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, the test measures serum levels of HIV antibodies. Enzyme-linked immunosorbent assay (ELISA) testing is a screening test for HIV infection, which measures the presence of HIV antibodies in the blood.
Choice B is wrong because, the test monitors the progression of HIV, is incorrect as the ELISA test only indicates the presence of HIV antibodies in the blood, and does not monitor the progression of HIV. Choice C is wrong because, the test results are accurate 24 hr after HIV exposure, is incorrect as it takes at least 2-4 weeks for HIV antibodies to develop in the blood after exposure to the virus. Choice D is wrong because, a positive result indicates initiation of immunoglobulin administration, is incorrect as there is no treatment for HIV with immunoglobulin.
Correct Answer is B
Explanation
The correct answer is Choice B because, don personal protective equipment. The nurse should protect herself first by putting on personal protective equipment to prevent contamination and further spread of the suspected bioterrorism agent.
Choice A is wrong because, report the client's condition to the Federal Bureau of Investigation, is incorrect as this is not the primary role of the nurse, and the client's condition should be reported to the local public health department. Choice C is wrong because, disinfect contaminated areas of skin with isopropyl alcohol, is incorrect as this is not a recommended treatment for bioterrorism-related illnesses, and the nurse should avoid touching the client or any contaminated items. Choice D is wrong because, move the client to a quarantine area, is incorrect as the nurse should not move the client, but instead limit contact with the client and follow established infection control protocols.
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