CCMA Exam

studied byStudied by 1 person
0.0(0)
Get a hint
Hint

Advance Beneficiary Notice (ABN)

1 / 279

flashcard set

Earn XP

Description and Tags

CCMA Exam

Health

280 Terms

1

Advance Beneficiary Notice (ABN)

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

New cards
2

Allowed Amount

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

New cards
3

Copayment

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

New cards
4

Coinsurance

a provision under which both the insured and the insurer share the covered losses, typically 80:20

New cards
5

deductible

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

New cards
6

Explanation of Benefits

a form created by the insurance company to explain what charges were covered, denied, or need more documentation based on the claims submitted by the physician's office

New cards
7

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

New cards
8

Medicare

A federal program of health insurance for persons 65 years of age and older by Part A (hospitalization) or Part B (routine medical office visits)

New cards
9

Tricare

U.S. government health insurance plan for all military personnel

New cards
10

CHAMPVA

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

New cards
11

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

New cards
12

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

New cards
13

CMS-1500 form

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

  • 33 blocks

  • divided into three section

New cards
14

CMS-1500 Section 1

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

New cards
15

CMS-1500 Section 2

Patient/insured section: contains information about the patient or insured; includes boxes 1-13

New cards
16

CMS-1500 Section 3

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

New cards
17

Supine Position

New cards
18

Dorsal Recumbent Position

New cards
19

Sims' Position

New cards
20

Knee-elbow position

New cards
21

Fowler's Position

New cards
22

Lithotomy Position

New cards
23

Epidural Injection

epidural space of the spine

New cards
24

Intra-arterial Injection

injection into an artery (to break up clots)

New cards
25

Intra-articular Injection

injection into joint space

New cards
26

Intradermal Injection

Skin of the upper chest, forearms, upper pack. 5-15º angle

New cards
27

intramuscular injection

deltoid, vastus lateralis, ventrogluteal muscles

New cards
28

Intraosseous Injection

Bone marrow

New cards
29

Intraperitoneal Injection

within the peritoneal cavity

New cards
30

Intrapleural Injection

pleural space (lungs)

New cards
31

Intrathecal Injection

Subarachnoid space (brain)

New cards
32

Fat soluble vitamins

A, D, E, K

New cards
33

Water Soluble vitamins

B1, B2, B3, B6, Folate, B12, Pantothenic acid, biotin, C.

New cards
34

Erikson's stages of psychosocial development

  1. trust vs. mistrust

  2. autonomy vs. shame and doubt

  3. initiative vs. guilt

  4. industry vs. inferiority

  5. identity vs. role confusion

  6. intimacy vs. isolation

  7. generativity vs. stagnation

  8. integrity vs. despair

New cards
35

Grief Cycle

denial, anger, bargaining, depression, acceptance

New cards
36

Sagittal Plane

divides body into left and right

New cards
37

Coronal Plane

divides body into front and back

New cards
38

Transverse Plane

horizontal division of the body into upper and lower portions

New cards
39

Right Upper Quadrant (RUQ)

Right lobe of liver, gallbladder, right kidney, portions of stomach, small and large intestine

New cards
40

Left Upper Quadrant (LUQ)

Left lobe of liver, stomach, pancreas, left kidney, spleen, portions of large intestine

New cards
41

Right Lower Quadrant (RLQ)

cecum, appendix, right ovary and tube, right ureter, right spermatic cord

New cards
42

Left Lower Quadrant (LLQ)

contains parts of the small and large intestines, left ovary, left fallopian tube, left ureter

New cards
43

Epigastric Region

located above the stomach

New cards
44

Umbilical Region

New cards
45

hypogastric region

New cards
46

Right Hypochondriac Region

right lateral region just below the ribs

New cards
47

Left Hypochondriac Region

left upper region below the rib cartilage

New cards
48

Right lumbar Region

right middle region near the waist

New cards
49

Left Lumbar Region

New cards
50

Right Iliac Region

New cards
51

Left Iliac Region

New cards
52

Chain of Infection

infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host

New cards
53

Wheezing

Difficult breathing with a high-pitched whistling or sighing sound during expiration

New cards
54

Rales

Crackles; wet crackling noise in lungs

New cards
55

Rhonchi

loud rumbling sounds heard on auscultation of bronchi obstructed by sputum

New cards
56

kg -> lbs

1 kg = 2.2 lbs

New cards
57

Trendelenburg position

New cards
58

Intradermal needle gauge

27-28

New cards
59

Intradermal Needle Length

3/8 in

New cards
60

Subcutaneous Needle Gauge

25-26

New cards
61

Subcutaneous Needle Length

1/2 to 5/8 inch

New cards
62

Intramuscular Needle gauge

20-23

New cards
63

Intramuscular Needle Length

1-3 inches

New cards
64

Smaller

the higher the needle gauge number, the ___ the diameter

New cards
65

Precertification

A process required by some insurance carriers in which the provider must prove medical necessity before performing a procedure.

