Combo NCCT study guide

Human Exposure

"Contact w/ blood or other body fluids to which universal precautions apply through percutaneous inoculation, or contact w/ an open wound, non-intact skin, or mucous membranes during the perfomance of normal duties" this definition (found in the Federal Registration) applies to.....

Serologic

.......testing should be made available by the employer to all workers who maybe concerned they've been infected w/ HIV through an occupational exposure.

Pre Certification

.....is a method used for determining whether a particular service/ procedure is covered under a pts policy?

Ulnar

1 of the arteries that supplies the hand and forearm is.....

Costs of FFS

1. Health insurance premiums 2. Yearly deductible 3. Co-insurance

Third

A newsletter that weighs less than 1 lb is considered______class mail.

Time Limit

A notice of insurance claim or proof of loss must be filed w/in a designated....or it can be denied.

Outpatient

A pt receiving ambulatory care at a hospital or other health facility w/o being admitted as a bed pt is called a(n)....?

Extended care Facility

A skilled nursing facility for pts receiving specialized care after discharge from a hospital is called.....?

Exposure Incident

A specific eye, mouth, other mucous membrane, non intact skin, or parenteral contact w/ blood, or other potentially infectious materials that results from the performance of an employees duties is called.....

Benefits

A sum or money provided in an insurance policy, payable for covered services is called.....?

Health Maintenance Organization (HMO)

A type of managed care plan.

Referral

A(n).....report includes info relating to the pts main reason for scheduling an appointment to see the physician.

Insurance cap

AKA: stop loss Limits amount of money paid out of pocket in any one year

Fee for service (FFS)

AKA: traditional, indemnity Insurance company pays for the services provided to the individuals covered by the policy

an EPA

All spills of blood contaminated fluids should be promptly cleaned up using.....approved germacide, or a 1:10 solution of household bleach.

Co-payments

Amount paid at the time of service which is the responsibility of the patient.

Patient ledger card

An accounting form on which professional service descriptions, charges, payments, adjustments, and current balance are posted chronologically.

Deductible

An amount the insured must pay before policy benefits begin is called...?

Partial Disability

An injury that prevents a worker from performing 1 or more of the regular functions of his job would be known as....?

Health Maintenance Organization

An organization that offers health insurance at a fixed monthly premium w/ little or no deductible and works through a primary care provider is called....?

Third-party payer

Any organization that provides payment for specified coverages provided under the health plan

Checkbook

As part of the office bookkeeping procedures, the physicians bank statement should be reconciled w/ the....?

Indemnities

Benefits that are made in the form of cash payments are known as....?

First

Business or hand written mail that weighs less than 11 oz is known as______class mail.

Clean claims

Claims that can be processed for payment quickly without being returned.

Managed care

Complex health care system in which physicians, hospitals, and other health care professionals organize an interrelated system of people/facilities that communicate with one another and work together as a unit - or network.

Unreliable

Concerning ECG's for irregular rhythms any method of rate calculation that depends on intervals b/w complexes is....

Group insurance

Contract between insurance co. and employer that covers eligible employees. Generally least expensive.

CPT

E/M codes are located in the .....manual.

Pleural Effusion

Escape of fluid into the thoracic cavity is called...

Waiver

Exception given to providers stating they don't have to comply with ASCA deadline for compliance.

Social Security

FICA provides benefits for....

Mono-spaced fonts

Font type where characters take up equal space. Ex- Courier 12pt font.

Microbiological Agents

General infection control procedures are designed to prevent transmission of a wide range of....and to provide a wide margin of safety in the varied situations encountered in the health care environment.

Catastrophic

Health insurance that provides protection against the high cost of treating severe or lengthy illnesses or disabilities is called....?

2

How many hematocrit tubes should be collected from the pt?

Participating provider (PAR)

In contractual agreement with insurance co. to accept amount paid by insurance co. as payment in full.

Comprehensive

In insurance, greater coverage of diseases or an accident, and greater indemnity payment in comparison w/ a limited clause is called.....?

Third-party administrator (TPAs)

Individual or org who processes claims and performs other contractual admin services

Decubitus Ulcers

Infected pressure sores on the skin are called........

Usual, customary, and reasonable

Insurance plans that pay a physicians full charge if it doesnt exceed his normal charge or doenst exceed the amount normally charged for the service is called...?

Managaed care plan

Involves the financing, managing, and delivery of health care services and comprises a group of providers who share the financial risk of the plan or who have an incentive to deliver cost-effective, but quality, service. PPO, HMO, POS.

Unethical

It is______to deny treatment to an HIV infected patients.

Timeline for filing BCBS claims

Just be filed within 365 days following last date of service

Res Judicata

Latin for "things decided"- that is, a matter already decided by judicial authority is called?

Res Gestae

Latin for "things done; deeds"; the facts and circumstances attendant to the act in question would be called?

Employee Retirement Income Security Act 1974

Law that governs self-insured plans.

