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
