The EOB is generated when your provider submits a claim for the services you received. What Is a “Business Associate?”. a joint funding program by federal and state governments (excluding Arizona) for low-income patients on public assistance for their medical care. A. Case managers do not use the nursing process. 107 Cards in this Set. Each Managed Care Organization offered total health care for a predetermined monthly fee. The traditional fee-for-service program offered directly through the federal government. The managed care plan offered through private insurance companies. The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). Which of the following antiretroviral therapy regimens should the pharmacist recommend for this patient? These include provider networks, provider oversight, prescription drug tiers, and more. The following is intended to provide some general guidance on the statute, the regulations which implement it, and the reported cases which interpret it. No one engaged in any part of health care delivery or planning today can fail to sense the immense changes on the horizon, even if the silhouettes of those changes, let alone the details, are in dispute. b. Physicians are paid a flat per-member per-month fee for basic health care services, regardless of whether their services are used by the patient HMO's are heavily regulated by federal and state laws, which vary by state. Perhaps the most widely discussed is the expansion of eligibility to adults with incomes up to 133 percent of the federal poverty level (FPL). Definition. continue getting care no longer considered medically reasonable or necessary, you must issue the notice before the patient gets the non-covered care in order to transfer financial liability. Term. Members who choose outside providers will be billed a deductible and higher co-payment to reflect the physician’s fees. All of the following are examples of managed care plans except. Which of the following statements accurately describes the clinical nurse leader (CNL)? Managed care plans are health insurance plans with the goal of managing two major aspects of healthcare: cost and quality. Involvement of the medical staff is critical in all patient safety projects. It attempts to control costs by modifying the behavior of providers and patients. To be eligible, a primary care physician must work in and have the ability to make referrals among the network providers. These providers and facilities all have to meet a minimum level of quality. B. The Code of Ethics for Nurses uses the term patient to refer to recipients of nursing care. The derivation of this word All of the following are characteristics of PPOs except: A) flexibility B) managed health care C) limited physician choice D) fixed fee medical services View Answer Term. The purpose of managed health care insurance plans is to A. ... Pharmacy/Chain C. Hospital/Health Systems D. Administrative/Pharmacy Director E. Critical Care Pharmacy F. Long-term Care G. Managed Care/PBM H. Oncology I. C. After insertion, the cervix should be smoothly covered. A flexible benefits plan typically: Allows employees to select the benefits they prefer from options established by the employer. The value-based care model ties medical payments to the quality of care provided (like not being readmitted to the hospital within a certain time frame). The Marketing guidelines reflect CMS' interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare Prescription Drug Benefit rules (Chapter 42 of the Code of Federal Regulations, Parts 422 and 423). Back. Which of the following statements accurately describe an aspect of managed care? •Understand customer need. C. Projects should focus on medical errors. Direct clinical practice is a core competency of any APN role, although the actual skill set varies according to the needs of the patient population. Specialty Pharmacy J. Industry/Manufacturing. a. The term “managed care” is used to describe a type of health care focused on helping to reduce costs, while keeping quality of care high. Show Result. Health plans are entities that provide or pay the cost of medical care, such as private health insurers or managed care organizations, and governmental payors and health programs such as Medicaid, Medicare, or Veterans Affairs. A nursing process is written together with a nursing care plan. The Nurse Practice Act regulates the licensing and practice of nursing; it describes the scope of practice. A. As she pays her co-payment, she says "Oh dear, the doctor told me to see someone, but I can't remember what he said. Which of the following statements about the nursing process is true. c. That information is a valuable resource that must be managed no matter what form it takes. A health maintenance organization (HMO) is a form of health care that provides services for a fixed period on a prepaid basis. “Transgender” describes a person's gender D. They can all describe either a person's orientation or … Section 2. D. provided by the same physician. The following are examples of hospital joint ventures that are unlikely to raise significant antitrust concerns. E) The managed care system may required approval for specialty care. In general, there are three levels of public health - local, state, and federal. D. Cats have a renal portal elimination system whereby diazepam … The following is a list of certain key issues with respect to the MCO’s relationship with its members: Access To Care. 26. 33. A managed care plan’s contractual responsibilities generally include the following key requirements: Network development and maintenance. The managed care plan that allows plan members to go outside of the plan’s network to see health care providers. community bases trans cultural nursing. The person chooses a primary care physician to manage the person B. HMOs are a common type of managed health care. Midterm Ch 1-8 Finals Ch 1-14, 25 CHAPTER 1 Which model of health is most likely used by a person who does not believe in preventive health care? Issuing an Advance Written Notice of Non-coverage When Multiple Entities Provide Care Then it will tell you to do a proof. Ethics, in general, are the moral principles that dictate how a person will conduct themselves. C. The insurer would pay … Which of the following statements accurately describe an aspect of managed care? T files a claim on his Accident and Health policy after being treated for an illness. Managed care organizations receive summaries of a patient’s medical