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 C
Explanation
The correct answer is Choice C because, "Refer clients to the appropriate community agency if signs of abuse are evident." This is the correct answer because it is an appropriate secondary prevention strategy related to violence and abuse. By referring clients to the appropriate community agency, the nurse is providing a proactive measure to prevent further harm and ensure that the client receives appropriate care.
Choice Ais wrong because, "Teach a parenting skills class at a child development center," is not the correct answer because it is a primary prevention strategy and not related to violence and abuse.
Choice Bis wrong because, "Assess clients for withdrawal and passivity during home health visits," is not the correct answer because it is a secondary prevention strategy related to depression, not violence and abuse.
Choice Dis wrong because, "Coordinate a personal defense program at a local agency," is not the correct answer because it is a tertiary prevention strategy and not related to violence and abuse.
Correct Answer is B
Explanation
The correct answer is Choice B because, "I have to turn my head completely to see things that are beside me." This statement suggests the possibility of impaired peripheral vision, which could be a safety concern. The nurse should assess further and possibly refer the client for further evaluation.
Choice A is wrong because, "I have to change my hearing aid battery weekly," is not the correct answer as it is a routine self-care task for individuals with hearing aids. Choice C is wrong because, "I prepare my medications for the week on Sundays," is not the correct answer as it is a routine self-care task for individuals who take multiple medications. Choice D is wrong because, "I prepare all of my own meals," is not the correct answer as it is a routine selfcare task for many individuals.
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