Medical Assisting Exam Notes

Health Care Systems and Settings

• The medical field can be overwhelming due to new terminology, legal concerns, direct or indirect patient care, unique processes, and high expectations.
• A holistic approach aids in understanding the healthcare system.
• Understanding the roles and responsibilities of the entire healthcare team is crucial for effectiveness and cohesiveness.
• Respect and assistance among team members are essential for optimal patient care.

Medical Assistant Roles, Responsibilities, Scope of Practice, and Titles

MA Roles

• MAs primarily work alongside providers in outpatient or ambulatory healthcare settings, such as medical offices.
• They are cross-trained to perform both administrative and clinical duties.
• Administrative duties include greeting patients, scheduling, handling correspondence, and answering telephones.
• Clinical duties include obtaining medical histories, providing patient education, performing laboratory tests, and preparing and administering immunizations.
• MAs achieve credentialing by passing a national certification exam.

MA Responsibilities

• Responsibilities vary based on the setting.
• Duties can be primarily administrative, clinical, or a combination of both.

Administrative Duties

• Scheduling patient appointments
• Patient registration (demographics, payer information, compliance forms)
• Updating and working in patient records
• Sending claims to insurance
• Collecting patient responsibility amounts (copays, coinsurance, deductible)

Clinical Duties

• Collecting and processing lab specimens
• Performing diagnostic testing (EKG, spirometry)
• Preparing and cleaning examination rooms
• Preparing the patient for evaluation and procedure
• Measuring vital signs
• Preparing medications and administering immunizations

Evolving Role of MAs

• The MA role is constantly changing and evolving, including patient navigation and care coordination.
• MAs guide patients through the healthcare system, helping them understand processes and connect with specialists.
• They coordinate with the patient care team within the clinic and externally with specialty care teams.
• MAs ask questions on the patient’s behalf to nurses and providers to understand the plan of care and provide information to the patient in a clear way.
• When coordinating with other teams, MAs can provide helpful context about the patient’s social determinants of health and barriers to care.
  They also support the patient in being scheduled appropriately and in a timely manner with specialists.

Scope of Practice

• Scope of practice describes duties delegated based on education, training, and experience.
• The scope of practice for the MA does not include the practice of medicine.
• Medical assistants should not perform duties they have not been trained or certified to do.
• Prior to practice, review the duties and restrictions related to medical assisting, which vary by state.
• Healthcare organizations may have stricter policies and procedures that they enforce, but they must comply with state regulations at minimum.

Variables for the Scope of Practice

• Variables that affect the scope of practice include the regulations and policies issued by state medical boards.
• An MA with appropriate training may safely provide supportive services that are simple, routine medical tasks under the supervision of a licensed physician.
• In addition, the MA may only provide supportive services set forth by the medical office’s organizational policies.
• These often include measuring height and weight, measuring vital signs, and performing various diagnostic and laboratory testing.
• Organizational policies must adhere to state and government guidelines to comply with current laws.

Titles

• Over 50 years ago, medical providers began hiring assistants to support their medical practice and recognized the need for administrative support.
• Over time, this turned into the MA role, combining administrative and clinical responsibilities.
• In 1956, a formal medical assistant association was formed and recognized by 15 states.
• The profession continued to evolve and was recognized by the U.S. Department of Education in 1978.
• At that time, training was completed on the job by the provider and other office staff.
• Formalized training and certification programs arose as training became time-consuming and expensive for providers.
• Many clinical offices look to hire only those who have completed formal training and certification, ensuring they have the necessary skill set to work in patient care.
• Offices also follow specific guidelines requiring medical assistants to have current certification to input data regarding government insurance reimbursements into electronic health records.

