AMT CMAS cheat sheet

Scheduling rule: fixed-interval appointments assign equal time slots; wave scheduling books several patients at the start of each hour to absorb arrival variance.

Patient registration minimum data set: legal name, date of birth, sex, address, phone, insurance carrier and member ID, guarantor, and emergency contact.

Medical record retention is set by state law and payer contract; federal Medicare conditions generally require 5 years, and many states require 7 years past last encounter (verify state statute).

Release of protected health information requires a valid authorization containing purpose, specific data elements, expiration date or event, and patient signature.

The daily encounter form (superbill) captures date, provider, diagnoses, procedures, and charges, and is the source document for charge entry.

Accounts receivable aging buckets are typically 0-30, 31-60, 61-90, and 90+ days; balances over 90 days generally signal collection follow-up.

A patient's legal name change should be documented with a supporting legal document, with the prior name retained in the record as an alias.

Appointment reminder lead time of 24-48 hours reduces no-show rates; no-show policies must be disclosed in writing before fees are assessed.

Word building: prefix + root + suffix; the suffix usually determines the class of the term (for example -itis = inflammation, -ectomy = surgical removal).

Directional prefixes: hyper- above/excessive, hypo- below/deficient, inter- between, intra- within, sub- under, supra- above.

Common roots: cardi/o heart, hepat/o liver, nephr/o kidney, oste/o bone, derm/o skin, neur/o nerve, pulmon/o lung, gastr/o stomach.

SOAP note structure: Subjective (patient-reported), Objective (exam findings and test results), Assessment (diagnosis or impression), Plan (treatment and follow-up).

Charting rule: document only what was personally performed or observed; late entries are added with the current date, time, and a notation of the late entry.

Abbreviation safety: the Joint Commission's do-not-use list includes U (write unit), IU (write international unit), QD/QOD, and trailing zeros (write 1 mg, not 1.0 mg).

Surgical suffix -plasty means repair or reconstruction; -pexy means fixation; -ostomy means creating a mouth or opening; -otomy means cutting into.

Plural rules: words ending in -a take -ae (vertebra to vertebrae), -is takes -es (diagnosis to diagnoses), -um takes -a (datum to data).

Clean claim rate is the percentage of claims accepted on first submission without edits or denials; it is a core revenue-cycle performance metric.

Charge entry rule: each service line links a CPT/HCPCS code, an ICD-10-CM code, units, and a fee; the fee schedule amount is not the same as the allowed amount.

Payment posting must reconcile the billed charge, contractual adjustment, allowed amount, patient responsibility, and payer payment so the line balances to zero.

Coordination of benefits: the primary payer pays first; the secondary payer considers the primary's payment and adjustment before paying its share.

Timely filing limits are set by payer contract and can be as short as 90 days for commercial plans; Medicare generally allows 12 months from the date of service.

Denial management categories: registration/eligibility, coding, authorization, medical necessity, and timely filing; each denial reason maps to a distinct corrective action.

Refund rule: when a payer or patient overpays, the overpayment is refunded or offset per contract; Medicare overpayments must be reported and returned within 60 days of identification.

Accounts receivable days (days in A/R) = total A/R divided by average daily charges; lower values indicate faster collection.

ICD-10-CM structure: 3-7 characters; the first character is the chapter letter or number, and later characters add body site, laterality, encounter type, and sequela detail.

Coding convention: 'code first' denotes an underlying etiology that must be sequenced before the manifestation; 'use additional code' denotes a required secondary code.

ICD-10-CM guidelines: code to the highest level of documented specificity; do not code a diagnosis documented only as 'probable', 'suspected', or 'rule out' in the outpatient setting.

CPT modifier 25 applies to a significant, separately identifiable evaluation and management service on the same day as a procedure; modifier 59 identifies a distinct procedural service.

E/M level selection uses medical decision making or total time on the date of the encounter, depending on the code set version in effect; both elements are not combined.

HCPCS Level II codes cover supplies, drugs, and equipment (J-codes for injectables, A-codes for supplies, E-codes for durable medical equipment).

