Certification Exam

Medicare Part A

(Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B

(Medical Insurance) Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Advance Beneficiary Notice (ABN)

(Waiver of liability) a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.

Truth in Lending Act of 1968 (Regulation Z)

1968, United States federal law designed to promote the informed use of consumer credit, by requiring disclosures about its terms and cost to standardize the manner in which costs associated with borrowing are calculated and disclosed.

What is the difference between a felony and a misdemeanor

A crime is a felony if it is punishable by imprisonment in a state prison or penitentiary. A misdemeanor is generally a crime that is punishable for a year or less in prison, or only in a county or local jail.

Managed care organizations (MCOs)

A healthcare provider whose goal it is to provide appropriate, cost-effective medical treatment.

Government plans

A plan established or maintained for its employees by the Government of the United States, by the government of any State or political subdivision

What is Medicaid

A program created by the federal government, but administered by the state, to provide payment for medical services for low-income citizens.

Prior authorization

A requirement that your physician obtain approval from your health insurance plan to prescribe a specific medication for you.

Locum tenens (tenant)

A temporary substitute, especially for a doctor; A doctor who provides care where it's needed most

Preferred Provider Organization (PPO)

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan's network.

Aging of accounts

An accounts receivable aging is a report that lists unpaid customer invoices and unused credit memos by date ranges

00100-01999

Anesthesia 1st category/thing done before surgery

p1-p6

Anesthesia Physical Status Modifiers Puts you to sleep

0001F-9007F

Category II Codes *uck II codes

1p-8p

Category II Modifiers 2nd part of code

0042T-0468T

Category III Codes T Three after 0s

P00-P96

Certain conditions originating in the perinatal period Perinatal

A00-B99

Certain infectious and parasitic diseases ABnormal disease

Commercial plans

Commercial health insurance is a type of health insurance that covers medical expenses and disability income for the insured.

Q00-Q99

Congenital malformations, deformations and chromosomal abnormalities Q allele

Violation of scope of practice can result in

Denial of eligibility for the CMA (AAMA) Exam, Scores invalidated, scores withheld, or scores recalled, Probation, Reprimand, Temporary revocation of the CMA (AAMA) credential, Permanent revocation of the CMA (AAMA) credential

Death and Dying Stages

Denial, Anger, Bargaining, Depression, Acceptance

D50-D89

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism DB(8)

I00-I99

Diseases of the circulatory system Intrabody circulation

K00-K95

Diseases of the digestive system KAOpectate

H60-H95

Diseases of the ear and mastoid process Hearing loss after 60

H00-H59

Diseases of the eye and adnexa (the parts adjoining an organ) Hit in the eye

N00-N99

Diseases of the genitourinary system Nads

M00-M99

Diseases of the musculoskeletal system and connective tissue Muscles

G00-G99

Diseases of the nervous system Ganglia

J00-J99

Diseases of the respiratory system Just breathe

L00-L99

Diseases of the skin and subcutaneous tissue Lesion on skin

Defense mechanisms

Eating, drugs

E00-E89

Endocrine, nutritional and metabolic diseases

99201-99499

Evaluation and Management Services Boring must be last

V00-Y99

External causes of morbidity Very Overweight

Z00-Z99

Factors influencing health status and contact with health services Zika

Medicare Part C (Medicare Advantage Plans) include:

Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, Medicare Medical, Savings Account Plans

S00-T88

Injury, poisoning and certain other consequences of external causes STuff

0001U-0003U

Laboratory Analyses ( 1 unit of insulin)

Health maintenance organization (HMO)

Limits coverage to care from doctors who work for or contract with the HMO

Controlled Substances Act of 1970

Made illegal the manufacture, importation, possession, use and distribution of certain narcotics, stimulants, depressants, hallucinogens, anabolic steroids and other chemicals. Established the drug schedules (I-V)

90281-99607

Medicine Services and Procedures I did 9 prescriptions

F01-F99

Mental, Behavioral and Neurodevelopmental disorders iDubbz

0001M-0009M

Multianalyte Assay M

C00-D49

Neoplasms Cancer/Damage to tissues

Part D adds prescription drug coverage to:

Original Medicare, Some Medicare Cost Plans, Some Medicare Private-Fee-for-Service Plans, Medicare Medical Savings Account Plans

80047-89398

Pathology and Laboratory Procedures I drew 8 patients for lab

Health Information Technology for Economic and Clinical Health (HITECH) Act

Patient's right to inspect, amend, and restrict access to his/her medical record

O00-O9A

Pregnancy, childbirth and the puerperium Oopherectomy

22-99

Provider Services and Ambulatory Service Center Modifiers 22 when I started Ambulatory work

70010-79999

Radiology Procedures I was 7 when I needed an xray

10021-69990

Surgery Next after anesthesia

R00-R99

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Random stuff

Public Health and Welfare Disclosure

The Privacy Rule permits covered entities to disclose protected health information, without authorization, to public health authorities who are legally authorized to receive such reports for the purpose of preventing or controlling disease, injury, or disability.

Respondeat superior

The action against the employer is based on the theory of vicarious liability, wherein a party can be held liable for the acts of a different party. The employer-employee relationship is the most common area _______________ is applied, but the doctrine is also used in the agency relationship.

Medicare

The federal health insurance program for people who are 65 or older, certain younger people with disabilities

Res ipsa loquitor

The principle that the occurrence of an accident implies negligence.

Precertification

The process by which a patient is pre-approved for coverage of a specific medical procedure or prescription drug.

TRICARE

__________ provided to active duty members and most retired military personnel and their dependents.

People qualify for Medicaid by __________.

meeting federal income and asset standards, by fitting into a specified eligibility

Accounts payable

money owed by a company to its creditors

Accounts receivable

money owed to a company by its debtors

Bundled payment

programs in which providers are paid a single fee for a set of evidenced-based services related to a diagnosis

Asset

property owned by a person or company, regarded as having value and available to meet debts, commitments, or legacies

Uniform Anatomical Gift Act _______________.

was passed in the US in 1968 and has since been revised in 1987 and in 2006. The Act sets a regulatory framework for the donation of organs, tissues, and other human body parts in the US. The UAGA helps regulate body donations to science, medicine, and education.

Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)

___________ provides coverage to the spouse or widow(er) and to the children of a Veteran who: is rated permanently and totally disabled due to a service-connected disability, was rated permanently and totally disabled due to a service-connected condition at the time of death, died of a service-connected disability, died on active duty and the dependents are not otherwise eligible for Department of Defense TRICARE benefits

Relative Value Units (RVU)

a measure of value used in the United States Medicare reimbursement formula for physician services

neoplasm

a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer

Diagnosis Related Groups (DRG)

a statistical system of classifying any inpatient stay into groups for the purposes of payment

Liabilities

a thing for which someone is responsible, especially a debt or financial obligation

Subpoena duces tecum

a writ ordering a person to attend a court and bring relevant documents

Subpoena

a writ ordering a person to attend a court.

credit

an entry recording a sum received, listed on the right-hand side or column of an account

debit

an entry recording an amount owed, listed on the left-hand side or column of an account

Upcoding

assign an inaccurate billing code to (a medical procedure or treatment) to increase reimbursement