Additional Certifications

• MAs can further their careers and extend their scope of work through continued education, leading to additional certifications, including the following:
  • Certified medical administrative assistant (CMAA)
  • Certified phlebotomy technician (CPT)
  • Certified EKG technician (CET)
  • Certified billing and coding specialist (CBCS)
  • Certified electronic health records specialist (CEHRS)

Provider and Allied Health Roles, Responsibilities, Scope of Practice, Titles, and Credentials

Physician Information

• All practicing doctors must be licensed in the state where they practice.
• To pursue a license, they must first complete eight years of school—four years of undergraduate college, followed by four years of medical or osteopathic school.
• Upon graduation, prospective physicians then move on to residency.
• Residency is a two- to seven-year training period where they receive intensive on-the-job training with the direct oversight of a licensed physician.
• Finally, physicians must pass parts I, II, and III of the U.S. Medical Licensing Examination.
• There are two primary types of physicians: medical doctor (MD) and doctor of osteopathy (DO).
• Their scope of practice and responsibilities are nearly the same, though their training and expertise have slight variations.
• Medical doctors are allopathic providers and the most widely recognized type of doctor.
• Medical doctors diagnose illnesses, provide treatments, perform procedures such as surgical interventions, and write prescriptions.
• Doctors of osteopathy complete requirements like those of MDs to graduate and practice medicine.
• In addition to modern medicine and surgical procedures, DOs use osteopathic manipulative therapy to treat patients.

Midlevel Providers

• In addition to physicians, there are two primary types of midlevel providers: physician assistants and nurse practitioners.

Physician Assistant

• Physician assistants (PA) must practice medicine under the direction and supervision of a licensed MD or DO, but they can make clinical decisions.
• In order to be licensed as a PA in the state of practice, individuals must first complete at least four years of college, followed by two years of PA school.
• Most PAs will focus on a specific specialty, such as cardiology or orthopedics.

Nurse Practitioner

• Nurse practitioners (NP) provide basic patient care services, including diagnosing and prescribing medications for common illnesses.
• Nurse practitioners require advanced academic training beyond the registered nurse (RN) degree and have an extensive amount of clinical experience.
• In most states, NPs must work under the supervision of a physician, but in some states they can practice independently.

Nurses

• Nurses are found in almost every healthcare setting.

Licensed Practical Nurse

• A licensed practical nurse (LPN) must be licensed in their state.
• Typically, one year of schooling through an accredited program, along with passing a state board examination, is required to obtain an LPN license.
• LPNs are somewhat limited in their scope of practice, as the role is designed to be assistive.
• They can measure vital signs, administer some medications, and perform clinical care such as wound care.
• Often, the role of an LPN is to observe patients, recording and reporting on status changes.
• While they may work in many different settings, a primary use of LPNs recently is in long-term care settings due to the increasing number of older adults in the general population.
• In some states, an LPN may also be referred to as an LVN (licensed vocational nurse).

Registered Nurse

• A registered nurse (RN) must complete more schooling in the form of an associate degree, diploma graduate, or baccalaureate degree.
• They, too, must pass a state board examination to be licensed.
• Due to the more intensive training, RNs have a much broader scope of practice than LPNs.
• RNs can work in clinical settings, public health agencies, administrative capacities, and educational settings.

Allied Health Professionals

• Medical laboratory technicians perform diagnostic testing on blood, bodily fluids, and other specimens under the supervision of a medical technologist.
• Medical receptionists check patients in and out, answer phones, schedule appointments, and perform other administrative tasks.
• Occupational therapists assist patients who have conditions that disable them developmentally, emotionally, mentally, or physically.
• Pharmacy technicians may perform routine medication dispensing functions that do not require the expertise or judgment of a licensed pharmacist.
  Pharmacy technicians must work under the direct supervision of a pharmacist.
• Physical therapists assist patients in improving mobility, strength, and range of motion.
• Radiology technicians use various imaging equipment to assist the provider in diagnosing and treating certain diseases.

Licensing Versus Certification and Maintenance of Certification

Licensure vs. Certification

• A medical school graduate must be licensed before beginning the practice of medicine.
• Being licensed by the state to practice medicine allows them to diagnose conditions and provide treatment.
• Licensing helps ensure that anyone providing medical care has the adequate knowledge and skill set to do so safely.
• It is important to understand the laws and regulations within each state to avoid violations of any kind.

