dram,1 oz

Metric: 30 mL

Household Value: 1 cup

Apothecary value: 8 oz

Metric: 240 mL

Household Value: 1 pint

Apothecary value: 1 pint

Metric: 480 mL

Household Value: 1 quart

Apothecary value: 1 quart

Metric: 960 mL

Household Value: 1 gallon

Apothecary value: 1 gallon

Metric: 3,830 mL

Household Value: 2.2 lb

Apothecary value: 2.2 lb

Metric: 1 kg

Route: Epidural

Location: Epidural space (spine)

Medication Formulations: Injectable liquid

CCMA permitted to administer: no

Route: Intra-Arterial

Location: Arteries (to break up clots)

Medication Formulations: Injectable liquid

CCMA permitted to administer: no

Route: Intra-Articular

Location: Within a joint space

Medication Formulations: Injectable liquid

CCMA permitted to administer: no

Route: Intradermal

Location: Skin of the upper chest, forearms, upper back

Medication Formulations: Injectable liquid

CCMA permitted to administer: yes

Route: Intramuscular (IM)

Location: Deltoid, vastus lateralis, ventrogluteal muscles

Medication Formulations: Injectable liquid

CCMA permitted to administer: yes

Route: Intraosseous

Location: Bone Marrow

Medication Formulations: Injectable liquid

CCMA permitted to administer: no

Route: Intraperitoneal

Location: Peritoneal Cavity (abdomen)

Medication Formulations: Injectable liquid

CCMA permitted to administer: no

Route: intrapleural

Location: Pleural space (lungs)

Medication Formulations: Injectable liquid

CCMA permitted to administer: no

Route: Intrathecal

Location: Subarachnoid space (brain)

Medication Formulations: Injectable liquid

CCMA permitted to administer: no

Route: Intravenous (IV)

Location: Major veins, most often in arms and hands, or via central venous access devices

Medication Formulations: Injectable liquid

CCMA permitted to administer: no

Route: Subcutaneous

Location: Under the skin of the abdomen, anterior thighs, upper outer arms, upper back (under shoulder)

Medication Formulations: Injectable liquid

CCMA permitted to administer: yes

Classifying Solubility of Vitamins

their absorption, transportation, storage, and excretion depend on the availability of the substance in which they dissolve in.

Fat-Soluble Vitamins

A, D, E, K

Water-Soluble Vitamins

B₁, B₂, B₃, B₆, folate, B₁₂, pantothenic acid, biotin, C

Erikson’s Stages of Psychological 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

• Ego Integrity vs. Despair

The Grief Cycle

Denial → Anger → Bargaining → Depression → Acceptance