A nurse is collaborating with a case manager for a client who is part of a health maintenance organization. Which of the following payment structures does a health maintenance organization typically use?

The provider directly bills the client for a predetermined percentage of the cost of services.

The client pays the insurer a percentage of the total costs for each service provided.

The provider receives a fixed sum from the client on a monthly or yearly basis.

The client pays the provider directly for each individual service rendered.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While it’s true that some healthcare providers may bill clients directly for a predetermined percentage of the cost of services, this is not typically how health maintenance organizations (HMOs) operate. In an HMO, the provider usually has a contract with the HMO and receives payment directly from the HMO, not the client.

Choice B rationale

This choice describes a type of cost-sharing arrangement known as coinsurance, where the client pays a percentage of the total costs for each service provided. However, this is more characteristic of certain types of insurance plans, such as preferred provider organizations (PPOs), rather than HMOs.

Choice C rationale

This is the correct answer. In an HMO, the provider typically receives a fixed sum from the HMO on a monthly or yearly basis, regardless of the number of services rendered. This payment structure is known as capitation.

Choice D rationale

This choice describes a fee-for-service payment structure, where the client pays the provider directly for each individual service rendered. While this was a common payment method in the past, it is not typically used by HMOs. In an HMO, the provider usually receives payment directly from the HMO, not from the client.

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Correct Answer is D

Explanation

Choice A rationale

Evaluating the effectiveness of local disaster-preparedness drills is an important step in disaster management. However, it is not the first action to take when developing a disaster- preparedness plan. This step usually comes later, after identifying the community’s risks and capabilities, assembling a team, and providing education.

Choice B rationale

Assembling an emergency disaster response team is crucial in disaster management. However, before assembling a team, it is important to first identify the community’s risks and capabilities. This will help in determining the composition and roles of the team members.

Choice C rationale

Providing education about first aid and triage is an essential part of disaster preparedness. However, this is not the first step. Before providing education, it is important to first understand the community’s risks and capabilities.

Choice D rationale

Identifying the community’s risks and capabilities is the first action to take when developing a disaster-preparedness plan. This involves determining what natural disasters the community is likely to face and the community’s capacity to respond to these disasters.

A. Request a referral for a social worker. B. Discuss the client’s wishes with their provider. C. Ask the client why they do not want to continue treatment. D. Instruct the client that they need to change their advance directives first.

Correct Answer is C

Explanation

Choice A rationale

Requesting a referral for a social worker may be beneficial in some cases, but it is not the most appropriate initial response. The nurse should first seek to understand the client’s feelings and concerns.

Choice B rationale

Discussing the client’s wishes with their provider is important, but it should come after understanding the client’s perspective. The nurse should respect the client’s autonomy and privacy.

Choice C rationale

This is the correct answer. The nurse should ask the client why they do not want to continue treatment. This allows the nurse to understand the client’s perspective, provide emotional support, and ensure that the client is making an informed decision.

Choice D rationale

Instructing the client to change their advance directives first is not the most appropriate initial response. While advance directives are important legal documents that express a client’s wishes for medical treatment, the nurse should first seek to understand the client’s feelings and concerns.

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A nurse is collaborating with a case manager for a client who is part of a health maintenance organization. Which of the following payment structures does a health maintenance organization typically use?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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