Health Care System & Insurance
A patient receives a separate bill for the office visit, ECG, and laboratory testing. At the next appointment, the patient asks why each service has an individual charge.
Which reimbursement model should the medical assistant recognize?
Fee-for-service
A student graduates from an educational program reviewed and approved for meeting established educational standards. The student later passes a national examination.
Which statement correctly describes these two achievements?
A. The program is certified, and the student is accredited.
B. The program is accredited, and the student is certified.
C. Both the program and student are licensed.
D. Both the program and student are accredited.
The program is accredited, and the student is certified.
A competent adult patient refuses a procedure after receiving information about its purpose.
Which patient right is primarily being exercised?
Autonomy
A patient says, “I'm worried that this pain could mean something serious.”
Which response by the medical assistant is most therapeutic?
Open ended question is needed:
"Tell me more about what is worrying you."
A patient says, “The doctor gave me this medication, but it makes me dizzy. Should I stop taking it?”
Which response is most appropriate?
I will let the provider know that you are experiencing dizziness.
A patient enrolled in a managed-care plan needs a referral to a specialist. Before approving the referral, the insurance company evaluates whether the service is medically necessary.
Which process is being used?
Utilization review
A medical assistant arrives before the first patient, notices that specimen supplies are low, verifies inventory, and restocks the examination rooms without being asked.
Which professional characteristic is best demonstrated?
Initiative
A medical assistant tells a patient, “The procedure is completely safe. Nothing will go wrong,” even though the MA is not qualified to discuss procedural risks.
Which ethical principle is most directly threatened?
Veracity
A patient says, “I keep forgetting my evening medication.”
Which response is most likely to obtain useful information?
A. “Why don't you take it like you're supposed to?”
B. “You understand how important the medication is, correct?”
C. “What seems to make taking the evening dose difficult?”
D. “Do you forget because you are busy?”
What seems to make taking the evening dose difficult?
Rational: Remember "why” questions can make patients defensive and recommends open questions that identify the underlying difficulty.
A patient's spouse asks the MA for laboratory results. The patient is an alert adult and no authorization permitting disclosure to the spouse is documented.
What should the MA do?
Decline to disclose the information without appropriate authorization.
A patient asks why the insurance company will pay for one medication but not another medication in the same drug category. Which resource most likely determines which medications the plan prefers?
Formulary
A certified medical assistant has observed another employee perform a procedure several times but has never been trained or evaluated on the procedure. The provider tells the MA to perform it because the office is busy.
What should the MA do?
Explain that the MA has not been trained or validated to perform the procedure.
Rational:
Certification does not permit a medical assistant to exceed training or scope.
A patient has signed a consent form but then tells the MA, “I signed it because they told me to, but I don't really understand what they're doing.”
What is the best action?
Stop the consent process and notify the provider that the patient needs clarification.
A patient states, “This office doesn't care about patients. I've been waiting almost an hour.”
Which response by the medical assistant is best?
I can understand why the delay is frustrating. Let me check on your visit status.
While rooming a patient, the MA notices that the patient avoids eye contact, has trembling hands, and repeatedly says, “I'm fine.”
What should the MA do first?
Recognize the nonverbal cues and invite the patient to discuss how they are feeling.
A patient receives acupuncture while continuing medication and physical therapy prescribed by the provider. During intake, the patient asks the medical assistant whether acupuncture should replace the prescribed treatment.
Which response is most appropriate?
I can document that you are using acupuncture and make sure the provider is aware.
Rational:
Chapter 1 emphasizes respectful documentation rather than approving or dismissing a patient's treatment choice.
The medical assistant has the following tasks:
Which task should the MA complete first?
Report the shortness of breath
An MA leaves a patient's electronic record displayed on an unattended computer in a hallway. Another visitor reads the patient's diagnosis.
Which issue is most directly involved?
Improper access to PHI
Rational: HIPAA requires procedures preventing unauthorized viewing of computer screens and other materials containing PHI.
A patient says, “I can't deal with another surgery.”
The medical assistant responds, “It sounds as though the thought of another procedure is overwhelming.”
Which communication technique is the MA using?
Reflecting
A patient refuses a diagnostic procedure. The MA knows the test is important and believes refusing it is a poor decision.
Which action best demonstrates professional and ethical behavior?
Respect the patient's decision and report the refusal according to office procedure.
A busy primary care practice receives a fixed monthly payment for every patient enrolled with the practice. One patient has six visits this month, while another has none.
Which statement best describes the financial arrangement?
A. The practice receives additional reimbursement for each of the six visits.
B. The practice receives the same predetermined payment for each enrolled patient regardless of number of visits.
C. The insurance company performs utilization review after every patient encounter.
D. The practice bills each procedure separately but receives a discounted payment.
The practice receives the same predetermined payment for each enrolled patient regardless of number of visits.
A medical assistant notices a coworker repeatedly leaving unfinished documentation at the end of the shift. Today, one missing entry involves information the provider needs before making a patient-care decision.
Which action is most appropriate?
Report the missing patient-care information through the appropriate chain of command.
A medical assistant fails to follow an established procedure. However, the mistake is discovered immediately, corrected, and the patient experiences no injury.
Which element necessary to establish professional negligence is missing?
Damage
Remember the 4 D's
A patient has limited English proficiency. The patient's adult daughter answers every question before the patient has an opportunity to respond.
Which action is most appropriate?
Direct communication toward the patient and arrange appropriate language assistance as needed.
A patient arrives 30 minutes late and becomes angry when told that the provider is behind schedule. During the conversation, the patient states, “I don't care what the doctor says. I'm going to stop taking all of my medication.”
Which action should the medical assistant take?
Address the patient's frustration, clarify what the patient means, and communicate the medication concern to the provider.