Health Care Licensure

• Licensure is regulated by state statutes through the medical practice acts.
• An MD, DO, or Doctor of Chiropractic degree is issued upon graduation from a medical or chiropractic institute.
• Licensure for physicians is mandatory and controlled by a state board of medical examiners.
• Licensure may be accomplished by examination, reciprocity, or endorsement.
• Every state requires a written examination for MDs to practice.
• Some states grant the license to practice medicine by reciprocity, which automatically recognizes that the requirements were met by another state.
• Graduates of medical schools in the U.S. are licensed by the endorsement of the national board certification.
• Licensure by endorsement is granted on a case-by-case basis based on examinations.
• Graduates not licensed by endorsement must pass the state board exam.
• As of 2022, no state requires medical assistants to be licensed.
• However, some states dictate that to complete specific services such as x-rays, individuals must have a license to perform that particular skill.
• For example, Florida does not require a medical assistant to have a license to collect prescribed routine laboratory specimens.
• However, in Washington, even nationally certified medical assistants must get licensing credentials through the Washington State Department of Health to perform phlebotomy or EKGs.

Certification

• In addition, the government may require certification for the medical assistant to enter prescriptions into a computerized order-entry system.
• Advantages of certification include increased initial job placement, higher wages, and career advancement opportunities.

Maintaining a Certification

• Once certification is obtained, it must be maintained to stay current.
• This ensures that medical assistants have the most up-to-date information about the medical field and provides validity to the overall profession.
• Each certification has different requirements for recertification, so medical assistants should understand and follow the recertification process of the organization sponsoring their certification.

Types of Health Care Organizations and Delivery Models

Inpatient and Outpatient

• Inpatient care occurs while the patient is admitted to a hospital or facility.
• Ambulatory care refers to any care received in an outpatient facility.
  This includes many types of care settings.

Primary Care Clinics

• Primary care clinics are outpatient care settings where patients are seen for routine type visits, including wellness checks, prevention counseling, chronic conditions, medication management, and minor acute needs.
• Primary care will be discussed in more detail later in the chapter.

Specialty Care Clinics

• Specialty care clinics are outpatient facilities where patients who have complex or severe diseases and conditions are seen for routine visits by doctors who specialize in a specific disease or condition.

Home Health

• Home health refers to specific types of care provided to those who cannot leave their home easily.
• Physical, occupational, and speech therapy are common types of home care.
• Skilled nursing is also common in the home health setting.
• It must be prescribed and overseen by a provider, typically a primary care provider (PCP).
• Home health is not used on an ongoing basis for a patient but is ordered for a set period based on an acute event, usually hospitalization.
• Home health orders include goals for the patient, such as managing their medications and ambulating safely.
• The service is complete when the goals are reached.
• Medical assistants working for the ordering provider are often responsible for submitting the order for home health, coordinating to ensure the patient is enrolled and scheduled, and assisting with the administrative aspects of the orders.

Mobile Health Units

• Mobile health units bring healthcare to the communities that most need it and may otherwise lack access to the services provided.
• Teams working in a mobile health unit are equipped with means of transportation that allow for the setup and use of specialized medical equipment.
• The COVID-19 pandemic brought this type of care to much of the country in the form of mobile testing and vaccination options.

Hospice

• Hospice care is end-of-life care focused on comfort rather than curative efforts.
• Patients can qualify for hospice care if they have a terminal illness at the end stage.
• It can be delivered as outpatient or inpatient care.
• Typically, a patient will begin hospice outpatient but can transition to inpatient care as they need a higher level of care near the end of life.

Patient-Centered Medical Home

• The patient-centered medical home (PCMH) is a care delivery model in which a PCP coordinates treatment to ensure patients receive the required care when and where they need it and in a way they can understand.
• This encompasses all aspects of care, from prevention and wellness education to acute illness and chronic disease management to end-of-life care.
• The PCMH is a team-based approach to healthcare in which a provider leads an interprofessional team to work collaboratively and effectively for their patients.
• Medical assistants are an integral piece of the PCMH team—assisting with direct patient care, care coordination, patient education, and administrative tasks essential to the model.

