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 B
Explanation
The correct answer is Choice B because, "Teaching parenting techniques to new parents." This is the correct answer because it is a primary prevention strategy aimed at reducing violence and abuse in the local community.
Choice A is wrong because, "Providing treatment for a young adult who has a substance use disorder," is not the correct answer because it is a tertiary prevention strategy aimed at treating an individual after they have developed a substance use disorder.
Choice C is wrong because, "Conducting counseling for at-risk parents," is not the correct answer because it is a secondary prevention strategy aimed at reducing the risk of violence and abuse in families who are at-risk.
Choice D is wrong because, "Assessing a family for marital discord," is not the correct answer because it is a secondary prevention strategy aimed at identifying and addressing issues within a family, but it is not specifically related to violence and abuse.
Correct Answer is D
Explanation
The correct answer is Choice A because, Double-bag soiled dressings in polyethylene bags. The nurse should double-bag soiled dressings in polyethylene bags to contain the infection and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA). The bags should be securely tied and labeled as contaminated.
Choice B is wrong because, Encourage the client to use a HEPA filter in the house, is not the correct answer because a HEPA filter is not effective in controlling the spread of MRSA.
Choice C is wrong because, Wear a mask when within 3 feet of the client, is not the correct answer because wearing a mask is not necessary unless the nurse is providing direct care to the client and is within 3 feet of them.
Choice D is wrong because, Remove fresh flowers from the client's home, is not the correct answer because fresh flowers are not a source of MRSA.
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