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 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 client pays the insurer a percentage of the total costs for each service rendered by the provider.
The Correct Answer is A
The correct answer is Choice A because, "The provider is paid a fixed sum for the client on a monthly or yearly basis." A health maintenance organization (HMO) provides a fixed payment to the provider for the client on a monthly or yearly basis.
Choice B is wrong because, "The provider bills the client directly for a predetermined percentage of the cost of services," is not the correct answer. This is an example of a fee-forservice payment structure, not an HMO payment structure.
Choice C is wrong because, "The client is participating in a fee-for-service health care insurance program," is not the correct answer. This is not an HMO payment structure.
Choice D is wrong because, "The client pays the insurer a percentage of the total costs for each service rendered by the provider," is not the correct answer. This is an example of a preferred provider organization payment structure, not an HMO payment structure.
Explanation: An HMO provides a fixed payment to the provider for the client on a
monthly or yearly basis. The provider billing the client directly for a
predetermined percentage of the cost of services, the client participating in a feefor-service health care insurance program, and the client paying the insurer a percentage of the total costs for each service rendered by the provider are not examples of HMO payment structures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A"]
Explanation
The correct answer is Choice A because, "Offer to face the client's bed toward the east." This is the correct answer because traditional American Indian practices include spiritual and cultural beliefs that may require facing the client's bed towards the east.
Choice B is wrong because, "Provide direct eye contact when communicating with the client's family," is not the correct answer because direct eye contact may be seen as disrespectful in some American Indian cultures.
Choice C is wrong because, "Develop a list of appropriate hot and cold food choices," is not the correct answer because it is not specific to traditional American Indian practices.
Choice D is wrong because, "Discuss safe use of herbal medications," is not the correct answer because it is not specific to traditional American Indian practices and may be considered invasive or disrespectful in some cultures.
Correct Answer is C
Explanation
The correct answer is Choice C because, "Motor vehicle safety," as it is the leading cause of death for adolescents. The nurse should prioritize educating the adolescents on how to be safe while driving or riding in a car, such as always wearing a seatbelt and not drinking and driving.
Choice A is wrong because, "Substance abuse prevention," is not the correct answer as it is important to address but not the leading cause of death for adolescents. Choice B is wrong because, "Sports injury prevention," is also not the correct answer as it is not the leading cause of death for adolescents, although it is important to educate on injury prevention. Choice D is wrong because, "Gun safety," is also not the correct answer as it is not the leading cause of death for adolescents.
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