Medical Terminology and Concepts, Exams of Nursing

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Advance Beneficiary Notice (ABN) 🗸🗸🗸 : A form provided to the patient when the provider believes Medicare will probably not pay for services received Allowed Amount 🗸🗸🗸 : The maximum amount a third-party payer will pay for a particular procedure or service Copayment 🗸🗸🗸 : a small fixed fee paid by the patient at the time of an office visit Coinsurance 🗸🗸🗸 : a provision under which both the insured and the insurer share the covered losses, typically 80: deductible 🗸🗸🗸 : specific amount of money a patient must pay out of pocket before the insurance carrier begins paying

Explanation of Benefits 🗸🗸🗸 : 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) 🗸🗸🗸 : Providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer Medicare 🗸🗸🗸 : 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 🗸🗸🗸 : U.S. government health insurance plan for all military personnel CHAMPVA 🗸🗸🗸 : covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities Medicaid

🗸🗸🗸 : 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 🗸🗸🗸 : 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- 15 00 form 🗸🗸🗸 : Standard insurance form used by all government and most commercial insurance payers.

• 33 blocks
• divided into three section CMS-1500 Section 1 🗸🗸🗸 : Carrier Block: contains the address of the insurance carrier and is located at the top of the form CMS-1500 Section 2 🗸🗸🗸 : Patient/insured section: contains information about the patient or insured; includes boxes 1- 13

CMS-1500 Section 3 🗸🗸🗸 : Physician/Supplier Section: contains information about the physician or supplier: boxes 14 - 33 Supine Position 🗸🗸🗸 : Dorsal Recumbent Position 🗸🗸🗸 : Sims' Position 🗸🗸🗸 : Knee-elbow position 🗸🗸🗸 : Fowler's Position 🗸🗸🗸 : Lithotomy Position 🗸🗸🗸 :

Epidural Injection 🗸🗸🗸 : epidural space of the spine Intra-arterial Injection 🗸🗸🗸 : injection into an artery (to break up clots) Intra-articular Injection 🗸🗸🗸 : injection into joint space Intradermal Injection 🗸🗸🗸 : Skin of the upper chest, forearms, upper pack. 5 - 15 º angle intramuscular injection 🗸🗸🗸 : deltoid, vastus lateralis, ventrogluteal muscles Intraosseous Injection 🗸🗸🗸 : Bone marrow Intraperitoneal Injection 🗸🗸🗸 : within the peritoneal cavity Intrapleural Injection

🗸🗸🗸 : pleural space (lungs) Intrathecal Injection 🗸🗸🗸 : Subarachnoid space (brain) Fat soluble vitamins 🗸🗸🗸 : A, D, E, K Water Soluble vitamins 🗸🗸🗸 : B 1 , B 2 , B 3 , B 6 , Folate, B 12 , Pantothenic acid, biotin, C. Erikson's stages of psychosocial development 🗸🗸🗸 : 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 🗸🗸🗸 : denial, anger, bargaining, depression, acceptance

Sagittal Plane 🗸🗸🗸 : divides body into left and right Coronal Plane 🗸🗸🗸 : divides body into front and back Transverse Plane 🗸🗸🗸 : horizontal division of the body into upper and lower portions Right Upper Quadrant (RUQ) 🗸🗸🗸 : Right lobe of liver, gallbladder, right kidney, portions of stomach, small and large intestine Left Upper Quadrant (LUQ) 🗸🗸🗸 : Left lobe of liver, stomach, pancreas, left kidney, spleen, portions of large intestine Right Lower Quadrant (RLQ) 🗸🗸🗸 : cecum, appendix, right ovary and tube, right ureter, right spermatic cord Left Lower Quadrant (LLQ)

🗸🗸🗸 : contains parts of the small and large intestines, left ovary, left fallopian tube, left ureter Epigastric Region 🗸🗸🗸 : located above the stomach Umbilical Region 🗸🗸🗸 : hypogastric region 🗸🗸🗸 : Right Hypochondriac Region 🗸🗸🗸 : right lateral region just below the ribs Left Hypochondriac Region 🗸🗸🗸 : left upper region below the rib cartilage Right lumbar Region 🗸🗸🗸 : right middle region near the waist Left Lumbar Region

🗸🗸🗸 :

Right Iliac Region 🗸🗸🗸 : Left Iliac Region 🗸🗸🗸 : Chain of Infection 🗸🗸🗸 : infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host Wheezing 🗸🗸🗸 : Difficult breathing with a high-pitched whistling or sighing sound during expiration Rales 🗸🗸🗸 : Crackles; wet crackling noise in lungs Rhonchi 🗸🗸🗸 : loud rumbling sounds heard on auscultation of bronchi obstructed by sputum kg - > lbs

