b. 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 _____. A. F) Planning and monitoring are conducted to ensure standards are followed. Of the following types of plans, costs for the patient are lowest, but choice of providers is most restricted, in a: *a. Correct - Your answer is correct. d) Tertiary care: Term. cultures tend to be unstable. True. A physician suspects that his patient , Mr. Jones, may have bladder cancer. Managed care organizations combine health insurance with the delivery of healthcare services to keep costs low and provide quality care. A nursing care plan is a product of the nursing process. Wrong - Your answer is wrong. 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. 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. D. 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. 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. D) maintains a sustainable noncompetitive advantage. The following is a list of certain key issues with respect to the MCOs relationship with its members: Access To Care. c. It lowers cost through the elimination of waste and excess. B. Chapter 12. The data that states send to CDC contains patient identifiers (true/false) False. C. After insertion, the cervix should be smoothly covered. Perhaps the most widely discussed is the expansion of eligibility to adults with incomes up to 133 percent of the federal poverty level (FPL). Statements that describe activities and attributes of nurses in this Code of Ethics are to be understood as normative or prescriptive statements expressing expectations of ethical behavior. Which of the following statements best describes an integrated delivery system? copayment: Which of the following is a characteristic of Medicaid? All of the following are examples of managed care plans except. There is a loss of privacy. The managed care plan offered through private insurance companies. Identify processes and outcomes that meet customer needs. community bases trans cultural nursing. From a sampling of records in the current files, you have determined that the average thickness of each record is 2 inches. A member of the covered entitys workforce is not a business associate. Five Basic Characteristics of Managed Care Plan (1) 1. Specialty Pharmacy J. Industry/Manufacturing. Covered entities include health care providers, health plans, and health care clearinghouses. Annual physical Immunization shots as required Age related preventative treatment c. That information is a valuable resource that must be managed no matter what form it takes. Term. Health maintenance organizations Preferred provider organizations Indemnity arrangements Point-of-service plans. Background: Survey studies have shown that physicians believe managed care is having significant impact on many of their professional obligations. Identify and study best-of-class organizations. 26. T files a claim on his Accident and Health policy after being treated for an illness. 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 Medically-Monitored Intensive Inpatient 3.7 24 hour nursing care with physician availability for significant problems in Dimensions 1, 2 or 3. A flexible benefits plan typically: Allows employees to select the benefits they prefer from options established by the employer. Fixed-price reimbursement is a feature of managed care. Managed care plans are health insurance plans with the goal of managing two major aspects of healthcare: cost and quality. Definition. A. This is a false statement as the health record only documents physicians care. 2. C. Both the nursing process and the nursing care plan are purely critical thinking strategies. The words, lesbian, gay, bisexual, and transgender describe: A. The Patient Protection and Affordable Care Act (ACA, P.L. b) primary care. B. Information technology implementation is required to efficiently start patient safety projects. Once daily B. Information sources are readily identifiable and under the control of the organization. Which of the following statements about managed health care is FALSE? Section 2. D. Select all that apply. 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. Definition. A person responsible for a child's welfare who uses physical force to remove a weapon from the child's possession B. 5. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP) . This creates a lack of privacy in regards to individual medical issues or concerns that take place. a. The MCO, PIHP, or PAHP must continue the enrollee's benefits if all of the following occur: ( 1) The enrollee files the request for an appeal timely in accordance with 438.402 (c) (1) (ii) and (c) (2) (ii); ( 2) The appeal involves the termination, suspension, or reduction of Provide quality health care while containing costs. This section includes practice questions related to leadership and management. With these plans, the insurer signs contracts with certain health care providers and facilities to provide care for their members at a reduced cost. Which of the following is true for managed care health insurance plans? Patients who belong to a managed care health plan, such as an HMO, are responsible for a small per-visit fee collected at the time of the visit. 