Medical Terminology Used by the Medical Assistant

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Daymar College

Medical assistants use medical terminology in everyday tasks including medical reporting, charting and electronic record data entry. Some of the medical terminology used by medical assistants includes healthcare delivery models, insurance terms, insurance coding and billing standards, common abbreviations, acronyms and symbols, medical conditions, medical procedures, medical instruments, medical word building and positional/directional terminology.

Healthcare Delivery Models

Healthcare delivery models are systems that manage and dispense healthcare for patients. The different models include HMOs, PPOs, POS, PCMH, ACOs, Hospice Care Collaborative Care Models, Medicare and Medicaid.

  • HMO – Health Maintenance Organization; gives the patient access to in-network doctors and hospitals. The patient must pick an in-network primary care physician that refers the patient to specialists.
  • PPO – Preferred Provider Organization; allows the patient to visit whatever in-network physician or healthcare provider they like without first requiring a referral from a primary care physician.
  • POS – Point-of-Service plan; a type of managed care plan that is a hybrid between an HMO and a PPO. Participants in a POS plan designate an in-network primary care provider however they may go outside of the provider network for health care services.
  • PCMH – Patient Centered Medical Homes; a medical home model of care where providers and care teams meet patients at home for both routine exams and complex conditions.
  • ACO - Accountable Care Organizations or Payment for Performance; groups of doctors, hospitals and healthcare providers that voluntarily give coordinated care to their Medicare patients.
  • Hospice Care – end of life care to help patients who are dying have peace, comfort and dignity.
  • Collaborative Care Model – a model for integrating mental health care into primary care medical settings. Collaborative Care works to improve the physical and mental health of people with mental illness.
  • Medicare – the federal health insurance program that provides health benefits to Americans age 65 and older. Medicare Part A covers hospital services and Medicare Part B covers doctor services.
  • Medicaid – a health insurance program, funded by federal and state governments, that provides health benefits to low-income individuals who cannot afford Medicare.

Insurance Terminology

Medical assistants will need to become familiar with common insurance terminology to process insurance billing and claims. The patient will also need explanation of insurance terminology from the medical assistant. For a glossary of insurance terminology visit Healthcare.gov. The following is a subset of insurance terms:

  • Co-Payment – the amount owed, by a patient, after the benefit plan has paid the medical fee
  • Deductible – the amount of money that the patient must pay for medical services before the insurance company pays benefits.
  • Out-of-Pocket Costs – the amount the patient is responsible for paying above the annual maximum.
  • Health Savings Account (HAS) – savings account that lets patients put aside money on a pre-tax basis to pay for qualified medical expenses.
  • Coverage – medical benefits covered under a medical benefit plan.
  • Formulary – a list of prescription drugs covered by a prescription drug plan.
  • COBRA – federal law that allows patients to temporarily keep health coverage after employment termination.
  • HIPPA – Health Insurance Portability and Accountability Act (HIPAA) of 1996; a federal law that includes Administrative Simplification Provisions that require all health plans to use a standard format for electronic exchange, privacy and security of health information.

Insurance Coding and Billing

Some medical terminology coincides with coding standards set forth to standardize medical coding from physician to physician and throughout a healthcare system. Using the ICD-10-CM, CPT and HCPCS coding standards allows physicians, healthcare facilities and insurance companies properly treat patients and process claims.

  • ICD-10-CM - The International Classification of Diseases, Clinical Modification is a system used by healthcare providers to classify and code all diagnoses, symptoms and procedures in conjunction with hospital care.
  • CPT – Current Procedural Terminology; a medical code set used to report medical, surgical and diagnostic procedures to physicians and health insurance companies.
  • HCPCS – Healthcare Common Procedure Coding System; coding for health care services such as ambulance, durable medical equipment, prosthetics, orthotics and other supplies used outside of a physician’s office.

Common Medical Abbreviations, Acronyms, and Symbols

There are hundreds of common medical abbreviations and acronyms. To learn more about medical abbreviations and acronyms visit Medicinenet.com.

  • ACL – abbreviation for anterior cruciate ligament; ACL injuries are one of the most common ligament injuries to the knee.
  • ADHD – abbreviation for attention deficit hyperactivity disorder
  • BP – abbreviation for blood pressure
  • CBC – abbreviation for complete blood count
  • COPD – abbreviation for chronic obstructive pulmonary disease
  • CPAP – abbreviation for continuous positive airway pressure
  • SIDS – abbreviation for sudden infant death syndrome
  • “+” - symbol for positive
  • “–“ – symbol for negative

Medical Conditions, Procedures, and Instruments

To learn about the different medical conditions visit Medicinenet.com. The following is a subset of medical conditions, procedures and instruments:

  • AIDS – condition called Acquired Immunodeficiency Syndrome which is an advanced stage of infection with the Human Immunodeficiency Virus (HIV).
  • Cancer – the uncontrolled growth of abnormal cells anywhere in the body.
  • Rheumatoid Arthritis – condition that causes chronic inflammation of the joints and other areas of the body.
  • Asthma – condition causing chronic inflammation of the bronchial tubes making them swell, narrowing the airway.
  • Migraine – condition of having periodic attacks of headaches on one or both sides of the head.
  • Alzheimer’s Disease – a condition causing physical and functional changes in the brain leading to memory loss and dementia.
  • Biopsy – medical procedure that extracts a sample of tissue for examination to determine the presence of a disease.
  • Chemotherapy – medical procedure used to treat cancer and prolong the life of the patient.
  • Vaccination – medical procedure that provides active acquired immunity to a particular disease.
  • CAT Scan – medical procedure that takes images of the structures within the body.
  • Ultrasound – radiology technique using high-frequency sound waves to produce images of the organs and structures of the body.
  • Forceps – medical instrument used to grasp and hold an object.
  • Scalpel – medical instrument used to cut the skin
  • Suture – medical instrument used to hold body tissue together after surgery.
  • Stethoscope – medical instrument used to hear sounds from movements within the body including heart beat and breath sounds.
  • Reflex Hammer – medical instrument used to test the motor reflexes of the body.
  • Thermometer – medical instrument used to record a patient’s body temperature.
  • Otoscope – medical instrument used to look into the external ear cavity.

Medical Word Building (prefixes, suffixes, plurals)

To learn many of the important prefixes and suffixes, visit Quizlet Medical Terminology 350. To learn about forming medical plural terms visit How to Derive a Plural in Medical Terminology. The following is a subset of medical prefixes and suffixes:

  • Cardi – prefix for the heart
  • Cerebr – prefix for the brain
  • Gastr – prefix for the stomach
  • Hyper – prefix for above normal
  • Hypo – prefix for below normal
  • otomy – suffix meaning to cut into
  • ologist – suffix meaning specialist

Positional and Directional Terminology

Positional and directional terms describe anatomical positioning. To learn more about positional and directional terminology visit Quizlet Flash Cards. The following are a subset of positional and directional terms:

  • Anterior (ventral) – front side of the body
  • Posterior (dorsal) – back side of the body
  • Lateral – pertaining to the side
  • Medial – pertaining to the middle of the body
  • Supine – lying on one’s back
  • Prone – lying on one’s belly

Do these medical terms interest you? Want to become a medical assistant? The Medical Assisting program at Daymar College is designed to prepare current and future employees for the fast-paced changes encountered in the health care industry, and to help develop training, skills and attitudes necessary to excel in medical assisting. Contact us to learn more about a great opportunity to become a medical assistant.