Comprehensive Medical Assisting Certification and Clinical and Administrative Study Guide

Professional Medical Assisting and Credentials

• Registered Medical Assistant (RMA) Certification: This credential is offered by the American Medical Technologists (AMT).

• National Center for Competency Testing (NCCT): Candidate certification provided by the NCCT is valid for a period of $5$ years from the date of certification indicated on the candidate's certificate.

• American Academy of Professional Coders (AAPC): The specific AAPC certification for physician practice is the Certified Professional Coder (CPC®).

• Professional Attitudes: Maintaining professional conduct is paramount. Discussing an interesting patient with a significant other is considered a serious breach of confidentiality and illustrates a lack of professional attitude. Appropriate professional behaviors include prompt attention to details, returning patient telephone calls, and the correct use of medical terminology.

Administrative Protocols and Office Management

• Task Prioritization: To maintain office flow and safety, tasks must be prioritized. Typically, performing procedures and dismissing patients is the lowest priority compared to rooming patients, assisting providers with emergencies, or working on pending files with immediate tasks.

• Facility Environment Maintenance:

  • The medical office should be maintained at a comfortable temperature range between $68-74^{\circ}F$.

  • When filing in a new cabinet, it is recommended to place files in the bottom drawers first to provide stability and prevent the cabinet from tipping.

• Filing Systems and Records:

  • Most filing systems are based directly or indirectly on an alphabetical arrangement.

  • Geographic Filing: The primary disadvantage of this system is that it requires the user to have a degree of familiarity with a specific geographic area.

  • Alphabetical Indexing Rules:

    1. The first unit indexed is the Last Name (Surname).

    2. Hyphenated surnames and firm names are indexed as one unit.

    3. Conjunctions and prepositions (e.g., ‘and’, ‘for’) are disregarded and omitted.

    4. In the indexing sequence, surnames are first, followed by the first (given) name, then the middle name, and finally titles.

• Scheduling Systems:

  • Clustering: This method involves scheduling patients with similar diagnoses, treatments, or needs within a specified time frame.

  • Template Management: When using a template with morning and afternoon slots for urgent visits, the medical assistant should book the morning appointments first to ensure patients requiring immediate attention are seen early.

  • Paper vs. Electronic: An advantage of paper scheduling is that some styles allow for scheduling as far out as a year or more. EHR systems, however, provide an automatic audit trail for recording missed appointments.

• Communication Protocols:

  • Telephone Etiquette: When answering, always identify yourself and let the caller know when to expect a response. Do not remain expressionless (voice should be pleasant). Always repeat back recorded information.

  • Patient Questions: If a patient calls with a medical question, document the information and relay it to the doctor. One should never guess at the answer or treat the concern lightly.

  • Identity Verification: If an attorney calls for records, verify they are authorized to receive the information and offer to call them back after verification.

  • Waiting Room Management: If a significant delay occurs, notify the patient tactfully and offer the option to reschedule.

Legal, Ethical, and Regulatory Frameworks

• The Physician-Patient Contract: The relationship is a contract. An Express Contract is created when a patient explicitly accepts a physician’s offer of treatment. From this point, the provider has an affirmative duty to care for the patient according to an Expected Standard of Care, which refers to standards associated with a doctor of similar training and experience.

• Ownership of Records: In a private practice, the provider ’owns’ the physical medical record, though the patient has a right to the information contained within them.

• Regulatory Compliance:

  • Drug Enforcement Administration (DEA): Providers most often interact with the Office of Diversion Control.

  • DEA-41 Form: This form is completed when damaged or contaminated controlled substances are destroyed.

  • HITECH Act: Signed as part of the American Recovery and Reinvestment Act, this provides the Health and Human Services (HHS) department the authority to establish programs to improve quality through health information technology.

  • Joint Commission: In $1989$, the Joint Commission began requiring operational linkages between risk management and quality assurance.

• Ethics and Referrals: Physician self-referral (referring a patient to a facility in which the physician has a financial interest or investment) is widely considered a conflict of interest.

• Statute of Limitations: Medical records must be kept for a period at least equal to the statute of limitations beyond a patient's death or reaching the age of majority.

• Consent Exceptions: A patient does not need to provide signed consent for the release of information regarding a public health risk.

