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98 Cards in this Set
- Front
- Back
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What are the 3 types of PA Programs?
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1. extensive training in general medical theory and clinical practice
2. extensive training in the theory of one medical specialty 3. narrowly circumscribed background in general medical practice |
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Define PA.
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A healthcare professional liscnsed to practice medicine with thte supervision of a physician.
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Name some examples of specialty PA Programs.
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anesthesiology
pathology orthopedic urological surgical |
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What is the FLEX?
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foreign liscensing examination
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What is the ECFMG?
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educational commission for foreign medial graduates
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What must IMGs do to become licensed in the US?
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Pass the FLEX or ECFMG followed by a one year US residency.
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Why are IMGs utilized in the US?
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1. to relieve physician shortages in the US
2. to solve the problem of geographical maldistribution of physicans in the US 3. if licensed, IMGs could address the problem of undeserved areas in the US |
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What are 4 problems associated with IMGs?
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1. lack of English language skills
2. lack of recent practice experience 3. inability to verify past medical education 4. fraudulent applications claiming medical education |
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What is a system of medical practice based on the use of small doses of a drug that in large doses is capable of producing symptoms in healthy individuals which are similar to those of the disease being treated?
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homeopathy
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What is a system of medical practice based on the thory that the normal body is capable of making its own remedies against infection/disease and that disturbances in the musculoskeletal system affect other bodily parts causing many disorders that can be corrected by various manipulative techniques in conjunction with conventional medical, surgical, and pharmacological therapeutic procedures?
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osteopathy
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What is a system of treatment of disease that avoids drugs and surgery and emphasizes the use of natural agents (air, sunshine, food, and water) and physical means (manipulation, exercise, and electrical treatment)?
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naturapathy
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What is a system of medical practice that aims to combat disease by use of remedies producing effects different from or incompatible with those produced by the disease treated?
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allopathy
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What is a system of medical practice that uses the recuperative powers of the body and the relationship between the musculoskeletal structures and the functions of the body (particularly of the spinal column and the nervous system) in the restoration and maintenance of health?
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chiropactic
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What are some PA functions?
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1. conduct physical exams
2. diagnose and treat illnesses 3. order and interpret tests 4. counsel on preventative health care 5. assist in surgery 6. write prescriptions |
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T or F: PAs exercise autonomy in medical decision making.
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true
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T or F: A PA's practice does not include education, research, and administrative services.
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false
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What are some differences in the education of MDs v. PAs?
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1. length and intensity
2. research/clinical content 3. interpersonal skills ignored/valued |
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What are some differences in the practice of MDs v. PAs?
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1. independence/interdependence
2. patient as disease/patient as person orientation |
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What is the philosophical difference between PAs v. NPs?
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interdependent with/independent of MDs
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What are some educational differences between PAs v. NPs?
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1. medical/nursing model
2. basic science/nursing basis 3. moderate/heavy psychosocial emphasis |
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What are some differences in the practice of PAs v. NPs?
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1. interdependant but autonomous/independent but collaborative
2. physican mentality (salaried)/shift mentality |
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What is the difference in reimbursement of PAs v. NPs?
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to employer/direct
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Why should a PA have Malpractice Insurance?
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1. provider responsibility
2. litigation against PAs 3. separate liability limits 4. policy ownership 5. individual defense 6. adjusted coverage (multiple positions) 7. coverage follows individual PA 8. peace of mind |
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What covers incidents happening during the policy period without regard to when the claims are reported?
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occurance form
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What covers a medical incident only when it happened and was reported to the insurance company while the policy was in effect?
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claims-made form
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What allows the insured to continue to report incidents that happened during the policy period after the claims-made policy has ended?
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tail coverage
(extended reporting endorsement) |
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What is retroactive insurance that protects against those events that have already occurred during the claims-made policy period but have not been reported before the policy expiration date?
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prior acts coverage
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What is a state administered program where each state sets its own guidelines regarding eligibility and services?
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medicaid
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Who funds medicaid?
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federal government and individual state
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How are funds distributed for medicaid?
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according to the percentage of the state's population below the poverty level
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Are PA services covered under medicaid?
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yes, under fee-for-service or Medicaid managed care programs
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What is the rate of reimbursement for PA medical services under Medicaid?
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100% of the fee paid to physicians
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What is a government-administed social insurance program designed to provide hospital and medical care for the elderly?
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Medicare
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What persons are included in Medicare?
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1. the elderly
2. disabled persons 3. persons suffering from end-stage renal disease who need dialysis or kidney transplants |
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Who administers Medicare?
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Centers for Medicare and Medicaid Services (CMS)
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What is CMS?
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Centers for Medicare and Medicaid Services
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What are the responsibilites of CMS?
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1. responsible for interpreting and implementing laws
2. promulgating rules and regulations 3. contracting with private health insurance companies to process medicare claims |
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What is Medicare Part A?
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HOSPITAL INSURANCE:
1. covers inpatient hospitalization and nursing facility care, home health care, and hospice care 2. reimbursement payments handled by fiscal intermediaries |
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What is Medicare Part B?
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SUPPLEMENTAL MEDICAL INSURANCE:
1. covers professional services provided by physicians, PAs, and certain other authorized practitioners in the office, clinic, hospital (including ER) and nursing facility 2. pays for durable medical equipment 3. reimbursement payments processed by private insurance companies in each state (Medicare carriers) |
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What is Medicare Part C?
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1. option through which beneficiaries elect to receive their health care from HMOs or other managed care entities
2. often include enhanced benefit packages like pharmaceuticals, eye glasses, and routine physicals |
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What PA services does Medicare cover?
