Solution Manual For Administrative Medical Assisting, 8th Edition

ministrative Medical Assisting 8th Edition French Solutions Manual Download: http://testbanklive.com/download/administrative-medical-assisting-8th-edition-french-solutions-manual/ CHAPTER 2 The Health Care Environment: Past, Present, and Future COMPETENCIES Following are the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Accrediting Bureau of Health Education Schools (ABHES) competency standards for medical assisting ­educational programs that apply to this chapter. A full list of competencies may be found in Section III of this Instructor Manual as well as Appendix B of the textbook. CAAHEP Areas of Competence V.C Concepts of Effective Communication—Cognitive 6. Define coaching a patient as it relates to compliance with treatment plan and adaptations relevant to individual patient needs V.P Concepts of Effective Communication—Psychomotor 4. Coach patients regarding office policies and treatment plan VIII. C Third-Party Reimbursement—Cognitive 1. Identify types of third-party plans 2. Outline managed care requirements for patient referrals 3. Describe processes for precertification and preauthorization 4. Define patient-centered medical home X. C Legal Implications—Cognitive 5. Discuss licensure and certification as they apply to health care providers ABHES Areas of Competence 1. General Orientation a. Describe the current employment outlook for the medical assistant d. List the general responsibilities and skills of the medical assistant 3. Medical Terminology c. Apply various medical terms for each specialty d. Define and use medical abbreviations when appropriate and acceptable LESSON PLAN SUGGESTIONS 1. Discuss some pioneers of medicine and trends of the future. 2. Emphasize how the health care delivery system is changing throughout the United States and discuss the role of managed care and traditional care in your state. 3. Evaluate which medical practice settings exist in your area. 4. Discuss the answers to the review questions and exercises completed for the previous chapter. 5. Assign and discuss the abbreviation and spelling review lesson in the Workbook. 6. Assign the review questions and critical thinking exercises in the Workbook for homework. 7. Workbook Job Skills 2-1 through 2-5 may be assigned for homework. 8. Job Skill 2-2 may be role-played by the students depending on instructor’s preference. 14­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. download all chapters instantly please go to Solutions Manual, Test Bank site: testbanklive.com Chapter 2   The Health Care Environment: Past, Present, and Future ADDITIONAL ACTIVITIES 1. Obtain a video, CD, or DVD about one of the pioneers of medicine. 2. Invite a guest speaker from a managed care organization to speak on managed care systems in your area or state. Allow time for a question-and-answer period following the presentation. 3. Assign students to clip a newspaper or magazine article about managed care or health care reform. Tell students to summarize the article and explain what impact the information in the article will have on the patient, the physician, and the employees in the physician’s office. This assignment may be presented as an oral report given at this time or later in the semester. 4. Tell students to look in the telephone book and determine how many different types of health care settings exist in your area, as well as the type and number of physician specialists. 5. Invite a representative from an employment agency to discuss employment opportunities in the health care profession. 6. Ask a utilization review nurse to speak about the need for the utilization review process in today’s managed care system. 7. Plan a field trip to a local hospital or clinic and tour various departments. 8. Make flash cards of abbreviations for review during class. 