A nurse is collaborating with a case manager for a client who is part of a health maintenance organization. Which of the following payment structures does a health maintenance organization typically use?
The provider directly bills the client for a predetermined percentage of the cost of services.
The client pays the insurer a percentage of the total costs for each service provided.
The provider receives a fixed sum from the client on a monthly or yearly basis.
The client pays the provider directly for each individual service rendered.
The Correct Answer is C
Choice A rationale
While it’s true that some healthcare providers may bill clients directly for a predetermined percentage of the cost of services, this is not typically how health maintenance organizations (HMOs) operate. In an HMO, the provider usually has a contract with the HMO and receives payment directly from the HMO, not the client.
Choice B rationale
This choice describes a type of cost-sharing arrangement known as coinsurance, where the client pays a percentage of the total costs for each service provided. However, this is more characteristic of certain types of insurance plans, such as preferred provider organizations (PPOs), rather than HMOs.
Choice C rationale
This is the correct answer. In an HMO, the provider typically receives a fixed sum from the HMO on a monthly or yearly basis, regardless of the number of services rendered. This payment structure is known as capitation.
Choice D rationale
This choice describes a fee-for-service payment structure, where the client pays the provider directly for each individual service rendered. While this was a common payment method in the past, it is not typically used by HMOs. In an HMO, the provider usually receives payment directly from the HMO, not from the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Organizing an event to improve the morale of the home health staff is a good practice for maintaining a positive work environment. However, it does not directly provide feedback regarding care quality.
Choice B rationale
Teaching clients’ family members how to care for a wound in the home setting is an important part of a home health nurse’s role. It ensures continuity of care and empowers family members to participate in the care process. However, this activity does not provide direct feedback on care quality.
Choice C rationale
Orienting staff members to a new piece of equipment that will be used in the home setting is crucial for ensuring safe and effective care. However, this activity does not provide direct feedback on care quality.
Choice D rationale
Tracking the number of postoperative clients who are readmitted to the acute care facility is the correct answer. This activity provides direct feedback on the quality of care provided by the home health agency. A high readmission rate may indicate issues with discharge planning, patient education, or follow-up care.
Correct Answer is A
Explanation
Choice A rationale
The first action to take in the initial phase of planning a smoking cessation program should be to determine the prevalence of smoking in the community. This is important because it helps to understand the magnitude of the problem and the potential impact of the program. It also helps in setting realistic goals for the program and in securing funding and other resources.
Choice B rationale
While formulating objectives for the smoking cessation program is an important step, it should come after determining the prevalence of smoking in the community. The objectives should be based on the needs and characteristics of the target population, which can only be understood by first assessing the prevalence.
Choice C rationale
Gaining community support for the program is crucial for its success. However, this should come after the prevalence of smoking has been determined and objectives for the program have been formulated.
Choice D rationale
Evaluating the methods of successful smoking cessation programs can provide valuable insights for planning the program. However, this should not be the first action. The first step should be to understand the extent of the problem in the community.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.