Technology-Based Methods for Providing Health Care and Information

Telehealth and Virtual Visits

• Telehealth is healthcare delivered virtually, most commonly via video call.
• The increase in telehealth expanded to eliminate patients from coming in contact with communicable diseases, provide convenience, and allow patients in rural areas to obtain specialty care where it may not have been offered before.
• Telehealth can be an excellent option for patients and providers to review many aspects of care, but it does come with limitations.
• Medical assistants may have multiple responsibilities when it comes to virtual visits.

MA Responsibilities in Virtual Visits

• Scheduling virtual visits may require more time because the MA must gather or confirm the patient’s email address, ensure the link has been sent, and review instructions.
• Some offices offer patients a test visit in which an administrator or MA will log into the link to ensure the patient can access it when it is time for their appointment.
• Medical assistants may also participate in the actual visit, just as they would with a standard office visit.
• This can include gathering a history, verifying medication and pharmacy information, setting an agenda, and following up with the patient on the next steps, such as referral or diagnostic testing coordination.

Patient Portals

• Patient portals are a common feature in electric health records.
• This feature allows patients to log into a patient-facing aspect of the EHR to view their personal health information, such as test results, visit notes, and patient education materials.
• Many patient portals include an option to securely message the healthcare team about concerns and plans of care.
• Some portals also allow patients to schedule appointments directly without needing to call the office.
• The benefits of patient portals include increased transparency about care, decreased wait times for patients to receive results, and reduced demand on the office staff due to direct access limiting the need for phone calls.
• The MA may be responsible for uploading information to the portal, as well as assisting the patient with enrolling and getting set up with an account.
• Medical assistants should understand the portal’s functionality and the clinic’s policies and procedures around appropriate use.

Health Care Payment Models

Fee for Service

• The U.S. healthcare system is largely based on the fee-for-service model in which providers and medical facilities bill insurance and patients for the services provided.
• Every examination, medical service, test, and procedure has an associated procedural code and charge.
• These charges are managed through the provider’s medical billing department and sent to the insurance (or directly to the patient) for payment.
• The insurance then charges the patient a predetermined amount for which they are responsible.

Value-Based Plans

• The healthcare system is increasingly moving toward value-based plans or care.
• The health care system is increasingly moving toward value-based plans or care.

The Quadruple Aim

• Improved patient outcomes
• Improved patient satisfaction
• Lower cost
• Health care professional well-being
• Rather than costs being determined by each service, the cost is more holistic.
• This model prioritizes prevention and early intervention over complex intervention to prevent unnecessary downstream costs.
  Clinics and healthcare systems that adopt this model are rewarded financially for keeping patients healthy rather than making money based on visits, procedures, and interventions once the patient has become ill.

Other Health Care Models

Managed Care

• 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.

Capitation (partial or full)

• Patients are assigned a per-member, per-month payment based on age, race, sex, lifestyle, medical history, and benefit design.
• Payment rates are tied to expected usage regardless of how often the patient visits.
• Like bundled payment models, providers are incentivized to help patients avoid high-cost procedures and tests to maximize their compensation.
• Under partial- or blended-capitation models, only specific types or categories of services are paid based on capitation.

Health maintenance organization (HMO)

• This plan contracts with a medical center or group of providers to provide preventive and acute care for the insured person.
• HMOs generally require referrals to specialists, as well as precertification and preauthorization for hospital admissions, outpatient procedures, and treatments.

Preferred provider organization (PPO)

• These plans have more flexibility than HMO plans.
• An insured person does not need a PCP and can go directly to a specialist without referrals.
• Although patients can see providers in or out of their network, an in-network provider usually costs less.

Point-of-service (POS) plan

• POS plans allow a great deal of flexibility for patients.
• They can self-refer to specialists and do not need an assigned PCP.
• Like PPO, the cost depends on whether the providers they see are within the plan’s panel.

