NHA CCMA ADVANCED REAL Exam 2022/2023 Graded A+

Advance Beneficiary Notice (ABN) - ANSWER A form provided to the patient when the provider believes Medicare will probably not pay for services received Allowed Amount - ANSWER The maximum amount a third-party payer w ...

Advance Beneficiary Notice (ABN) - ANSWER A form provided to the patient when the provider believes Medicare will probably not pay for services received Allowed Amount - ANSWER The maximum amount a third-party payer will pay for a particular procedure or service Copayment - ANSWER a small fixed fee paid by the patient at the time of an office visit Coinsurance - ANSWER a provision under which both the insured and the insurer share the covered losses, typically 80:20 deductible - ANSWER specific amount of money a patient must pay out of pocket before the insurance carrier begins paying Explanation of Benefits - ANSWER a form created by the insurance company to explain what charges were covered, denied, or need more documentation based on the claims submitted by the physician's office Participating provider (PAR) - ANSWER Providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer Medicare - ANSWER A federal program of health insurance for persons 65 years of age and older by Part A (hospitalization) or Part B (routine medical office visits) Tricare - ANSWER U.S. government health insurance plan for all military personnel CHAMPVA - ANSWER covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities Medicaid - ANSWER provides health insurance to the medically indigent population through a cost-sharing program between federal and state governments for those who meet specific eligibility criteria Managed Care - ANSWER is an umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals CMS-1500 form - ANSWER Standard insurance form used by all government and most commercial insurance payers. - 33 blocks - divided into three section CMS-1500 Section 1 - ANSWER Carrier Block: contains the address of the insurance carrier and is located at the top of the form CMS-1500 Section 2 - ANSWER Patient/insured section: contains information about the patient or insured; includes boxes 1-13 CMS-1500 Section 3 - ANSWER Physician/Supplier Section: contains information about the physician or supplier: boxes 14-33 Supine Position - ANSWER Dorsal Recumbent Position - ANSWER Sims' Position - ANSWER Knee-elbow position - ANSWER Fowler's Position - ANSWER Lithotomy Position - ANSWER Epidural Injection - ANSWER epidural space of the spine Intra-arterial Injection - ANSWER injection into an artery (to break up clots) Intra-articular Injection - ANSWER injection into joint space Intradermal Injection - ANSWER Skin of the upper chest, forearms, upper pack. 5-15º angle intramuscular injection - ANSWER deltoid, vastus lateralis, ventrogluteal muscles Intraosseous Injection - ANSWER Bone marrow Intraperitoneal Injection - ANSWER within the peritoneal cavity Intrapleural Injection - ANSWER pleural space (lungs) Intrathecal Injection - ANSWER Subarachnoid space (brain) Fat soluble vitamins - ANSWER A, D, E, K Water Soluble vitamins - ANSWER B1, B2, B3, B6, Folate, B12, Pantothenic acid, biotin, C. Erikson's stages of psychosocial development - ANSWER 1. trust vs. mistrust 2. autonomy vs. shame and doubt 3. initiative vs. guilt 4. industry vs. inferiority 5. identity vs. role confusion 6. intimacy vs. isolation 7. generativity vs. stagnation 8. integrity vs. despair Grief Cycle - ANSWER denial, anger, bargaining, depression, acceptance Sagittal Plane - ANSWER divides body into left and right Coronal Plane - ANSWER divides body into front and back Transverse Plane - ANSWER horizontal division of the body into upper and lower portions Right Upper Quadrant (RUQ) - ANSWER Right lobe of liver, gallbladder, right kidney, portions of stomach, small and large intestine Left Upper Quadrant (LUQ) - ANSWER Left lobe of liver, stomach, pancreas, left kidney, spleen, portions of large intestine Right Lower Quadrant (RLQ) - ANSWER cecum, appendix, right ovary and tube, right ureter, right spermatic cord Left Lower Quadrant (LLQ) - ANSWER contains parts of the small and large intestines, left ovary, left fallopian tube, left ureter Epigastric Region - ANSWER located above the stomach Umbilical Region - ANSWER hypogastric region - ANSWER Right Hypochondriac Region - ANSWER right lateral region just below the ribs Left Hypochondriac Region - ANSWER left upper region below the rib cartilage Right lumbar Region - ANSWER right middle region near the waist Left Lumbar Region - ANSWER Right Iliac Region - ANSWER Left Iliac Region - ANSWER Chain of Infection - ANSWER infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host Wheezing - ANSWER Difficult breathing with a high-pitched whistling or sighing sound during expiration Rales - ANSWER Crackles; wet crackling noise in lungs Rhonchi - ANSWER loud rumbling sounds heard on auscultation of bronchi obstructed by sputum kg -> lbs - ANSWER 1 kg = 2.2 lbs Trendelenburg position - ANSWER Intradermal needle gauge - ANSWER 27-28 Intradermal Needle Length - ANSWER 3/8 in Subcutaneous Needle Gauge - ANSWER 25-26 Subcutaneous Needle Length - ANSWER 1/2 to 5/8 inch Intramuscular Needle gauge - ANSWER 20-23 Intramuscular Needle Length - ANSWER 1-3 inches Smaller - ANSWER the higher the needle gauge number, the ___ the diameter Precertification - ANSWER A process required by some insurance carriers in which the provider must prove medical necessity before performing a procedure. EMR - ANSWER electronic medical record suffix - ANSWER word ending prefix - ANSWER a syllable or word that comes before a root word to change its meaning Pancreas - ANSWER digestion and endocrine Thymus - ANSWER endocrine and immune Upcoding - ANSWER A fraudulent practice in which provider services are billed for higher procedural codes than were actually performed, resulting in a higher payment.