9. Medical Pioneers: For instructors who think it is worthwhile to have students memorize famous historical figures who contributed to medicine, the following are name/word/sound associations that may be helpful to memorize pioneers mentioned in the textbook. Barnard, Christiaan: Barton, Clara: Currie, Pierre and Marie: Fleming, Alexander: Hunter, John: Jenner, Edward: Koch, Robert: Long, Crawford Williamson: Nightingale, Florence: Pasteur, Louis: Paré, Ambroise: Reed, Walter: Roentgen, Wilhelm K: Sabin, Albert: Salk, Jonas Edward: Sims, James Marion: Starzl, Thomas Earl: von Leeuwenhoek, Anton: Barnard transplanted a heart (sounds alike) Cross L A Red American (acronym for part of Clara’s name) MetallicARIE ChemicalURIElement (= radium used to treat cancer—­ partial acronym) If the patient coughs up phlegm he/she can take an antibiotic like penicillin (discovered penicillin) He hunted and found scientific surgery Jenny is small (developed process of vaccination and smallpox vaccine) ROBERTeburculin KO Cholera (partial acronym) How LONG will it last? (employed ether anesthesia) NIGHTINGALE: She went out in the night, even in a gale storm to nurse the sick (founder of nursing) Developed Pasteurization (father of Preventive medicine) He didn’t use his paring knife! (father of modern surgery) Mosquitoes are found in tall grass called “reeds.” They can be green or “­yellow.” (discovered yellow fever caused by a virus carried from one person to another by mosquitoes) Roentgenology, another word for radiology (x-ray) SA—What do you say? Say it with your mouth. (developed oral polio ­vaccine) Invented SALK vaccine for polio Originated SIMS’ position (laying on side with one knee bent) SurgeryTARZLiver (performed first liver transplant) Leeuwenhoek LEE SEES (developed lens to see bacteria) 15­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2   The Health Care Environment: Past, Present, and Future STOP AND THINK CASE SCENARIOS AND ANSWERS Traditional versus Managed Care Scenario: Janet takes her two grandmothers to see the same physician who accepts Medicare and Senior Medicare. She arranges both of their appointments for Tuesday morning. Granny needs to write a check for her yearly deductible, and Nana pays a $10 copayment. After they have both seen the doctor, the medical assistant appears with directions regarding their treatment plans. Granny needs to see a urologist and an appointment is made for the following day. Nana needs to have an x-ray and an authorization will be processed. The medical assistant will call when it is approved. Critical Thinking: 1. What type of Medicare plan is Granny on? Medicare Rationale: Deductibles are collected for patients on regular Medicare. 2. What type of Medicare plan is Nana on? Medicare Senior HMO Rationale: Copayments are collected for patients who have selected a Medicare Senior HMO plan. 3. What type of MCO does the physician belong to that enables him or her to see both of these types of patients in the office? Independent Practice Association (IPA) Rationale: IPA physicians can see regular fee-for-service (e.g., Medicare) patients alongside of HMO (e.g., Senior Medicare) patients in the same office setting. Determination of Benefits Scenario: A patient is seen in the office and the physician determines that a bronchoscopy is needed. You are asked to make sure the procedure is a covered benefit, determine what the payment will be, and find out whether prior approval is necessary. Critical Thinking: Consider which process is necessary to determine the following: 1. What process will you go through to determine whether bronchoscopy is a covered benefit? precertification 2. What process will you go through to determine the maximum dollar amount that the insurance company will pay for this procedure? predetermination 3. What process will you go through to determine if prior approval is necessary? preauthorization Types of Medical Practice Settings Scenario 1: You have a desire to go to a physician who will know you by name and treat you like family. Critical Thinking: What type of practice setting will you look for? solo practitioner Scenario 2: You would like to walk into a physician’s office without having to make an appointment. Critical Thinking: What type of practice setting will you look for? urgent care center Scenario 3: You are looking for a job as an administrative medical assistant and benefits are more important to you than high pay. Critical Thinking: What type of practice setting will you look for? large clinic, hospital, hospital-owned physician practice, medical center, or managed care organization Rationale: Typically, the larger the practice, the larger the benefit package is. Scenario 4: You have a friend who is a burn victim and you want to work in a setting that treats such patients. Critical Thinking: What type of practice setting will you look for? specialized care center Scenario 5: You believe that the physician should treat the body, mind, and soul, not just the physical ailment. Critical Thinking: What type of practice setting will you look for? holistic health environment 16­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2   