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 ["A","D","E"]
Explanation
The correct answers are A, D, and E. Primary prevention activities aim to prevent the onset of disease or injury. Teaching a class about the risks of cigarette smoking and organizing a program to promote skateboard safety are examples of primary prevention activities. Lobbying for funding for health promotion efforts is also a primary prevention activity because it aims to prevent the occurrence of illness or injury in the community. Creating a plan of care for children who have a diagnosis of diabetes mellitus and recommending a seating arrangement for a child in a body cast are examples of secondary prevention activities, which aim to detect and treat health problems early to prevent complications.
Correct Answer is ["B","C","D"]
Explanation
The correct answers are B, C, and D. The nurse should assist the client in using guided imagery, maintain the head of the client's bed in an elevated position after eating, and provide sips of room-temperature ginger ale between meals. Guided imagery can help distract the client from the nausea and promote relaxation.
Elevating the head of the bed after eating can help prevent reflux and nausea. Ginger ale can help relieve nausea and can be sipped slowly between meals. Using seasonings to enhance the flavor of foods is not likely to help with chemotherapyinduced nausea, and cold milk as a meal replacement may not provide enough calories and nutrients.
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