Laterality and encounter rules: ICD-10-CM requires right, left, or bilateral designation where the code set provides it, and initial versus subsequent encounter must match the documentation.

National Correct Coding Initiative edits define code pairs that are not separately payable; a modifier may override only when the documentation supports separate services.

Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, and some home health; Part B covers physician services, outpatient care, and durable medical equipment.

Medicare Part C (Medicare Advantage) is a managed care alternative to Original Medicare; Part D covers outpatient prescription drugs.

Medicaid is a joint federal-state program with state-set eligibility and benefits; coverage and billing rules vary by state.

Managed care models: HMO generally requires in-network care and a PCP gatekeeper; PPO permits out-of-network care at higher cost sharing; POS combines features of both.

Cost-sharing terms: deductible is the amount paid before benefits begin; copayment is a fixed dollar amount; coinsurance is a percentage of the allowed amount.

Prior authorization is payer approval obtained before a service; failure to obtain it when required commonly results in a denial that may be appealed.

COBRA allows continuation of group coverage for a limited period after a qualifying event; the qualified beneficiary may be responsible for the full premium.

Explanation of Benefits is not a bill; it shows billed charges, allowed amount, payer payment, and the patient's responsibility.

Scope of practice: a medical assistant performs only tasks permitted by state law and delegated by a supervising clinician; duties vary by state.

Chain of command: unresolved clinical concerns escalate from the clinician to the practice manager and then to the medical director.

Confidentiality applies in all settings, including elevators, waiting rooms, and social media; discussing a patient's information with unauthorized persons is a breach.

Professional boundaries prohibit personal or financial relationships with patients and prohibit accepting gifts that could influence care.

Standard precautions treat all blood and body fluids as potentially infectious; hand hygiene is performed before and after patient contact.

Documentation of a refused test or treatment should record what was offered, the patient's stated reason, and who was notified.

Cultural competence: use a qualified medical interpreter rather than a family member for clinical communication when the patient prefers another language.

Continuing education and credential maintenance (for example CMA (AAMA) recertification) are required to keep certification current.

Active listening techniques include paraphrasing, reflecting feelings, and asking open-ended questions to confirm understanding.

Teach-back method: the patient restates instructions in their own words; this verifies comprehension better than asking 'Do you understand?'

Plain-language rule: avoid jargon and abbreviations with patients; use common words and short sentences, and limit key instructions to a few points.

Nonverbal communication (eye contact, posture, tone) carries meaning alongside spoken words; positioning at eye level reduces perceived intimidation.

Telephone triage documentation records the time, caller identity, reported symptoms, advice given, and the clinician who authorized the advice.

Interpretation services: use a qualified medical interpreter, document the interpreter's name or ID, and avoid using minors as interpreters.

Conflict de-escalation: acknowledge the concern, state the facts neutrally, and offer a concrete next step with a timeframe.

Written communication with patients should be at a reading level the patient can understand and should avoid PHI in unsecured channels such as standard email or text.

HIPAA Privacy Rule permits disclosure of PHI for treatment, payment, and health care operations without authorization; other uses require authorization or a legal exception.

HIPAA Security Rule requires administrative, physical, and technical safeguards for electronic PHI, including access controls and audit trails.

Minimum necessary standard: limit PHI disclosed to the least amount needed for the stated purpose.

The HIPAA breach notification rule generally requires notifying affected individuals within 60 days of discovery of a breach.

Informed consent requires that the patient receive information on risks, benefits, and alternatives and voluntarily agree; the clinician obtains consent, not the assistant.

Mandatory reporting laws require reporting of suspected child abuse, elder abuse, and certain communicable diseases; specific requirements are set by state law.

Advance directives, including living wills and durable power of attorney for health care, state a patient's wishes when the patient cannot speak for themselves.

Ethical principles: autonomy (patient self-determination), beneficence (act for the patient's good), nonmaleficence (do no harm), justice (fairness), and veracity (truthfulness).