New cards
66

EMR

electronic medical record

New cards
67

suffix

word ending

New cards
68

prefix

a syllable or word that comes before a root word to change its meaning

New cards
69

Pancreas

digestion and endocrine

New cards
70

Thymus

endocrine and immune

New cards
71

Upcoding

A fraudulent practice in which provider services are billed for higher procedural codes than were actually performed, resulting in a higher payment.

New cards
72

Usual Fee

Fee for a service or procedure that is charged by a provider for most patients under typical circumstances.

New cards
73

Customary fee

fee typically charged for a service in a particular geographic area

New cards
74

Reasonable Fee

The generally accepted fee a physician charges for an exceptionally difficult or complicated service. A charge is considered reasonable if it is deemed acceptable after peer review even if it does not meet the criteria for a customary fee or prevailing charges.

New cards
75

Capitation

System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan.

New cards
76

Phantom Billing

Billing for services not performed

New cards
77

Who do you report to for Fraud?

Office of Civil Rights (OCR)

New cards
78

Who do you report to for unsecured HPI?

Secretary of Health and Human Services

New cards
79

What is the difference between eHPI and HPI? Who governs both?

New cards
80

HHS

U.S. Department of Health and Human Services

New cards
81

U.S. Department of Health and Human Services

provide essential services, including health care for low-income families, programs for older adults, and child services

New cards
82

CMS

Centers for Medicare and Medicaid Services

New cards
83

OSHA

Occupational Safety and Health Administration

New cards
84

Red Cross

An international organization dedicated to the medical care of the sick or wounded in wars and natural disasters

New cards
85

Legal Aid Society

One of a network of community law offices that provides free or low-cost legal assistance.

New cards
86

TJC

The Joint Commission Organization, establishing standards for hospitals/health related facilities

New cards
87

NAACLS

National Accrediting Agency for Clinical Laboratory Sciences

New cards
88

ACS

American Cancer Society

New cards
89

AHA

American Hospital Association

New cards
90

Accountable Care Organization (ACO)

a network of doctors and hospitals that voluntarily share responsibility for managing the quality and cost of care provided to a group of patients

New cards
91

Patient-Centered Medical Home (PCMH)

A model of primary care that provides comprehensive and timely care to patients, while emphasizing teamwork and patient involvement.

New cards
92

ACO vs PCMH

the ACO is primarily a value-based reimbursement model that incorporates "voluntary" collaboration among providers, whereas the PCMH is primarily a care delivery model involving significant collaboration as part of the certification process

New cards
93

Cluster Scheduling

the scheduling of similar appointments together at a certain time of day or week

New cards
94

Wave Scheduling

A certain # of patients are scheduled to arrive at the same time and are seen in which the order they arrive.

New cards
95

Open Scheduling

Patients are seen on a first come first serve basis. Walk-ins

New cards
96

Farenheit to Celsius

(F-32)/1.8

New cards
97

Fomite

A physical object that serves to transmit an infectious agent from person to person

New cards
98

Vector (medical)

an animal that is a carrier of a disease or a medication

New cards
99

Sanitization

removal of pathogens from objects to meet public health standards

New cards
100

Sterilization

The process that completely destroys all microbial life, including spores.

New cards

Explore top notes

note Note
studied byStudied by 18 people
... ago
4.0(1)
note Note
studied byStudied by 12 people
... ago
5.0(1)
note Note
studied byStudied by 34 people
... ago
5.0(1)
note Note
studied byStudied by 13 people
... ago
5.0(2)
note Note
studied byStudied by 1 person
... ago
5.0(1)
note Note
studied byStudied by 57 people
... ago
5.0(1)
note Note
studied byStudied by 22 people
... ago
5.0(1)
note Note
studied byStudied by 1975 people
... ago
4.7(11)

Explore top flashcards

flashcards Flashcard (93)
studied byStudied by 1 person
... ago
5.0(1)
flashcards Flashcard (115)
studied byStudied by 13 people
... ago
5.0(2)
flashcards Flashcard (22)
studied byStudied by 17 people
... ago
5.0(3)
flashcards Flashcard (75)
studied byStudied by 2 people
... ago
5.0(1)
flashcards Flashcard (29)
studied byStudied by 27 people
... ago
5.0(2)
flashcards Flashcard (40)
studied byStudied by 1 person
... ago
5.0(1)
flashcards Flashcard (20)
studied byStudied by 1 person
... ago
5.0(1)
flashcards Flashcard (134)
studied byStudied by 2615 people
... ago
4.0(26)
robot