🗸🗸🗸 : 1 kg = 2.2 lbs Trendelenburg position 🗸🗸🗸 : Intradermal needle gauge 🗸🗸🗸 : 27 - 28 Intradermal Needle Length 🗸🗸🗸 : 3/8 in Subcutaneous Needle Gauge 🗸🗸🗸 : 25 - 26 Subcutaneous Needle Length 🗸🗸🗸 : 1/2 to 5/8 inch Intramuscular Needle gauge 🗸🗸🗸 : 20 - 23 Intramuscular Needle Length 🗸🗸🗸 : 1 - 3 inches

Smaller 🗸🗸🗸 : the higher the needle gauge number, the ___ the diameter Precertification 🗸🗸🗸 : A process required by some insurance carriers in which the provider must prove medical necessity before performing a procedure. EMR 🗸🗸🗸 : electronic medical record suffix 🗸🗸🗸 : word ending prefix 🗸🗸🗸 : a syllable or word that comes before a root word to change its meaning Pancreas 🗸🗸🗸 : digestion and endocrine Thymus 🗸🗸🗸 : endocrine and immune

Upcoding 🗸🗸🗸 : A fraudulent practice in which provider services are billed for higher procedural codes than were actually performed, resulting in a higher payment. Usual Fee 🗸🗸🗸 : Fee for a service or procedure that is charged by a provider for most patients under typical circumstances. Customary fee 🗸🗸🗸 : fee typically charged for a service in a particular geographic area Reasonable Fee 🗸🗸🗸 : The generally accepted fee a physician charges for an exceptionally difficult or complicated service. A charge is considered reasonable if it is deemed acceptable after peer review even if it does not meet the criteria for a customary fee or prevailing charges. Capitation 🗸🗸🗸 : System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan.

Phantom Billing 🗸🗸🗸 : Billing for services not performed Who do you report to for Fraud? 🗸🗸🗸 : Office of Civil Rights (OCR) Who do you report to for unsecured HPI? 🗸🗸🗸 : Secretary of Health and Human Services What is the difference between eHPI and HPI? Who governs both? 🗸🗸🗸 : HHS 🗸🗸🗸 : U.S. Department of Health and Human Services U.S. Department of Health and Human Services 🗸🗸🗸 : provide essential services, including health care for low-income families, programs for older adults, and child services CMS 🗸🗸🗸 : Centers for Medicare and Medicaid Services

OSHA

🗸🗸🗸 : Occupational Safety and Health Administration Red Cross 🗸🗸🗸 : An international organization dedicated to the medical care of the sick or wounded in wars and natural disasters Legal Aid Society 🗸🗸🗸 : One of a network of community law offices that provides free or low-cost legal assistance. TJC 🗸🗸🗸 : The Joint Commission Organization, establishing standards for hospitals/health related facilities NAACLS 🗸🗸🗸 : National Accrediting Agency for Clinical Laboratory Sciences ACS 🗸🗸🗸 : American Cancer Society AHA

🗸🗸🗸 : American Hospital Association Accountable Care Organization (ACO) 🗸🗸🗸 : a network of doctors and hospitals that voluntarily share responsibility for managing the quality and cost of care provided to a group of patients Patient-Centered Medical Home (PCMH) 🗸🗸🗸 : A model of primary care that provides comprehensive and timely care to patients, while emphasizing teamwork and patient involvement. ACO vs PCMH 🗸🗸🗸 : the ACO is primarily a value-based reimbursement model that incorporates "voluntary" collaboration among providers, whereas the PCMH is primarily a care delivery model involving significant collaboration as part of the certification process Cluster Scheduling 🗸🗸🗸 : the scheduling of similar appointments together at a certain time of day or week Wave Scheduling 🗸🗸🗸 : A certain # of patients are scheduled to arrive at the same time and are seen in which the order they arrive. Open Scheduling

🗸🗸🗸 : Patients are seen on a first come first serve basis. Walk-ins Farenheit to Celsius 🗸🗸🗸 : (F- 32 )/1. Fomite 🗸🗸🗸 : A physical object that serves to transmit an infectious agent from person to person Vector (medical) 🗸🗸🗸 : an animal that is a carrier of a disease or a medication Sanitization 🗸🗸🗸 : removal of pathogens from objects to meet public health standards Sterilization 🗸🗸🗸 : The process that completely destroys all microbial life, including spores. Disinfection 🗸🗸🗸 : A process that eliminates many or all microorganisms, with the exception of bacteria spores, from inanimate objects

Ishihara Book 🗸🗸🗸 : used to test color vision. If the patient misses four or more, there might be a color deficiency tympanometry 🗸🗸🗸 : the use of air pressure in the ear canal to test for infections or presence of fluid in the middle ear Yellow Stopper color 🗸🗸🗸 : Sodium Polyanethol sulfonate (SPS) Yellow Lab Use 🗸🗸🗸 : for blood culture specimen collection in microbiology Light Blue Stopper Color 🗸🗸🗸 : Sodium citrate (anticoagulant) Light Blue Lab Use 🗸🗸🗸 : Coagulation studies Red Stopper Color 🗸🗸🗸 : Plastic: clot activator

