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 is paid a fixed sum for the client on a monthly or yearly basis.
The provider bills the client directly for a predetermined percentage of the cost of services.
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 client pays the insurer a percentage of the total costs for each service rendered by the provider.
The Correct Answer is A
The correct answer is Choice A because, "The provider is paid a fixed sum for the client on a monthly or yearly basis." A health maintenance organization (HMO) provides a fixed payment to the provider for the client on a monthly or yearly basis.
Choice B is wrong because, "The provider bills the client directly for a predetermined percentage of the cost of services," is not the correct answer. This is an example of a fee-forservice payment structure, not an HMO payment structure.
Choice C is wrong because, "The client is participating in a fee-for-service health care insurance program," is not the correct answer. This is not an HMO payment structure.
Choice D is wrong because, "The client pays the insurer a percentage of the total costs for each service rendered by the provider," is not the correct answer. This is an example of a preferred provider organization payment structure, not an HMO payment structure.
Explanation: An HMO provides a fixed payment to the provider for the client on a
monthly or yearly basis. The provider billing the client directly for a
predetermined percentage of the cost of services, the client participating in a feefor-service health care insurance program, and the client paying the insurer a percentage of the total costs for each service rendered by the provider are not examples of HMO payment structures.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is Choice A because "Assess the client's need for wound care supplies." Planning for wound care supplies is essential for a client who has a major burn injury. Wound care is crucial to prevent complications such as infection, and the case manager must ensure that the client has access to the appropriate wound care supplies.
Choice B is wrong because, "Provide physical and occupational therapy for the client in her home," is not the correct answer because physical and occupational therapy are interventions provided by therapists and not case managers. Choice C is wrong because, "Deliver family counseling to members of the client's household," is an example of psychosocial support and is not the primary responsibility of the case manager. Choice D is wrong because, "Administer personal care with bathing, dressing, and meal preparation for the client," is an intervention that is typically provided by home health aides and not case managers.
Correct Answer is A
Explanation
The correct answer is Choice A because, "Describe the place where you are currently living." Asking the client to describe their living situation will provide the case manager with information about the client's home environment and help identify any potential barriers to safe care. This information can then be used to develop a safe and effective discharge plan, which may include arranging for a special bed at home.
Choice B is wrong because, "Apply moisture barrier ointment three times a day," is not the correct answer because it focuses on a specific aspect of the client's care, rather than considering the broader context of their living situation. Choice C is wrong because, "Eat a balanced diet with high-protein snacks," is not the correct answer as it also focuses on the client's care, rather than their living situation. Choice D is wrong because, "A social worker can help you with the cost of supplies," is not the correct answer as it may not be the most pressing concern at the time of discharge planning.
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