file as part of the treatment planning and payment process. A nursing care plan is a product of the nursing process. Covered entities include health care providers, health plans, and health care clearinghouses. Twice daily C. Three times daily D. Four times daily. Sixteen hour/day counselor ability Medically-Managed Intensive Inpatient 4 24 hour nursing care and daily physician care for severe, unstable problems in Dimensions 1, 2 or 3. C.Medicaid is a common type of managed health care. True. The department has planned for units that are five shelves high, and each shelf is to be 45 inches wide and have 40 inches of actual filing space. A “business associate” is a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity. The creation of an opening of a portion of the colon through the abdominal wall to an outside surface is called a (n): Colostomy. It has become the predominant system of delivering and receiving American health care since its implementation … A. ¹ Additional details on features of federal Medicaid managed care authorities are available here.. Most of managed care's savings do not affect hospitalization. Term. Front. The ambulance personnel, following established procedure, asked if he had chest pain. You are planning to store 10 years' worth of records, and the average discharge rate is 2,500 per year. a. Score 1 User: Combining two or more segments of the industry to deliver the best care, at the most cost … Note that another frequently-used acronym, HSA, does not refer to a type of managed care. Individuals pay taxes throughout their working lives and generally become eligible for Medicare when they reach age 65. In outbreaks reported from acute care settings in the U.S. following implementation of universal masking, unmasked exposures to other health care workers were frequently implicated. Definition. Which of the following best describes why pharmacists and pharmacy technicians should inquire as to the intended purpose of the animal when preparing a compounded prescription for an animal patient? This fee is commonly called a(n) ____. These providers and facilities all have to meet a minimum level of quality. The words, “lesbian,” “gay,” “bisexual,” and “transgender” describe: A. Methods: Primary care physicians were asked about the impact of managed care on: (1) physician-patient relationships, (2) the ability of physicians to carry out their professional ethical obligations, and (3) quality of patient … A physician suspects that his patient , Mr. Jones, may have bladder cancer. Standards of care describe the competency level of nursing care as described by the ANA. The data that states send to CDC contains patient identifiers (true/false) False. 4. b. Empirical studies show little evidence that managed care quality was lower than that found in fee-for-service plans. Select all that apply. A. D.PPOs are a common type of managed health care. D. Annual physical Immunization shots as required Age related preventative treatment A member of the covered entity’s workforce is not a business associate. c. It lowers cost through the elimination of waste and excess. Which of the following phrases is characteristic of case management as a method of healthcare delivery? A situation in which only higher-risk employees choose and use certain benefits under a flexible benefits plan provided by employers is referred to as _____. From a sampling of records in the current files, you have determined that the average thickness of each record is 2 inches. A. The Point of Service (POS) managed healthcare system has characteristics of both HMOs and PPOs. 7. 1. 2. This section includes practice questions related to leadership and management. A child who does not undergo surgery due to the parents' religious beliefs according to a bona fide religion C. A parent who provides inadequate clothing due to reasons beyond the control of the parent D. A teacher who engages in nonconsensual sexual … 4. With these plans, the insurer signs contracts with certain health care providers and facilities to provide care for their members at a reduced cost. Information sources are readily identifiable and under the control of the organization. B. approved by the primary care physician. c. This is a false statement as the health record only documents care provided by patient families. Information technology implementation is required to efficiently start patient safety projects. For the following statements, please indicate whether the medication use system / health record that is available to ... o Transitional ICU means that a private attending and an intensivist provide co-managed care of ICU patients. cultures tend to be unstable. B. The Medicaid program is jointly funded by the federal government and states. There is a loss of privacy. C. Replace fee- for-service plans with affordable, quality care to healthcare consumers. B) The care of the patient is carefully planned and monitored by the primary care provider. d. Medically-Monitored Intensive Inpatient 3.7 24 hour nursing care with physician availability for significant problems in Dimensions 1, 2 or 3. Which of the following statements is true concerning vaginal diaphragm use? •Identify processes and outcomes that meet customer needs. Financial Management. The term used to describe sophisticated and highly complex medical care is... a) managed care. Which of the following is an example of a confirming response to a patient? d. All of the above. d. Empirical evidence suggests that managed care fails to reduce health care spending. The insurance company sends you EOBs to help make clear: The cost of the care you received. Following approval of the managed care state plan amendment or waiver, the federal government conducts oversight of states to ensure that they comply with the program accountability requirements and that states hold managed care plans accountable for the … Question options: Clinical model Role performance model Adaptive model Eudaimonistic model The clinical model of health views the absence of signs and … Which of the following statements about managed care are true? Weegy: In managed care, all services must be monitored and approved. This is a true statement. Medicare was established in 1965 under Title XVIII of the Social Security Act as a federal health insurance program for individuals age 65 and older, regardless of income or health status. Which of the following is a characteristic of primary healthcare? Managed Care seemed to most authorities the