The Health Care Environment: Past, Present, and Future EXAM-STYLE QUESTIONS AND ANSWERS 1. What is the name of the medical profession symbol, which is represented by a serpent coiled around a staff, and according to Greek legend, represents a Greek god of healing? a. Twin snakes b. Aesculapius c. Caduceus d. Asclepius e. Serpent 2. The “father of medicine” was: a. Imhotep b. Hippocrates c. Pasteur d. Lister e. Salk 3. The “father of modern surgery” was: a. Pierre Curie b. Francis Crick c. Ambroise Paré d. Walter Reed e. William Harvey 4. The founder of the American Red Cross was: a. Clara Barton b. Florence Nightingale c. Ignaz P. Semmelweis d. John Hunter e. Edward Jenner 5. Managed care started the practice of “utilization review” to: a. review physicians’ diagnostic skills b. review all aspects of the medical practice c. utilize HMO personnel more efficiently d. monitor and control areas in medicine where overuse occur e. control physicians’ decision-making 6. The managed care organization that has been in existence the longest is a/an: a. PPO b. IPA c. HMO d. EPO e. POS 17­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2   The Health Care Environment: Past, Present, and Future 7. The type of managed care organization that offers the patient flexibility when making a choice of going to a contracted or noncontracted physician at the time services are needed is a/an: a. PPO b. HMO c. IPA d. EPO e. POS 8. A freestanding practice center that provides extended hours and walk-in appointments is a/an: a. medical center b. family practice c. medical clinic d. specialized care center e. urgent care center 9. A specialty that deals with the management and control of obesity is called: a. a weight control clinic b. bariatric medicine c. gerontology d. nuclear medicine e. medical genetics 10. A medical specialty that determines the causes and nature of diseases and contributes to diagnosis, ­prognosis, and treatment is called: a. gerontology b. family practice c. internal medicine d. surgery e. pathology 11. The abbreviation for a doctor of ophthalmology is: a. OD b. OP c. OphD d. DO e. MD ABBREVIATION AND SPELLING REVIEW Definitions for the abbreviations are found in textbook Tables 7-1 and 10-3 as well as in the list of abbreviations in Appendix B of the Workbook. Students should use their medical dictionaries for spelling. Chart note for Troy Wenzlau. W E Fx L Pt DNS White Emergency Fracture Left Patient did not show 18­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2   The Health Care Environment: Past, Present, and Future re-exam SD X Mo P&S Yr I Mg IM Ofc Wks reexamination state disability multiplied by (for) Months permanent and stationary Year Injection Milligrams intramuscular Office Weeks REVIEW QUESTIONS AND ANSWERS 1. Briefly describe the contribution of each of the following: a. Imhotep is known as the god of healing who wrote the first prescription. b. Edward Jenner developed the process of vaccination and discovered the smallpox vaccine. c. Frederick Banting discovered insulin. d. Anton van Leeuwenhoek developed the first lens strong enough to see bacteria. e. Pierre and Marie Curie are known for their discovery of and work with radium. f. Paul Ehrlich developed the drug to fight syphilis and developed chemotherapy. 2. Match the pioneer in medicine in the left column with the appropriate item in the right column by writing the letters in the blanks. m Ignaz Phillip Semmelweis a. father of modern anatomy k Joseph Lister b. father of medicine g Louis Pasteur c. founder of nursing h Jonas Edward Salk d. discovered the x-ray j Clara Barton e. developed the first lens strong enough to see bacteria i Asclepius f. discovered how yellow fever is transmitted l Ambroise Paré g. father of bacteriology f Walter Reed h. discovered the vaccine against polio n William Harvey i. Greek god of healing d Wilhelm C. Roentgen j. founded the American Red Cross b Hippocrates k. father of sterile surgery a Andreas Vesalius l. father of modern surgery o James Marion Sims m. fought against puerperal fever c Florence Nightingale n. demonstrated circulation of blood q Alexander Fleming o. invented the vaginal speculum p. discovered insulin q. discovered penicillin 3. Name several factors that contributed to the rise of health care costs as medicine advanced. Answers may vary: advanced life expectancy, better life support measures, new drugs, malpractice insurance, more ­sophisticated tests and procedures, more advanced equipment. 