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 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 healthcare insurance program.
The provider is paid a fixed sum for the client on a monthly or yearly basis.
The Correct Answer is D
In a health maintenance organization (HMO), the provider is paid a set amount of money for each client enrolled in the program. This payment structure is known as capitation.
The provider is responsible for providing all necessary healthcare services to the client within the confines of the capitated payment.
The client is not required to pay the provider directly for any services rendered within the HMO network.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The client's statement that they are afraid of experiencing pain near the end of life may indicate a risk for suicide, as it suggests that the client may be considering suicide as a way to avoid the anticipated pain. The other statements do not necessarily indicate a risk for suicide.
Statement a) may indicate a desire to maintain autonomy and control over their healthcare decisions.
Statement b) may indicate a hopeful attitude, which can be a protective factor against suicide.
Statement d) may indicate a reliance on social support, which can also be a protective factor against suicide.
Correct Answer is C
Explanation
This indicates that the client may have internal bleeding, which is a life-threatening condition that requires immediate medical attention. The nurse should provide supportive care, such as administering oxygen, and arrange for rapid transport to a trauma center.
The client with superficial partial-thickness burn injuries over 5% of his body may require medical attention, but this is not immediately life-threatening.
The client who is ambulatory and exhibits manic behavior may require psychological support, but this is not a priority in the acute phase of a traumatic event.
The client who has a femur fracture with a 2+ pedal pulse may require immobilization and pain management, but this is also not a priority in the acute phase of a traumatic event.
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