best available answer. d) Tertiary care: Term. Accreditation allows the facility, school, or hospital to operate and be recognized in good standing according to standards set by peers. A proof in calculus is when it will make a statement, such as: If y=cos3x, then y'''=18sin3x. A. Use of knowledge and measurement tools to inform improvement. B. Managed care organizations are a: system in which financing, administration, and delivery of health care are linked to provide medical services to subscribers for a prepaid fee. access to expensive healthcare services through the utilization of HMOs , PPOs and POSs . is a health cost assistance program: A patient's diagnosis as established by the physician ____. This is a false statement as the health record only document’s physician’s care. 6. Healthcare Delivery Systems. The managed care plan that is allowed to contract directly with employers to provide health care services is the: ... What are two statements that describe the standards for specialists physicians? In addition, there are many different types of data on managed care programs including encounter data, enrollment data, and program information. This creates challenges for analyzing and monitoring managed care programs and limits the ability to compare states. It calls for the establishment … This concept addresses the MCO’s decisions relative to coverage sought by its members. Family and Medical Leave Act b. B) manages the price paid for services. Describe the key steps in developing a modern quality management program. Chapter 12. The principle objective of the medical profession is to render service to humanity with full respect for the dignity of man. Health maintenance organizations Preferred provider organizations Indemnity arrangements Point-of-service plans. Which of the following statements best describes past efforts to develop vaccines for coronaviruses? The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). Fixed-price reimbursement is a feature of managed care. 3 APNs build on the competence of the RN skill set and demonstrate a greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions, and significant role autonomy. 20) Managed care can be described by all of the following except: A) manages the patient’s utilization of services. 3. D) maintains a sustainable noncompetitive advantage. The state program that is comprised of Parts A, B, C, and D. •Identify and study best-of-class organizations. The insurer would pay $4,440, and Crystal would pay $2,960. Back. Questions and Answers. Five Basic Characteristics of Managed Care Plan (1) 1. A. FNP 590 Midterm and Finals Questions with Answers and Explanations. Drug utilization review (DUR) is defined as an authorized, structured, ongoing review of prescribing, dispensing and use of medication. B. In risk-based managed care plans, states delegate responsibility to the MCO for creating and maintaining a … Insurance License Texas Life and Health Paper 29. E. Resources are allocated to too many projects. The following is a list of certain key issues with respect to the MCO’s relationship with its members: Access To Care. Which of these statements best describes oritavancin when formulated as Kimyrsa? For the HHCCN, the POC ends when an HHA stops delivering all services. Which statement best describes a psychotherapist’s goal of avoiding all dual relationships? 5. When in place, the woman is aware that the diaphragm fits snugly against the vaginal walls. c) secondary care. This concept addresses the MCO’s decisions relative to coverage sought by its members. the managed care plan that is allowed to contract directly with employers to provide health care services is the: physician-hospital organization. precertification. 5. d. copayment: Which of the following is a characteristic of Medicaid? Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. This means you have to solve the equation step by step, coming to the solution, which should be the same as in the statement. Managed care organizations combine health insurance with the delivery of healthcare services to keep costs low and provide quality care. Which of the following is true for managed care health insurance plans? A. Unlimited access to providers B. High-quality care C. Shared risk D. Preventive care A. Unlimited access to providers *There are five distinguishing features of managed care: controlled access to providers, comprehensive case management, risk sharing, preventive care, and high-quality care. c. That information is a valuable resource that must be managed no matter what form it takes. The most common health plans available today often include features of managed care. Correct - Your answer is correct. 11The Clinton administration's proposed Health Security Act (HSA, 1993) gives appreciable attention to information systems and related matters. Which of the following describes one of the elements that the nurse practitioner has successfully met? Care/Practice Setting Highlights; Payor-based case manager: May implement the Case Management Process for a client upon direct contact via the telephone by the client/support system or upon referral from other professionals working for the payor organization such as a medical director, a claims adjuster, a clerical person, or a quality/performance improvement … a. He wants to visually examine Mr. Jones' bladder. True. A group of healthcare organizations that collectively provides a full range of coordinated health-related services. Front. F) Planning and monitoring are conducted to ensure standards are followed. Adverse selection. The goal of a managed care system is to keep the costs of health care as low as possible without sacrificing the quality of the care that is given. This is done by creating a network of providers that can provide care and referrals whenever there is a health need which needs to be addressed. b. Once daily B. Each is intended to demonstrate an aspect of the analysis that would be used to evaluate the venture. D. Which of the following statements best describes an integrated delivery system? This creates a lack of privacy in regards to individual medical issues or concerns that take place. Wrong - Your answer is wrong. The origins of managed care can be traced back to at least 1929, when Michael Shadid, a physician in Elk City, Oklahoma, established a health cooperative for farmers in a small community without medical specialists or a nearby general hospital.
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