19­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2   The Health Care Environment: Past, Present, and Future 4. List the benefits of using a managed care organization (MCO) and a traditional health care system as you compare and contrast their similarities and differences. TRADITIONAL a. PCP choice b. choice of specialists c. hospital choice d. facility choice (laboratory and so forth) e. no authorization process f. immediate testing and referrals MANAGED CARE a. no deductible b. small copayment c. 100% coverage d. preventive services e. medication coverage f. medical supply coverage 5. In a health maintenance organization (HMO), what is the treating physician called? primary care physician (PCP) or gatekeeper 6. In a preferred provider organization (PPO), (a) what is the health care provider called and (b) what ­incentive is there for the patient to use this provider? a. preferred provider b. lower copayments and deductibles 7. In an independent practice association (IPA), how is the physician paid? fixed monthly capitation or on a fee-for-service basis 8. Why is an exclusive provider organization (EPO) called exclusive? It is offered to large employers who agree not to contract with any other plan. 9. What choice of care do patients have when belonging to a point-of-service plan? to receive services from an HMO, a PPO, or a fee-for-service plan (in network or out of network) 10. Managed care plans pay the physician by capitation. 11. Dr. Practon wants to know if Mrs. Snow’s managed care plan covers a particular surgical procedure. This is a process known as precertification. 12. Dr. Practon completes a form for preauthorization of a diagnostic test to be ordered for Lee Cho. This ­process may also be called prior authorization or prior approval. 13. Before scheduling elective surgery on Phyllis Horton, Dr. Practon wants to know the maximum amount the insurance plan will pay. This is a process known as predetermination. (optional answers: preestimate of cost or pretreatment estimate) 14. Name five popular types of managed care health plans and list their abbreviations. Any five of the following: a. Health maintenance organization (HMO) b. Preferred provider organization (PPO) c. Independent provider association (IPA) d. Exclusive provider organization (EPO) e. Physician provider group (PPG) f. Point of service plan (POS) g. Accountable care organization (ACO) h. Coordinated care organization (CCO) 15. A variety of specialists practicing medicine together is called: multispecialty practice. 16. List three services urgent care centers provide that most other practices do not offer. a. extended hours b. walk-in capability c. one-stop-shopping feature (laboratory, x-ray, and physical therapy on-site) 20­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2   The Health Care Environment: Past, Present, and Future 17. Why should the medical assistant meet the hospital personnel where his or her physician is on staff? to develop a relationship for better communication 18. Name several types of nonprofit hospitals. a. general b. community c. industry owned d. union owned e. church/religious 19. Name three important factors to consider when choosing a reliable laboratory. a. quality-control standards b. turnaround time c. cost to the patient CRITICAL THINKING EXERCISE ANSWERS 1. Choose the type of health care setting you would like to work in and list the reasons for your choice. Answers will vary. 2. Debate the right of the physician to practice or not practice “concierge” medicine. Instructor: This is a good question to have students consider while studying Chapters 2 and 3. The Principles of Medical Ethics for the Physician (Figure 3-3) can be used while determining which position the student wants to take. Pro argument: Students may argue that each physician has the right to select the medical specialty, ­location of practice, and type of practice he or she wishes; this is similar to the freedom that each of us ­experience in America when choosing a career (see Chapter 3, Figure 3-3, Principles of Medical Ethics for the Physician, VI). Con argument: Students may argue that the physician is biased against the poor and is putting money ­concerns before the care of people with health concerns (see Chapter 3, Figure 3-3, Principles of Medical Ethics for the Physician, IX). 