STUDY GUIDE FOR EXTERNSHIP ADMIN AND GENERAL (2)

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Monterey Peninsula College *

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130

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Health Science

Date

Dec 6, 2023

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STUDY GUIDE – MEDA 130 – ADMINISTRATIVE AND GENERAL CODING/BILLING What are the differences between CPT and ICD-10-CM codes? How are they structured (categories, subcategories)? What are the differences between new patients and established patients in terms of coding and billing? How is a CPT code determined for an E/M service? What are HCPCS codes used for? What are CPT modifiers - what is their purpose? What is a CMS-1500 form? What information must be included on it? What are common reasons for claim denial or rejection? What are the differences between facility billing and professional billing? What is a fee slip and what is it used for? Describe the billing cycle: HEALTH INSURANCE Who is eligible for coverage through government insurance (Medicare, Medicaid, CHAMPVA, TRICARE)? What are some differences between government and private health insurance? Describe: Health maintenance organization, managed care, IPO, PPO, EPO, POS plans Define: Co-payment, deductible, capitation, fee for service, coinsurance MEDICAL OFFICE ADMINISTRATION What are the different styles of appointment scheduling (wave, stream, modified wave, double-booking, walk-ins, cluster scheduling)? How should a phone be answered in the medical office? How are basic financial procedures (collecting payments, petty cash, pegboard accounting, bank deposits, check writing) performed in a medical office? What kinds of payments should be collected from the patient at the time of service? What is a day sheet? What do CPT codes have to do with patient charges? What should be done if a patient’s check bounces? What are things you should NOT do when trying to collect payment from a patient? What is a written truth-in-lending statement and when is it required?

LAW AND ETHICS What are the roles of the FDA, DEA, OSHA, CMS and HHS in healthcare? Who can give consent for treatment in California? What is a mature minor vs. emancipated minor? Define these ethical principles: autonomy – decisions through competency, ability to act, respect, self-determination beneficence – the action of helping others and doing no harm to others, helping people stay healthy or recover non-maleficence – do no harm confidentiality – keeping medical information private justice – fairness towards other people. Analyze self-behavior and beliefs. Same rules for everyone (even difficult patients); role fidelity – scope of practice veracity – tell the truth Describe these credentials: RN, MD, DO, NP, PA. What is the scope of practice for each credential? What professions must be licensed and why? Who issues health care licenses? What is HIPAA’s privacy rule and security rule? When can patient information be released to third parties? What is an ROI form? Who is legally responsible for the actions of an MA in a medical office? What is a mature minor? What is an emancipated minor? Who can consent for medical care? What are the four D’s of negligence? What is medical malpractice? What are the stages of a trial? What can be done to help prevent lawsuits? MEDICAL DOCUMENTATION Define these abbreviations: SOAP, CC, HPI, ROS, PFSH What elements must be documented for every encounter (office visit)? What must be included in every chart entry? What is an EMR? What is an EHR? How is information organized in the SOMR and POMR systems? PHARMACOLOGY How are new drugs developed, studied and classified? What are the three names of a prescription drug and who assigns them? What are pharmacodynamics and pharmacokinetics? Who decides whether a drug can be sold OTC or requires a prescription? What are the parts of a prescription? Which drugs are scheduled? How are scheduled drugs different from other drugs? What must be included on a manufacturer’s drug label? What abbreviations are commonly used in drug directions and prescriptions? Which abbreviations should NOT be used? What are the seven rights and three checks of drug administration? Define common classifications of medications and their basic purposes and a couple of example drugs for each: - antihypertensives - anti-psychotics - anti-depressants

- anti-inflammatories, analgesics, NSAIDS - benzodiazepines - hypnotics - opioids - diuretics - sodium channel blockers - adrenergic blockers vs. adrenergics - statins - triptans - anti-infectives - biologics MEDICAL TERMINOLOGY How are most medical terms structured (prefix, combining form (root + comb. vowel), suffix)? When is the combining vowel dropped? Review these most common word parts: PREFIXES COMBINING FORMS SUFFIXES a-, an- nephr/o -itis ante- ren/o -logy anti- hepat/o -algia pre- cardi/o -plegia pro- cis/o -tomy para- cephal/o -ectomy intra- splen/o -ectasis inter- spondyl/o -stenosis hypo- arthr/o -paresis hyper- phleb/o -uria dys- colon/o -emia mal- hemat/o, hem/o -ist ex- ur/o -ium, -um in- gynec/o -sis, -osis re- dermat/o -penia Take a practice test for free at: https://www.aama-ntl.org/cma-aama-exam/study/medical-terminology-practice-test

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STUDY GUIDE FOR EXTERNSHIP ADMIN AND GENERAL (2)

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