General vs. Specialty Health Care and Services

General Health Care Services

• General practitioners (GPs) are medical doctors who treat acute and chronic illnesses and provide patients with preventive care and health education.
• A GP may take a holistic approach to general practice that considers the biological, psychological, and social aspects relevant to the care of each patient’s illness.
• Family practitioners offer care to the whole family, from newborns to older adults.
• They are familiar with a range of disorders and diseases.
• However, preventive care is their primary concern.
• Internists provide comprehensive care for adults, often diagnosing and treating chronic, long-term conditions.
• They also offer treatment for common illnesses and preventive care.
• Internists must have a broad understanding of the body and its ailments to diagnose conditions and provide treatment.
  Internists may focus on pediatric or adult medicine rather than provide care across the lifespan.

Specialty Health Care Services

• Specialist care is used when a disease or diagnosis escalates beyond the area of expertise of a PCP.
• Specialists are providers focused on diagnosing and treating diseases and disorders of specific body systems.

Allergist

• Evaluates disorders and diseases of the immune system, including adverse reactions to medications and food, anaphylaxis, problems related to autoimmune disease, and asthma

Anesthesiologist

• Manages pain or administers sedation medications during surgical procedures

Cardiologist

• Diagnoses and treats diseases or conditions of the heart and blood vessels

Dermatologist

• Diagnoses and treats skin conditions

Endocrinologist

• Diagnoses and treats hormonal and glandular conditions; often works with patients who have diabetes

Gastroenterologist

• Manages diseases of the GI tract (stomach, intestines, esophagus, liver, pancreas, colon, and rectum)

Gynecologist

• Diagnoses and treats internal reproductive system and fertility disorders

Hematologist

• Diagnoses and treats blood and blood-producing organs, patients who have anemia, leukemia, and lymphoma

Hepatologists

• Studies and treats diseases related to the liver, biliary tree, gallbladder, and pancreas

Neonatologist

• Provides care of newborns, specifically those who are ill or premature

Nephrologist

• Manages diseases and disorders of the kidney and its associated structures

Obstetrician

• Provides care of patients during and after pregnancy

Oncologist

• Treats and provides care for patients who have cancer

Ophthalmologist

• Diagnoses and treats diseases and conditions of the eye

Orthopedist

• Treats injuries and diseases of the bones, joints, muscles, tendons, and ligaments

Neurologist

• Treats diseases and disorders of the brain and nervous system

Otolaryngologist

• Treats diseases and conditions of the ear, nose, and throat

Pediatrician

• Manages newborn to adolescent health

Psychiatrist

• Diagnoses and treats mental disorders and conditions

Radiologist

• Uses and interprets imaging to detect abnormalities in the body

Urologist

• Manages disorders of the urinary tract

Ancillary Services and Complementary Therapies

Ancillary Services

• Providing ancillary services in the provider’s office adds convenience for patients and increases revenue for the organization.
• Ancillary services meet a specific medical need for a particular population.

Examples of ancilliary services

• Urgent care provides an alternative to the emergency department.
• They cost less, have a shorter wait time, and are often conveniently located.
• Most have flexible hours and offer walk-in appointments.
• They are appropriate to use for non-life-threatening acute injuries and illnesses.
• Laboratory services perform diagnostic testing on blood, body fluids, and other specimens to conclude a diagnosis for the provider.
• Diagnostic imaging machines such as x-ray equipment, ultrasound machines, magnetic resonance imaging (MRI), and computerized tomography (CT) take images of body parts to further diagnose a condition.
• Occupational therapy assists patients who have conditions that disable them developmentally, emotionally, mentally, or physically.
• Occupational therapy helps the patient compensate for the loss of functions and rebuild to a functional level.
• Physical therapy assists patients in regaining mobility and improving strength and range of motion, often impaired by an accident, injury, or disease.

Complementary Therapies

• Acupuncture involves pricking the skin or tissues with needles to relieve pain and treat various physical, mental, and emotional conditions.
• Chiropractic medicine diagnoses and treats pain and overall body function through spinal manipulation and alignment.
• Energy therapy is the calm method of clearing cellular memory through the human energy field, promoting health, balance, and relaxation.
• It centers on the connection between life’s physical, emotional, and mental states found in various holistic healing techniques.
• Dietary supplements contain one or more dietary ingredients, including vitamins, minerals, herbs, or other botanicals.