3. Determine the job duties of an administrative medical assistant working in a patient-centered medical home. The organizational and interpersonal skills of an administrative medial assistant would be valued while working in a PCMH environment. Communicating with the in-charge physician and the health care team is vital, as well as scheduling visits of health care team members, tests, and procedures. Follow-up is also an important role because many health care professionals may be coming and going while giving various orders. Excellent medical record documentation and insurance filing skills would also be needed. Answers will vary and other skills may be named. 4. As a member of a multidisciplinary team, name several ways you, as an administrative medical assistant, can act as a patient advocate. Answers will vary. Here are some to consider: • Communicating openly with the patient and family members • Explaining procedures and tests that are ordered • Encouraging compliance with the physician’s orders • Asking if there are any unanswered questions; being available to answer them or direct them to a clinical medical assistant or to the physician • Making sure the patient is aware of office hours, telephone access, prescription refill protocol, physician’s availability, and what to do in an emergency 5. Role-play scenario: Outcomes will vary. Following are examples of what to look for: Listen for the students’ tone of voice, watch for eye contact, and notice the mannerisms used while communicating. Students should honor confidentiality, be courteous and demonstrate sensitivity, and display assertiveness and confidence while communicating with the provider and patient. 21­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2   The Health Care Environment: Past, Present, and Future Dr. Gerald Practon has ordered a colonoscopy and has asked you to call the managed care company to see what policies and procedures are in place. The patient is waiting to see if the procedure can be ­scheduled immediately. Place a call to precertify benefits—the student should ask and determine whether the ­colonoscopy is a covered benefit. Predetermine the dollar amount allowed—the student should obtain the ­dollar amount and then compare what the insurance company will pay with Dr. Practon’s fee schedule. Find out if preauthorization is needed—the student would need to ask the physician for the diagnosis in order to communicate the medical necessity to the insurance carrier or fill out the preauthorization form. And then notify the patient of your findings. The student should display concern and sensitivity while talking to the patient in a manner that he or she can understand. JOB SKILL 2-1 USE THE INTERNET TO RESEARCH AND WRITE AN ESSAY ABOUT A MEDICAL PIONEER Note to instructor: Famous medical pioneer names, listed under “Directions” in the job skill, may be assigned to students or may be written on cards and drawn by students. This exercise may be used as a collaborative effort with more than one student working together. If directed by you, this job skill may be done using library ­references. Answers will vary according to the pioneer or invention the student selects. COVER PAGE: The cover page should have the following items: Title: Use large font Author(s): Contributors to report; if more than one, separate names with commas Date: Spell out month, day, and year Name of School: Name, city, and state Summary/Abstract: Optional BODY: The one-page essay should be in the student’s own words and written at a level that patients would understand if read to them. The report may be read orally. BIBLIOGRAPHY (online sources): The bibliography should be listed as follows: Author Name: Last, first (one who wrote the online article) Title of Work: Main subject Title of Online Site: May be similar to web address Address/Path: http://www. (and so forth) Date of Message: Day, month, and year website was visited EXAMPLE: Bellis, Mary. “History of the Wheelchair.” About.com: Inventors. http://www.inventors .about.com/od/wstartinventions/a/wheelchair.htm. 2 September 2010 JOB SKILL 2-2 DIRECT PATIENTS TO SPECIFIC HOSPITAL DEPARTMENTS Note to instructor: Refer to textbook Figures 2-7A and 2-7B, a comprehensive list of hospital departments and the services they provide. 1. 2. 3. 4. medical records department dietetic/nutrition department laboratory department pharmacy department 5. respiratory care department 6. administration department 7. emergency room department Where does she go to pick up a copy of her operative report? Where can she attend a nutritional education class? Where does she go for a urinalysis? She has a question about the medication that was given to her when she left the hospital. Should she use a bronchodilator before she goes to have a  ­pulmonary function test? She would like to personally tell the hospital president how  ­wonderfully she was cared for during her hospital stay. She would like to speak to the physician who admitted her when she first arrived by ambulance at the hospital. 