Patient Communication and Human Behavior

• The Communication Process: This involves the interchange of information through thoughts, feelings, messages, or perceptions. In the sender-receiver process, the message originates with the sender and is picked up by the receiver.

  • Active Listening: Participating in a conversation by repeating words/phrases or giving approving/disapproving nods.

  • Body Language: Appropriate body language includes maintaining direct eye contact. Crossing arms or turning your back is unprofessional.

• Unconscious Defense Mechanisms:

  • Repression: Setting aside unpleasant thoughts and feelings.

• Patient Characteristics and Diversity:

  • Honesty is cited as the single most admired characteristic in a leader.

  • Culture: Understanding hereditary, cultural, and environmental influences is beneficial for working with diverse patients.

• Developmental and Special Populations:

  • Pediatrics: The "Four Es" to engage a child are Enlistment, Education, Encouragement, and Experience (Note: Evidence is not one of the typical four).

  • Geriatrics: Always greet older patients warmly and by name.

  • Hearing Loss Indicators: Indicators include not responding when spoken to out of sight range or talking in an unusually loud voice.

• Learning Styles: Approximately $5\%$ of the population are kinesthetic learners.

Medical Terminology and Anatomy

• Foundations: The majority of medical terms have Latin or Greek foundations. When building a term, the suffix should be identified first.

• Common Suffixes:

  • -rrhagia: Bursting forth of blood / hemorrhage.

  • -rrhea: Discharge.

  • -pathy: Disease.

  • Note: Suffixes commonly indicate a disease, procedure, or condition, but rarely a location.

• Anatomy and Body Systems:

  • Integumentary: The "true" skin is the dermis. The epidermis is the outermost layer.

  • Digestive: The alimentary canal is part of the digestive system. The combining form bucc/o refers to the cheek.

  • Reproductive: The primary structure in the male reproductive system is the testis.

  • Cellular: Phagocytosis is the process known as "cell eating."

  • Structural: Cartilage is found in the ear, voice box, and between spine bones, but is not naturally found in the wrist bones.

  • Terminology: Myelitis is the inflammation of the spinal cord. Afebrile means without fever, while Febrile means having a temperature above normal.

Clinical Procedures and Patient Care

• Medical Charting Methods:

  • POMR (Problem-Oriented Medical Record): The Problem List consists of physical, psychological, and social problems related to a condition.

  • HPIP Method: History, Physical exam, Impression, and Plan. The "History" and "Impression" are considered subjective findings in some contexts, while "Physical exam" is objective. ‘I’ stands for Impression.

  • Progressive Notes: The chief complaint should be written using the patient's own words.

• Asepsis and Surgical Procedures:

  • Disinfection: The process by which disease-producing microorganisms (pathogens) are killed.

  • Sterilization: The total destruction of all microorganisms.

  • Incision and Drainage (I&D): The procedure used to remove abscesses.

• Physical Examination:

  • General Appearance: A provider judges a patient's speech by asking the patient a few questions.

  • Recumbent: This term means lying down.

  • Measuring Height/Weight: In the medical office, the lower extremities (stature/weight) are measured most frequently.

• Specialty Care:

  • Pediatrics: Infants are typically examined every $2-3\,\text{months}$ for the first $18\,\text{months}$. They should be weighed unclothed. They first roll from back to side between $2-4\,\text{months}$. Head circumference is read to the nearest $1/8\,\text{inch}$.

  • OB/GYN: A Colposcopy is an examination of the vagina with a lighted instrument. A Pap smear (Papanicolaou technique) detects cancer by taking samples from the cervix, endocervix, and vagina (not the uterus). A Fetoscope is a stethoscope used for fetal heart rates. Breast exams should occur $7-10\,\text{days}$ after the start of a period.

Emergency Situations and First Aid

• Emergency Priorities: In an emergency, the secondary survey includes assessing vital signs. Stabilizing life-threatening conditions and calling for help are part of the primary survey.

• Convulsions: The most common cause of convulsions is a high fever.

• CPR (Cardiopulmonary Resuscitation):

  • If no pulse is found after assessment, the next step is to start chest compressions.

  • During two-rescuer CPR for children, the compression-to-ventilation ratio is $15:2$.

• Cardiac Symptoms: Chest pain due to lack of blood nourishment to the heart is called Angina Pectoris.

