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 provider is paid a fixed sum for the client on a monthly or yearly basis.
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 Correct Answer is B
Answer is b. The provider is paid a fixed sum for the client on a monthly or yearly basis.
A health maintenance organization (HMO) is a type of health insurance that contracts with a network of providers and facilities to offer care at a discounted rate. The HMO pays the provider a fixed sum for each client, regardless of the services they use. This is called capitation³. The HMO also requires the client to have a primary care provider who coordinates their care and makes referrals to specialists².
a. This statement is wrong because it describes a co-payment, which is a fixed amount that the client pays for each service. Co-payments are usually low in HMOs, but they are not the main payment structure².
c. This statement is wrong because it describes a fee-for-service health care insurance program, which is the opposite of an HMO. In a fee-for-service program, the client pays the insurer for each service they use, and the insurer reimburses the provider. This gives the client more freedom to choose their provider, but it also increases the cost of health care¹.
d. This statement is wrong because it describes a co-insurance, which is a percentage of the total cost that the client pays for each service. Co-insurance is more common in preferred provider organizations (PPOs), which are another type of health insurance that offer more flexibility than HMOs, but also higher premiums
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is choice D. Agricultural workers who are exposed to pesticides are at risk for dizziness, headache, nausea, and vomiting. Dizziness is a common acute effect of pesticide exposure. Hypoglycemia is not a common effect of pesticide exposure, although it can occur in some cases of organophosphate poisoning. Oliguria is a decrease in urine output, and diplopia is a condition where an individual experiences double vision, neither of which is commonly associated with acute pesticide exposure.
Correct Answer is B
Explanation
The correct answer is choice B, "Immunizing the clients against influenza." This is the priority for the nurse to include because older adults are at increased risk for complications from influenza. Immunization against influenza can help prevent serious illness and death in this population. While exercise, a low-fat diet, and dental examinations are important health promotion strategies for older adults, they are not as high a priority as influenza immunization. 
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