22­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2   The Health Care Environment: Past, Present, and Future 8. social services department 9. physical therapy department 10. business department 11. medical staff department 12. nuclear medicine department 13. radiology department 14. financial department 15. nursing administration department 16. magnetic resonance imaging department 17. physiology department 18. gastrointestinal laboratory 19. one-day surgery department She would like to know whether anyone has found a convalescent hospital for her mother, who is an inpatient and soon to be discharged. She would like to schedule occupational therapy. She does not understand a hospital bill and would like it explained. She would like the name of the new OB-GYN doctor from San Francisco who is performing deliveries at the hospital. She has a question regarding the contrast media that will be given to her before a bone scan. She would like to pick up a preparation kit for a barium enema. She has a question regarding an old refund that should have been sent to her by now. She would like to speak to the utilization review nurse who was assigned to her case. She would like to know if she can wear her wedding ring in the MRI machine. She would like to know how to dress for the treadmill test. She would like to know the preparation for a sigmoidoscopy that is scheduled. She would like to know what time to arrive for a blood transfusion. JOB SKILL 2-3 REFER PATIENTS TO THE CORRECT PHYSICIAN SPECIALIST Note to instructor: Refer to textbook Table 2-4, a list of physician specialties and administrative assisting job requirements. Patient Complaint Specialist 1. F Pregnant  A. Allergist 2. P Operation      B. Dermatologist 3. J Microbiology report     C. Neonatologist 4. Q Bladder and kidney problem   D. Neurologist 5. A Chronic runny nose from dust     E. Nuclear medicine 6. N Severe depression        F. Obstetrician 7. M Face lift    G. Ophthalmologist 8. C Premature infant H. Orthopedic surgeon 9. K Infant DPT injection   I. Otolaryngologist 10. I Ear discharge   J. Pathologist 11. O X-rays K. Pediatrician 12. H Fractured bone L. Physiatrist 13. L Rehabilitation for chronic back pain M. Plastic surgeon 14. D Multiple sclerosis (disease of nervous system)   N. Psychiatrist 15. G Glaucoma (increased pressure in eye)    O. Radiologist 16. B Severe case of skin psoriasis          P. Surgeon 17. E Bone scan (radionuclear)    Q. Urologist 23­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. ministrative Medical Assisting 8th Edition French Solutions Manual Download: http://testbanklive.com/download/administrative-medical-assisting-8th-edition-french-solutions-manual/ Chapter 2   The Health Care Environment: Past, Present, and Future JOB SKILL 2-4 DEFINE ABBREVIATIONS FOR HEALTH CARE PROFESSIONALS Note to instructor: Refer to textbook Table 2-5, a list of abbreviations of various professional positions in the field of medicine. 1. EMT emergency medical technician 2. DEM doctor of emergency medicine 3. MD medical doctor 4. FACS fellow of the American College of Surgeons 5. CMA (AAMA) certified medical assistant 6. LVN licensed vocational nurse 7. RNP registered nurse practitioner 8. RPT registered physical therapist 9. MT (ASCP) medical technologist 10. EMR electronic medical record 11. CMT certified medical transcriptionist 12. CPC certified professional coder 13. PA-C physician’s assistant—certified 14. VN visiting nurse JOB SKILL 2-5 DETERMINE BASIC SKILLS NEEDED BY THE ADMINISTRATIVE MEDICAL ASSISTANT Note to instructor: Refer to Table 2-4 in the textbook. Answers may vary slightly but should include the following main functions. 1. Schedule tests and appointments. 2. Know medical terminology that applies to each specialty area. 3. Display accurate keying/typing skills. 4. Process referrals from other physicians. 5. Handle telephone calls. 6. Have a mature and dignified personality and use a calm, diplomatic approach. 7. Know different body systems. 8. Possess transcription skills. 24­ © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. download all chapters instantly please go to Solutions Manual, Test Bank site: testbanklive.com