Medicaid

Low income pts can be covered by what type of insurance?

American Standard Code for Infomation Interchange (ASCII)

Most common character code used in OCR.

Encounter form

Multipurpose billing form that can be customized and preprinted for a particular specialty. aka superbill, routing form, or patient service slip.

RBC's

One of the vital functions of the long bones is the formation of....

Subscriber

One who belongs to a group insurance plan is called....?

Fourth

Parcel Post or.....class mail is used for bound printed material, film, and sound recordings.

Hematocrit

Performing a ........as part of a CBC determines the ratio of the volume packed RBC's to that of a whole blood.

Preferred provider organization (PPO)

Policy holders can go to the physicians included in the PPO network at reduced prices. If going to a physician out of the PPO network prices are higher.

Fiscal intermediary

Processes claims. Commercial insurer or agent(Blue cross) that contracts with DHHS/CMS to process/administer Part A Medicare claims for reimbursement.

Preferred provider organization (PPO)

Provide a high level of health care. Group of physicians work under PPO to provide medical services at a discount to enrolled of the PPO.

Administrative services organization (ASOs)

Provides a wide variety of health insurance admin services for orgs that have chosen to self-fund their health benefits

Occupational Exposure

Reasonable anticipated skin, eye, mucous membrane, or parenteral contact w/ blood, or other potentially infectious materials that may result from the performance of an employees duties is called.....

Optical character recognition (OCR)

Recognition of printed or written text characters by a computer.

Lifetime maximum cap

Set amount of which is covered. Once exceeded services are no longer paid by insurer.

Pro-coagulants

Sodium Citrate is an anticoagulant of choice for coagulation studies because it protects certain of the.......

Primary care physician (PCP)

Specific provider who oversees the patient's total health care treatment.

W-4

The # on the Employees Withholding Exemption Certificate is....

P

The .......wave represents atrial depolarization.

Jejunum

The 2nd portion of the small intestine is called the....

Sinus Arrest

The absence of 1 or more complete cardiac cycles where the rhythm is interrupted is referred to as......

Left arm, Right arm

The combination of sensors/ electrodes used for lead # 1 is.......

Self-insured/self-insurance

The employer is responsible for the employee's cost of medical services-not insurance co.

Sugar

The fresh-fractional urine specimen is used to test urine for.....

Enrollees

The individuals who have their health care and benefits coordinated and arranged by a network.

Pleurisy

The inflammation of the pleura is called....

Intercostal

The major artery that supplies the thorax is called the.....

Dorsiflexion

The medical term for bending backward is.....

Cell

The medical term for the basic unit of body structure is.....

Gavage

The medical term for tube feeding is....

Res ipsa Loquitur

The presumption or inference of negligence when an accident is otherwise unable to be explained in terms of ordinary and known experience is called?

Blood Films

The primary anticoagulant EDTA removes calcium by forming insoluble/ un-ionized calcium slats. It has an advantage of preventing platelet clumping and the formation of artifacts, therefore, good for the preparation of ......

Sterilization

The process of killing all microorganisms in a certain area is....

Current Procedure Terminology

The reference procedural code book that uses a #ing system developed by the AMA is called....?

AMA Code of Ethics

The statement "A physician shall respect the law" is part of the....?

Mouth/ the ostium uteri

The word element stomatis means.....

Pink

The.......pages of the Physicians Desk Reference is where a MA would be able to locate a medication by brand or generic name.

Nasopharynx and tosillar area

To obtain a specimen for a throat culture the.....must be swabbed.

Point-of-service plan (POS)

Type of managed care plan.

CMS-1500 (form)

Universal health insurance claim form that has OCR scannable red ink on the front and instructions on the back. Top portion(blocks 1-13) is for pt info and bottom portion(blocks 14-33) is for physician/supplier info.

EDTA added

What type of blood sample will be needed to perform a hemoglobin test?

Co insurance

When a pt has health insurance, the % of covered services that is the responsibility of the pt to pay is known as....?

Red

When collecting blood for a cholesterol test use a......top.

Glass

When preparing a blood smear, the spreader slide must be made of.....

Inner

When the right atrium contracts it forces blood through the tricuspid valve into the......ventricle.

Red-top

When using an evacuated tube for collection of electrolytes use a.....

Air Dry

When you pull the 2nd slide from the 1st slide, let them.....

CPT

Which codes can modifiers be added to, to indicate that a procedure/ service has been altered in some way?

Manslaughter

Which of these generally results from an act of carelessness, w/o an attempt to harm?

Edges should be feathered

Which of these is crucial in making a blood smear for a differential blood count?

Shifts up or down from the baseline

While the duration of the ST segment isnt generally of clinical significance, its an exceedingly important portion of the ECG because of......

15-20sec

You should wash your hand for approximately.....

Explanation of benefits (EOB)

aka remittance notice. Doc that details how the claim was adjudicated. Includes pt info, date of service, payments, or reasons for nonpayment.