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1. PA services billed at the physican rate and under the provider number
2. medicare reduces the payment to the 85% rate 3. reimbursement is made to the PAs employer |
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What PA services are typically reimbursed by Medicare?
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1. all levels of evaluation and management services (E/M)
2. consultations 3. initial hospital H&Ps 4. mental health services 5. all diagnostic tests 6. first assisting at surgery 7. ordering pt/plan of care 8. signing the certificate of medical necessity for durable medical equipment (DME) |
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T or F: Routine physicals and other certain restricted services are covered when performed by MDs or PAs.
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false
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T or F: Medicare follows PA regulations established in each state
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true
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T or F: Medicare requires a supervising MD be physically presnet unless billing "incident to."
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false
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T or F: Medicare does not require that physicians co-sign PA charts or orders unless required by state law.
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true
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T or F: Medicare hospital admission H&Ps and preop H&Ps performed by PAs do not require a MD co-signature.
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false
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What is the NPI?
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National Provider Identifier
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What is a 10 digit number used to identify health care professionals and health care organizations in order to electronically transmit or receive health information and submit claims?
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NPI
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What allows PA services in the office or clinic to be reimbursed at 100% of the physican fee schedule under certain criteria?
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"Incident to" provision of Medicare
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What Medicare provision allows 100% reimbursement when the service is typically performed in the physician's office or clinic, not nursing homes or hospitals?
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"Incident to" provision
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What Medicare provision allows 100% reimbursement when the service is within the PA's scope of practice and in accordance with state law?
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"Incident to" provision
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What Medicare provision allows 100% reimbursement when the physician is in the suite of offices when the PA renders the service?
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"Incident to" provision
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What Medicare provision allows 100% reimbursement when the physician personally treats the patient and establish the diagnosis on the patient's first visit or in the case of an established patient who comes with a new medical condition?
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"Incident to" provision
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What part of Medicare are PA hospital services billed under?
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Part B
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In non-skilled nursing homes, what is the rate at which PAs are reimbersed?
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85%
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What are the 2 main coding systems?
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ICD
CPT |
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What is ICD-9
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International Classification of Diseases, ninth revision
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What is used to provide a standard classification of diseases for the purpose of health records?
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ICD
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What assigns, publishes, and uses the ICD to classify diseases and to track mortality rates based on death certificates and other vital health records?
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WHO
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What is CPT-4
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Current Procedural Terminology
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What is ICD used for?
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diagnosis
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What is CPT used for?
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the visit, surgery, procedure, etc.
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What is a standard, universal code that is applied to medical procedures and services for the purpose of patient records?
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CPT
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What is CPT divided into?
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1. type of services
2. place of service 3. level of service |
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What are the category requirements of CPT?
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1. new patient/established outpatient
2. initial inpatient/follow-up hospital care 3. consultations/follow-up inpatient consults 4. emergency department |
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What are the patient history types of CPT?
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1. problem focused
2. expanded problem focused 3. detailed 4. comprehensive |
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What are the components of the history in CPT?
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1. cheif complaint
2. history of present illness 3. review of systems 4. past, family, social history |
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What is CC?
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chief complaint
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What is HPI?
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history of present illness
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What is ROS?
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review of systems
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What is PFSH?
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past, family, social history
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What does a problem focused history include?
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brief HPI
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What does an expanded problem focused history include?
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brief HPI
problem-pertinent ROS |
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What does a detailed history include?
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extended HPI
extended ROS pertinant PFSH |
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What does a comprehensive history include?
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extended HPI
complete ROS complete PFSH |
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What are the 8 elements of an HPI?
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1. location
2. quality 3. severity 4. duration 5. timing 6. context 7. modifying factors 8. associated signs and symptoms |
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How many elements does a brief HPI include?
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1-3
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How many elements does an extended HPI include?
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4+
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How many systems does an extended ROS include?
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2-9
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How many systems does a complete ROS include?
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10
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What are the types of medical decision making?
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straightforward
low complexity moderate complexity high complexity |
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What do minor surgical procedures include?
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preoperative visits
intraoperative procedures postoperative care/visits (same day or within 10 days) |
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What do major surgical procedures include?
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preoperative visits (beginning 1 day prior)
intraoperative procedures (all usual) postoperative care/visits (same day or within 90 days and complications outside OR) |
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What is an EMR?
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electronic medical record
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What do LA Medicaid programs coverage?
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100% of physician fee
not for assisting surgery |
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What does the LA Worker Compensation Program cover?
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100% of physician fee
physician signs all paperwork |
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What is CASPA?
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Central Application Service for Physician Assistants
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What is the only national certifying body for physician assistants?
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NCCPA
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What assures that certified PAs meet professional standards of knowledge and skills?
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NCCPA
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What are 2 steps to initial NCCPA certification?
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1. graduation from a PA program accredited by ARC-PA
2. successful completion of PANCE |
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What type of scoring does NCCPA use?
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content-based standard setting process
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How many times can you attempt PANCE?
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6 times within 6 years of your program completion
(only once in any 90 day period or up to 3x a year) |
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When does NCCPA certification need to be renewed?
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6-year certification maintence cycle comprised of 3 two-year blocks
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How many CME hours must be logged every 2 years?
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100 (50 Category 1)
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When must the PANRE be passed?
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in year 5 or 6 of your 6 year cycle
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What is an activity or provider that is preapproved by the AAPA, ACCME, AAFP, AMA or AOACCME?
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Category 1 CME
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Under what circumstances are the NCCPA certification removed?
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1. loss of licensure due to documented gross incompetence or unethical conduct
2. conviction of or pleading no contest to a felony offence 3. court decision that finds a PA mentally incompetant |
