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.
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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choiceb. Herpes simplex.
Choice A rationale:
Diphtheria requires droplet precautions because it is primarily spread through respiratory droplets when an infected person coughs or sneezes.
Choice B rationale:
Herpes simplex requires contact precautions because it is spread through direct contact with infected lesions or body fluids.
Choice C rationale:
Pulmonary tuberculosis requires airborne precautions due to its transmission through airborne particles when an infected person coughs, sneezes, or talks.
Choice D rationale:
Pertussis, also known as whooping cough, requires droplet precautions as it spreads through respiratory droplets.
Correct Answer is A
Explanation
The correct answer is choice A, "Seizures." Manifestations of alcohol withdrawal can vary depending on the severity of the addiction, the duration and frequency of alcohol consumption, and the presence of other medical conditions. Seizures are a common manifestation of alcohol withdrawal, which can occur within 6 to 48 hours after the last drink. Other manifestations of alcohol withdrawal include tremors, anxiety, sweating, nausea and vomiting, tachycardia, hypertension, and hallucinations. These manifestations can be severe and life-threatening, especially if not managed appropriately. It is essential to monitor clients with alcohol withdrawal closely, administer medications as ordered, and ensure that clients receive appropriate medical care to prevent complications and promote recovery.
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