A nurse is working with a case manager for a client who participates in a health maintenance organization. The nurse should identify that a health maintenance organization provides which of the following payment structures?

The provider bills the client directly for a predetermined percentage of the cost of services.

The provider is paid a fixed sum for the client on a monthly or yearly basis.

The client is participating in a fee-for-service health care insurance program.

The client pays the insurer a percentage of the total costs for each service rendered by the provider.

Answer and Explanation

The Correct Answer is B

Answer is b. The provider is paid a fixed sum for the client on a monthly or yearly basis.

A health maintenance organization (HMO) is a type of health insurance that contracts with a network of providers and facilities to offer care at a discounted rate. The HMO pays the provider a fixed sum for each client, regardless of the services they use. This is called capitation³. The HMO also requires the client to have a primary care provider who coordinates their care and makes referrals to specialists².

a. This statement is wrong because it describes a co-payment, which is a fixed amount that the client pays for each service. Co-payments are usually low in HMOs, but they are not the main payment structure².
c. This statement is wrong because it describes a fee-for-service health care insurance program, which is the opposite of an HMO. In a fee-for-service program, the client pays the insurer for each service they use, and the insurer reimburses the provider. This gives the client more freedom to choose their provider, but it also increases the cost of health care¹.
d. This statement is wrong because it describes a co-insurance, which is a percentage of the total cost that the client pays for each service. Co-insurance is more common in preferred provider organizations (PPOs), which are another type of health insurance that offer more flexibility than HMOs, but also higher premiums

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Correct Answer is C

Explanation

A.While insurance coverage is important, it is not a criterion for qualifying for hospice care. Hospice care focuses on providing comfort and support to terminally ill patients, regardless of insurance coverage.

B.Hospice care can be provided in various settings, including the home, hospice facilities, or inpatient units. The need for inpatient care due to a lack of a caregiver is not a criterion for hospice eligibility; rather, hospice focuses on the terminal nature of the illness.

C.Hospice careis a service for people with serious illnesses who choose not to get (or continue) treatment to cure or control their illness. People may choose to enroll in hospice care if the treatment is unlikely to be effective or if continuing it has become too burdensome.

D.Choice D states that the client has documentation stating they have less than 12 months to live. However, for hospice care eligibility, the standard criterion is a life expectancy ofsix months or less, as certified by a physician. This is a key distinction, as hospice care focuses on providing comfort and support during the final months of life, rather than extending life expectancy.

A. Native American cultural practices include being outspoken about pain. B. Puerto Rican cultural practices include the view that outspoken expressions of pain are shameful. C. Middle Eastern cultural practices include hiding pain from close family members. D. Chinese cultural practices include enduring pain to prevent family dishonor.

Correct Answer is B

Explanation

Cultural variances in the expression of pain can impact the assessment and management of pain. It is important to recognize and respect these cultural differences to provide culturally sensitive care. Puerto Rican cultural practices consider the expression of pain as a private matter, and individuals may not express their pain openly, as it may be viewed as a weakness or shameful. In contrast, Native American cultural practices often consider pain as a sign of strength, and individuals may express pain openly to receive validation and support from their community. Chinese cultural practices emphasize the importance of stoicism, and individuals may endure pain to prevent family dishonor. Middle Eastern cultural practices may consider pain as a test of faith, and individuals may hide their pain from close family members to avoid burdening them. By understanding these cultural variances, nurses can assess pain more effectively and develop culturally sensitive pain management plans.

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A nurse is working with a case manager for a client who participates in a health maintenance organization. The nurse should identify that a health maintenance organization provides which of the following payment structures?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse working for a hospice organization should identify which of the following criteria that must be met for a client to qualify for hospice care?

Correct Answer is C

Explanation

A nurse at a community clinic is preparing an educational guide about cultural variances in expression of pain. Which of the following information should the nurse include?

Correct Answer is B

Explanation

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