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 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. C) has the objective of only providing those services that are necessary to contain costs. B) manages the price paid for services. Healthcare Delivery Systems. An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products youve received. Give the insured an unlimited choice of providers C. Coordinate benefits D. Control health insurance claims expenses a joint funding program by federal and state governments (excluding Arizona) for low-income patients on public assistance for their medical care. access to expensive healthcare services through the utilization of HMOs , PPOs and POSs . Define indicators to measure performance. Select all that apply. Each Managed Care Organization offered total health care for a predetermined monthly fee. The Medicaid program is jointly funded by the federal government and states. It has become the predominant system of delivering and receiving American health care since its implementation 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. 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. 2.13) Which of the following best describes the purpose of managed care? Note that another frequently-used acronym, HSA, does not refer to a type of managed care. When in place, the woman is aware that the diaphragm fits snugly against the vaginal walls. prior authorization for hospital admission and some outpatient and in-office. the managed care plan that is allowed to contract directly with employers to provide health care services is the: physician-hospital organization. D. Cats have a renal portal elimination system whereby diazepam This means you have to solve the equation step by step, coming to the solution, which should be the same as in the statement. E. Resources are allocated to too many projects. Answer: b. The most common managed care financial arrangement, capitation, places healthcare providers in the role of micro-health insurers, assuming the responsibility for managing the unknown future health care costs of their patients. Small insurers, like individual consumers, tend to have annual costs that fluctuate far more than larger insurers. c. This is a false statement as the health record only documents care provided by patient families. Hosted by the American Counseling Associations 70th president Dr. S Kent Butler, each 50-minute episode features special guests in conversation about topics relevant to the professional work and identity of counselors, the business of counseling, and mental health care. Case managers do not use the nursing process. Provide for the continuation of coverage when an employee leaves the plan B. a. Adverse selection. Which of the following statements about managed care are true? This is a true statement. Managed care organizations receive summaries of a patients medical file as part of the treatment planning and payment process. These providers and facilities all have to meet a minimum level of quality. In general, there are three levels of public health - local, state, and federal. Which of the following describes one of the elements that the nurse practitioner has successfully met? Which of the following phrases is characteristic of case management as a method of healthcare delivery? Members who choose outside providers will be billed a deductible and higher co-payment to reflect the physicians fees. 2.14) Mrs. J. has just seen her provider. Family and Medical Leave Act b. 33. Which of the following statements about the nursing process is true. The insurance company sends you EOBs to help make clear: The cost of the care you received. Formal statement written and signed while a person is mentally competent that specifies how the person wishes to have his or her own death handled in the event that the person cannot participate in the decision making a. Which of the following statements is true concerning vaginal diaphragm use? A. a. The principle objective of the medical profession is to render service to humanity with full respect for the dignity of man. User: In managed care, all services must be A. monitored and approved. C.Medicaid is a common type of managed health care. Standards of care describe the competency level of nursing care as described by the ANA. Which of the following is a characteristic of primary healthcare? B. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Back. 107 Cards in this Set. 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. Individuals pay taxes throughout their working lives and generally become eligible for Medicare when they reach age 65. B. 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. Critique this statement: The health record documents services provided by allied health professionals and a patients family. The Nurse Practice Act regulates the licensing and practice of nursing; it describes the scope of practice. 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. d. Empirical evidence suggests that managed care fails to reduce health care spending. A person's gender C. The first three describe a person's orientation. d. d) tertiary care. Each is intended to demonstrate an aspect of the analysis that would be used to evaluate the venture. Issuing an Advance Written Notice of Non-coverage When Multiple Entities Provide Care Weegy: In managed care, all services must be monitored and approved. Objective(s): 4. 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. The following are examples of hospital joint ventures that are unlikely to raise significant antitrust concerns. 20) Managed care can be described by all of the following except: A) manages the patients utilization of services. Describe the key steps in developing a modern quality management program. 3. 