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 client pays the insurer a percentage of the total costs for each service rendered by the provider.
The client is participating in a fee-for-service healthcare insurance program.
The provider is paid a fixed sum for the client on a monthly or yearly basis.
The Correct Answer is D
In a health maintenance organization (HMO), the provider is paid a set amount of money for each client enrolled in the program. This payment structure is known as capitation.
The provider is responsible for providing all necessary healthcare services to the client within the confines of the capitated payment.
The client is not required to pay the provider directly for any services rendered within the HMO network.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The client has documentation stating he has less than 12 months to live.
Hospice care is a type of palliative care that focuses on providing comfort and support to individuals who are in the end stages of a terminal illness. In order to qualify for hospice care, a client must have documentation from a physician stating that they have a life expectancy of six months or less if their illness follows its normal course.
The client's insurance coverage may vary, but it is not a determining factor in qualifying for hospice care.
The decision to decline life-prolonging treatments is a personal one that may align with a client's end-of-life goals, but it is not a requirement for hospice care.
Finally, the need for inpatient care due to a lack of caregiver support may be a factor in determining the most appropriate level of care, but it is not a requirement for hospice care.
Correct Answer is B
Explanation
This statement is appropriate because it is a recommended preventive health measure for women in this age group to detect any potential eye problems early on.
Option A is incorrect because the American Diabetes Association recommends that individuals over the age of 45 should have their fasting blood glucose level checked every 3 years, not every 6 years.
Option C is incorrect because the United States Preventive Services Task Force does not recommend routine hearing screening in adults who do not have any symptoms of hearing loss.
Option D is incorrect because the American Cancer Society recommends that individuals over the age of 50 should have a screening colonoscopy every 10 years or a fecal occult blood test every year, not every other year until the age of 74.
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