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 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 health care insurance program.
The Correct Answer is A
A. In a health maintenance organization (HMO), providers typically receive a fixed sum (capitation) for each client enrolled, regardless of the services provided.
B. Billing the client directly for services rendered is more typical of fee-for-service or cost-sharing arrangements.
C. This option describes a cost-sharing model where the client pays a portion of the service costs, common in some insurance plans but not HMOs.
D. Fee-for-service insurance involves providers billing for each service provided, not typical in HMOs where payments are typically fixed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
A. Teaching about the risks of cigarette smoking is a primary prevention activity aimed at preventing initiation and to promote overall lung health.
B. Promoting skateboard safety is a primary prevention measure to reduce injuries before they occur.
C. Recommending seating arrangements for a child in a body cast is a secondary prevention measure.
D. Creating a plan of care for children with diabetes is a tertiary prevention activity.
E. Lobbying for funding is also a form of primary prevention, as it seeks to secure resources necessary to support ongoing and future health education and preventive programs.
Correct Answer is D
Explanation
A. Informing clients about community support is important but not as immediate as ensuring safety and recovery.
B. Spiritual support, while significant, should follow clinical needs and safety concerns.
C. Dietary consultations are valuable but are not typically as urgent as physical therapy needs post-surgery.
D. Informing the physical therapist about activity restrictions is crucial for ensuring safe recovery and rehabilitation.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.