5. A proof in calculus is when it will make a statement, such as: If y=cos3x, then y'''=18sin3x. b. A person's orientation B. Involvement of the medical staff is critical in all patient safety projects. The following is intended to provide some general guidance on the statute, the regulations which implement it, and the reported cases which interpret it. DUR encompasses a drug review against predetermined criteria that results in changes to drug therapy when these criteria are not met. Front. 2. B) The care of the patient is carefully planned and monitored by the primary care provider. c. That information is a valuable resource that must be managed no matter what form it takes. 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. It has become the predominant system of delivering and receiving American health care since its implementation c. Managed care focuses on the ability to pay. Dramatically improve the healthcare delivery system in the united states. Insurance License Texas Life and Health Paper 29. Ethics, in general, are the moral principles that dictate how a person will conduct themselves. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The EOB is generated when your provider submits a claim for the services you received. 111-148, as amended) made a number of changes to Medicaid. Managed care organizations receive summaries of a patients medical file as part of the treatment planning and payment process. Front. The glomerular filtration rate in cats is considerably slower than it is in humans, resulting in a much longer half-life for diazepam. This procedure is called a (n): 4. Have employees of a managed care organization provide patient care. Question options: Clinical model Role performance model Adaptive model Eudaimonistic model The clinical model of health views the absence of signs and D. provided by the same physician. 7. To be eligible, a primary care physician must work in and have the ability to make referrals among the network providers. 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. C. Replace fee- for-service plans with affordable, quality care to healthcare consumers. Additional details on features of federal Medicaid managed care authorities are available here.. Section 1. The purpose of managed health care insurance plans is to A. The person chooses a primary care physician to manage the person B. HMOs are a common type of managed health care. d. All of the above. Which of the following statements accurately describe an aspect of managed care? Which of these statements best describes oritavancin when formulated as Kimyrsa? If a claim was filed and $7,200 in costs remained after Crystal met the $200 deductible: A. Accreditation allows the facility, school, or hospital to operate and be recognized in good standing according to standards set by peers. 11The Clinton administration's proposed Health Security Act (HSA, 1993) gives appreciable attention to information systems and related matters. B. According to the American Nurses Association (ANA), the nursing code of ethics is a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.. C. Cats have a genetic mutation of the ABCG2 blood retinal barrier transporter protein that permits diazepam to enter the aqueous humor, where it exerts a unique ocular toxicity in cats. 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. In risk-based managed care plans, states delegate responsibility to the MCO for creating and maintaining a All of the following fundamentals describe the characteristics associated with transcultural nursing except: Definition. Questions and Answers. 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 Selected Answer : DRG Response Feedback : Managed Care Organizations , manage healthcare costs by negotiating discounted providers ? Twice daily C. Three times daily D. Four times daily. The managed care plan that allows plan members to go outside of the plans network to see health care providers. There is a loss of privacy. Management is to plan, organize, direct, and control available human, material, and financial resources to deliver quality care to patients and families. B. Managed care plans are health insurance plans with the goal of managing two major aspects of healthcare: cost and quality. "negotiate lower price". For the HHCCN, the POC ends when an HHA stops delivering all services. The client is a diabetic and is hypertensive. 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"). This is a suitable form of contraception for women with recurrent urinary tract infection. Back. Which of the following is an example of a confirming response to a patient? The traditional fee-for-service program offered directly through the federal government. A nursing process is written together with a nursing care plan. The Point of Service (POS) managed healthcare system has characteristics of both HMOs and PPOs. The term used to describe sophisticated and highly complex medical care is a) managed care. Definition. The ambulance personnel, following established procedure, asked if he had chest pain. It calls for the establishment 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? C. Projects should focus on medical errors. 4. The insurer would pay $4,440, and Crystal would pay $2,960. Lecture(s)/Slide(s): d13-18. D. The quality assurance committee should direct all patient safety efforts. 6. A. Which of the following statements accurately describe an aspect of managed care? He wants to visually examine Mr. Jones' bladder. Term. They allow people to go to any doctor they choose They are all preferred provider organizations They are required to provide free services to the poor They are designed to
