NHA CMAA flashcards
NHA CMAA · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Medicare Part A
- Medicare Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services; most people do not pay a monthly premium for it.
- Medicare Part B
- Medicare Part B helps cover medically necessary outpatient services, physician visits, preventive services, and durable medical equipment; it usually requires a monthly premium based on income.
- Birthday rule
- For dependent children covered by two parents' plans, the plan of the parent whose birthday occurs earlier in the calendar year is generally primary.
- Copayment
- A copayment is a fixed dollar amount the patient pays at the time of service, such as a $20 office visit fee, separate from deductible and coinsurance.
- Coinsurance
- Coinsurance is the percentage of allowed charges the patient pays after meeting the deductible; for example, 20% coinsurance means the patient pays 20%.
- CMS-1500 form
- The CMS-1500 is the standard paper claim form used to bill professional medical services, such as physician office visits, to Medicare and many other insurers.
- CPT codes
- CPT codes are five-character procedure codes used to report medical, surgical, and diagnostic services for billing and reimbursement.
- ICD-10-CM codes
- ICD-10-CM codes report diagnoses and reasons for visits; they support medical necessity and are required on professional claims.
- Insurance verification
- Insurance verification confirms a patient's eligibility, benefits, copayment, deductible, and referral or authorization requirements before the visit to prevent claim denials.
- Par level
- A par level is the minimum supply quantity set for an item; when stock falls to that level, staff reorder to avoid running out.
- No-show policy
- A no-show policy states the fee or consequence for missed appointments without notice and must be applied consistently and according to state law.
- Telephone triage
- Telephone triage is the process of assessing a caller's needs by phone; nonclinical staff should route clinical questions to licensed staff and emergencies to 911.
- Recall system
- A recall system reminds patients when preventive care or follow-up is due, using tickler files, postcards, phone calls, or electronic health record alerts.
- Check-in process
- Check-in typically includes verifying identity, updating demographics and insurance, collecting copayment, obtaining required signatures, and directing the patient to the waiting area.
- Check-out process
- Check-out typically includes scheduling follow-up, collecting balances, providing visit summaries, arranging referrals, and confirming the patient understands next steps.
- Release of information
- Release of medical information requires a valid signed authorization unless the disclosure is for treatment, payment, operations, or otherwise permitted by law.
- Active listening
- Active listening means giving full attention, paraphrasing the speaker's message, asking clarifying questions, and reflecting feelings to confirm understanding.
- Teach-back method
- Teach-back asks patients to explain information in their own words so staff can confirm understanding and correct misunderstandings before the patient leaves.
- Qualified interpreter
- A qualified medical interpreter is a trained individual who conveys information accurately between patient and staff; family members, especially minors, should not routinely interpret.
- SBAR handoff
- SBAR stands for Situation, Background, Assessment, and Recommendation; it is a structured communication tool used for clear patient handoffs.
- Minimum necessary
- The HIPAA minimum necessary standard requires limiting protected health information use or disclosure to the amount reasonably needed for the intended purpose.
- Plain language
- Plain language uses everyday words, short sentences, and focused key points so patients with varied health literacy can understand instructions.
- Professional boundaries
- Professional boundaries are limits that keep the medical assistant-patient relationship therapeutic, such as avoiding personal social media contact, romantic involvement, and inappropriate gifts.
- Conflict resolution
- Conflict resolution involves addressing issues privately, focusing on behavior rather than personality, using I-statements, and seeking a shared solution.
- Medical record ownership
- The physical or electronic medical record generally belongs to the healthcare facility or provider, but the patient has a legal right to access and obtain copies.
- Addendum
- An addendum is a dated addition to a medical record that corrects or supplements prior documentation without deleting or altering the original entry.
- Audit trail
- An audit trail is a security record that tracks who accessed or changed electronic health information and when, supporting accountability and breach investigations.
- Breach notification
- Under HIPAA, a covered entity generally must notify affected individuals within 60 days after discovering a breach of unsecured protected health information.
- Valid HIPAA authorization
- A valid HIPAA authorization identifies the patient, information to release, recipient, purpose, expiration date or event, and signature, and informs the patient of the right to revoke.
- Minimum necessary exception
- The minimum necessary standard generally does not apply to disclosures for treatment, to the patient, or when the patient signs a valid authorization.
- Emancipated minor
- An emancipated minor is a person under 18 with legal adult status, such as through marriage or court order, and may consent to their own medical care.
- Subpoena request
- When a subpoena requests records, staff should verify its validity, consult legal or risk management, and release only the specific information legally required.