Diagnostic Testing and Imaging

• Electrocardiography (ECG/EKG):

  • P Wave: Represents atrial depolarization and should precede each QRS complex.

  • QRS Complex: Represents ventricular depolarization and ventricular contraction.

  • Artifacts: Excessive hair can cause wandering baselines. Pacing spikes indicate that a pacemaker is firing.

• Medical Scopes: A Proctoscope is an endoscope used to view the rectum/anus.

• Skeletal Muscle Testing: Electromyography is the process of measuring electrical activity in a muscle as a result of nerve conduction.

• Vision Testing: The Ishihara test is an ophthalmological exam used to detect color blindness.

Laboratory Procedures and Phlebotomy

• Phlebotomy:

  • Cleaning: $70\%\,\text{isopropyl alcohol}$ is used to disinfect the site.

  • Rule of Two: A technician should only attempt to stick a patient twice in the same visit.

  • Complications: The most common complication of venipuncture is a bruise (hematoma).

  • Elderly Patients: Drawing blood may be difficult because veins are more prone to roll and skin/vessels are weaker.

• Clinical Science:

  • RBCs (Red Blood Cells): Total lifespan is approximately $120\,\text{days}$.

  • HbA1c: The American Diabetes Association recommends testing every $3-6\,\text{months}$ to monitor sugar levels.

  • Strep Screening: Specimens are collected from the throat.

  • Bleeding Time: A test measuring platelet function via a small incision in the arm.

• Microscopy: A monocular microscope has one eyepiece ($1$).

• CLIA ‘88: Administered by the Centers for Medicare and Medicaid Services (CMS). For moderately complex tests, CLIA mandates a clinical consultant with a minimum of a doctoral degree.

Insurance, Billing, and Financial Management

• Insurance Types:

  • Blue Cross: Originally set up to pay for hospital expenses.

  • Medicare: Pays $80\%$ of the approved bill amount once the deductible is met. If a 65+ employee works at a company with 20+ employees, the group plan is billed as primary and Medicare as secondary.

  • Medigap: Private insurance designed to supplement Medicare.

  • Managed Care: To generate a referral, the patient must see a PCP, who generates the referral, and the MA must verify eligibility.

• Reimbursement Models:     Diagnosis-Related Groups (DRGs): Used to hold down unnecessary costs by paying providers a fixed amount.     Accountable Care Organization (ACO): Groups of providers who come together voluntarily to give coordinated high-quality care to Medicare patients.     Prospective Payment System: A method where Medicare payment is based on a predetermined, fixed amount.

• Patient Accounts and Collections:

  • Truth in Lending Act (TILA): Requires disclosure of finance charges if paying in more than four ($4$) installments.

  • Collection Agencies: Often charge a percentage of the bill for their services.

  • Communication: In collection letters, avoid antagonistic words such as ‘ignored’.

  • Banking: The bank is referred to as the Drawee. To calculate a checkbook balance: $\text{Bank Balance} + \text{Deposits in Transit} - \text{Outstanding Checks}$. (e.g., $10345 <a target="_blank" rel="noopener noreferrer nofollow" class="link" href="tel:+ 2290 - 7650" data-prevent-progress="true">+ 2290 - 7650</a> = 4985$).

Pharmacology and Therapeutic Interventions

• Drug Classifications:

  • Ortho-Novum: Classified as a contraceptive.

• Infection Control:

  • Viral Conjunctivitis: Incubation period is approximately $24\,\text{hours}$ to several days.

  • Reservoir: The place where conditions are ripe for pathogens to replicate.

  • Needle Safety: Needles should never be recapped or broken; they must be placed in a puncture-proof biohazard container. The risk of Hepatitis C after a needlestick is between $1-2\%$.

  • Autoclave: Operates at $15-30\,\text{psi}$ at temperatures between $250-270^{\circ}F$.

• Injection Standards:

  • Intramuscular (IM): $21-23\,g$ needle, $1-1.5\,inch$ length, inserted at a $90^{\circ}$ angle.

  • Subcutaneous (SQ): $25\,g$ needle, $5/8\,inch$ length, inserted at a $45^{\circ}$ angle.

  • Intradermal (ID): $27\,g$ needle, $3/8-1/2\,inch$ length, inserted at a $10-15^{\circ}$ angle.

• Nutrition: Fats contain the most calories per gram ($9\,kcal/g$).