Glass: no additive (plain) Red Lab Use 🗸🗸🗸 : for serum determinations and may be used for routine blood donor screening and diagnostic testing of serum for infectious diseases Gold or tiger top (red-grey) Stopper Color 🗸🗸🗸 : - Serum separator tube (SST)

• Clot activator
• Thixotropic gel (creates barrier) Gold or tiger top (red-grey) Lab Use 🗸🗸🗸 : for serum determinations and may be used for routine blood donor screening and diagnostic testing of serum for infectious diseases Green Stopper Color 🗸🗸🗸 : Sodium Heparin and Lithium Heparin Green Lab Use 🗸🗸🗸 : for plasma determinations in chemistry Lavender Stopper Color 🗸🗸🗸 : EDTA (anticoagulant)

Lavender Lab Use 🗸🗸🗸 : WHOLE BLOOD hematology determinations, routine immunohematology testing and blood donor screening Gray Stopper Color 🗸🗸🗸 : Potassium oxalate and sodium fluoride Gray Lab Use 🗸🗸🗸 : Glucose testing (GTT) Medial Cubital Vein 🗸🗸🗸 : On the anterior surface of the vein. Vein of choice in intravenous injections. Cephalic Vein 🗸🗸🗸 : Large vein on the outermost side of the upper arm Basilic Vein 🗸🗸🗸 : large vein on the inner side of the upper arm Bipolar Leads 🗸🗸🗸 : Leads I, II, III

• record impulses that travel from a negative to positive pole Unipolar Leads 🗸🗸🗸 : aVR, aVL, aVF (augmented) Augmented 🗸🗸🗸 : having been made greater in size or value White electrode 🗸🗸🗸 : right arm Black electrode 🗸🗸🗸 : left arm Red electrode 🗸🗸🗸 : left leg Green Electrode 🗸🗸🗸 : right leg Chest Lead placement 🗸🗸🗸 :

Filing systems and processes 🗸🗸🗸 : - Conditioning

• Releasing
• Indexing and coding
• Sorting
• Storing and filing Conditioning 🗸🗸🗸 : involves grouping related papers together, removing all paper clips and staples, attaching smaller papers to regular sheets, and fixing damaged records Releasing 🗸🗸🗸 : marking the form to be filed with a mark of designated preference
• ready to be filed
• provider's initials
• using a stamp Indexing and coding 🗸🗸🗸 : Determining where to place the original record in the file and whether it needs to be cross-referenced in another section. A chart number is typically used for this. Sorting

🗸🗸🗸 : involves ordering papers in a filing structure and placing the documents in specific groups Storing and filing 🗸🗸🗸 : securing documents permanently in the file to ensure the medical record documents do not become misplaced ECG Leads 🗸🗸🗸 : smoke over fire (right side), clouds over grass (green is last so left) V1 🗸🗸🗸 : right side, FOURTH intercostal space V2 🗸🗸🗸 : left side of the sternum, directly across from V1 at the FOURTH intercostal space V4 🗸🗸🗸 : left side, FIFTH intercostal space V3 🗸🗸🗸 : left side, midway between V 2 and V 4 (placed after V 4 !!!)

V5

🗸🗸🗸 : Left side of the chest, FIFTH intercostal space, anterior axillary line V6 🗸🗸🗸 : left side of the chest, FIFTH intercostal space, midaxillary line P Wave 🗸🗸🗸 : atrial depolarization QRS Wave 🗸🗸🗸 : ventricular depolarization and atrial repolarization T wave 🗸🗸🗸 : ventricular repolarization P-R Interval 🗸🗸🗸 : starts at the beginning of the P wave and ends at the beginning of the Q wave. Atrial depolarization - > ventricular depolarization QT Interval

🗸🗸🗸 : starts at the beginning of the Q wave and ends at the end of the T wave. Ventricular depolarization - > ventricular repolarization ST Segment 🗸🗸🗸 : End of S wave and ends at the beginning of the T wave. ventricular depolorization - > ventricular repolarization Wandering baseline 🗸🗸🗸 : poor electrode connection Interrupted baseline 🗸🗸🗸 : A break in the tracing related to a disconnected or broken lead wire Holter monitoring rules 🗸🗸🗸 : - do not move electrodes

• no exposure to electrical forces such as metal detectors
• no showering (birth baths only) remittance advice (RA) 🗸🗸🗸 : a document that lists the amount that has been paid on each claim as well as the reasons for nonpayment or partial payment. used to pot payments to patient accounts ICD- 10 - CM

🗸🗸🗸 : 3 - 7 characters used CPT Codes 🗸🗸🗸 : billing codes for medical, surgical and diagnostic services What to include in a referral 🗸🗸🗸 : - demographic

• insurance information
• provider's ID info
• diagnosis
• planned procedure or treatment Accounts receivable 🗸🗸🗸 : amount owed to the provider for the services rendered Accounts payable 🗸🗸🗸 : debt incurred but not yet paid Assets 🗸🗸🗸 : property of an individual or organization LIABILITIES + CAPITAL = ASSETS Liabilities