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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Contact precautions are used for infections that are spread through direct or indirect contact with a patient or their environment. In the case of herpes simplex, the virus is spread through contact with lesions or secretions from an infected individual.
Option b requires airborne precautions, as tuberculosis is spread through the air.
Option c requires droplet precautions, as diphtheria is spread through respiratory droplets.
Option d also requires droplet precautions, as pertussis is also spread through respiratory droplets.
Correct Answer is B
Explanation
The first priority in discharge planning for this client should be to arrange for a home health nurse to visit the client following discharge to monitor the client's health and provide support. The client's condition is complex and requires ongoing monitoring and support to prevent relapse and ensure safety.
Providing the client with information on self-help groups and determining home safety measures are also important components of the discharge plan, but they should come after ensuring that the client has the necessary support in place. Contacting a social worker to assist with managing finances is not a priority at this time.
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