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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Related Questions
Correct Answer is C
Explanation
State health departments are responsible for monitoring and reporting communicable diseases within their respective states to the Centers for Disease Control and Prevention. Lyme disease is a nationally notifiable disease, which means that cases must be reported to the Centers for Disease Control and Prevention by the state health department.
Correct Answer is B
Explanation
Referring clients to the appropriate community agency if signs of abuse are evident is an example of secondary prevention. Secondary prevention aims to detect and treat a disease or condition early on to prevent it from progressing. In this case, referring clients to an agency that can provide support and resources for individuals experiencing abuse can prevent the abuse from escalating or becoming more severe.
Option Ais an example of tertiary prevention, which aims to minimize the impact of an already established disease or condition by maximizing function and preventing complications.
Option Cis an example of primary prevention and health promotion, which aims to improve overall health and well-being.
Option Dis an example of primary prevention, which aims to prevent a disease or condition from occurring in the first place.
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