NHA CCMA Exam Questions and Answers
Complete Solution
Medical assistants often patients before the provider visit. - Screen
- duties within the scope of practice for an MA –
- Educating patients on how to take their medication
- Health promotion of the patient
3. EKG
Vitals Performing urinalysis Performing a throat culture 7. Patient education
- duties outside the scope of practice for an MA –
- Diagnosing patients
- Administering narcotics
- Interpreting laboratory results
- Pathogenic identification
- Performing an Arterial Blood Gas (ABG)
- Prescribing medications
- examples of Allied health services - 1. Phlebotomy 2. Physical Therapy
- examples of where MA's provide care - 1. Hospital 2. Ambulatory Care center
- Home health agency 4. Hospice
Dep't of labor predicts that the MA field will (grow/drop) 23% from 214 to 2024. This is much (faster/slower) than normal. - grow; faster
- additional certifications for MA's - 1. CPT (Certified Phlebotomy Tech) 2. CET (Certified
EKG Tech) CBCS (Certified Billing & Coding Specialist) CEHRS (Certified Electronic Health Records Specialist)
Health case licensure is regulated by (state, federal, international) statutes. - State
Medical assistants are required to be: 1 / 3
Health care is the organization of individuals, establishments, and resources to deliver health care services and meet the needs of specific populations. - Delivery
- licensed b. certified c. both
- neither - d. neither
No state requires MA licensure (though it may be required for extended services such as X-ray). Certification is generally optional, but some states may require it.)
What is the payment model in health care? - It issues a single bundled payment to providers or health care facilities for all services rendered to treat a given condition or provide a given treatment.
Groups of physicians, hospitals, and other health care providers come together voluntarily to provide coordinated high-quality care to their *Medicare* patients. When succeeding in delivering high-quality care and spending health dollars wisely, they will share in the savings it achieves for the Medicare program. - Accountable Care Organizations (ACOs)
In this payment model, patients are assigned a per-member, per-month payment based on their age race, sex, lifestyle, medical Hx, and benefit design. Payment rates are tied to expected use regardless of how often the patient visits. - Capitation (partial or full)
A fixed dollar amount paid annually for all care. Participating providers can determine how money is spent. This model limits the level and the rate of increase of health care cost. There is typically a quality component as well. - Global budget
This plan contracts with a medical center or group of providers to provide preventative and acute care for the insured person. They generally require referrals to specialists, as well as precertification and preauthorization for hospital admissions, outpatient procedures, and treatments. - Health Maintenance Organization (HMO)
In this care delivery model, a primary care provider (PCP) coordinates treatment to make sure patients receive the required care when and where they need it., and in a way they can understand. - Patient-centered Medical Home (PCMH)
This reimbursement model compensates providers only if they meet certain measures for quality and efficiency. Generating quality benchmark measures connects provider reimbursement directly to the quality of care they provide. - Pay-for-performance
What is an ancillary service? - An ancillary service meets a specific medical need for a specific population.e.g. Urgent care, lab, imaging 2 / 3
- examples of alternative therapies - 1. Acupuncture
- Chiropractic
- Dietary supplements
A form provided to the patient when the provider believes Medicare will probably not pay for services received. - Advance beneficiary notice (ABN)
The maximum amount a third-party payer will pay for a particular procedure or service. - Allowed Amount
An amount of money that is paid at the time of medical service - Copayment
A specific amount of money a patient must pay out of pocket before the insurance begins paying. - Deductible
A statement from the insurance carrier detailing what was paid, denied, or reduced in payment. Also contains info about amounts applied to the deductible, coinsurance, and allowed amounts. - Explanation of Benefits (EOB)
Providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer. - Participating Provider (PAR)
Type of insurance which generally covers patients who are 65+ and/or disabled. - Medicare - Part A (Hospitalization) & Part B (Routine Visits)
Type of insurance which authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government. - Tricare
Type of insurance which covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities. - CHAMPVA
Umbrella term for type of insurance plan which provides healthcare in return for preset scheduled patients and coordinated care through a defined network of providers and hospitals. - Managed Care
Type of insurance which protects wage earners against the loss of wages and the cost of medical care resulting from an occupational accident/disease as long as the employee is not proven negligent. - Workers' Compensation
This type of insurance is flexible and allows pts to go directly to specialists without being referred. Pts can see any provider, but provider in-network usually cost less. - Preferred Provider Organization (PPO)
What is the most commonly-used health insurance claim form? - CMS-1500
What are the three sections of the CMS-1500 form? - - Section 1: Carrier Block
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