a. The Point of Service (POS) managed healthcare system has characteristics of both HMOs and PPOs. Dramatically improve the healthcare delivery system in the united states. Select all that apply. You are a community nurse visiting a client from Venezuela who lives in rural Montana. Critique this statement: The health record documents services provided by allied health professionals and a patient’s family. A proof in calculus is when it will make a statement, such as: If y=cos3x, then y'''=18sin3x. Lecture(s)/Slide(s): d13-18. 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. You are planning to store 10 years' worth of records, and the average discharge rate is 2,500 per year. Twice daily C. Three times daily D. Four times daily. A. prior authorization for hospital admission and some outpatient and in-office. d) tertiary care. There is a loss of privacy. 4. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. Selected Answer : DRG Response Feedback : Managed Care Organizations , manage healthcare costs by negotiating discounted providers ? 5. 2.14) Mrs. J. has just seen her provider. Family and Medical Leave Act 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. Which of the following statements about managed care are true? 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.”. 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"). •Identify processes and outcomes that meet customer needs. Weegy: In managed care, all services must be monitored and approved. The Medicaid program is jointly funded by the federal government and states. 1. Drug utilization review (DUR) is defined as an authorized, structured, ongoing review of prescribing, dispensing and use of medication. The insurance company sends you EOBs to help make clear: The cost of the care you received. Chapter 12. He wants to visually examine Mr. Jones' bladder. The glomerular filtration rate in cats is considerably slower than it is in humans, resulting in a much longer half-life for diazepam. Which of these statements best describes oritavancin when formulated as Kimyrsa? 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. Describe the key steps in developing a modern quality management program. DUR encompasses a drug review against predetermined criteria that results in changes to drug therapy when these criteria are not met. B. C. Replace fee- for-service plans with affordable, quality care to healthcare consumers. When in place, the woman is aware that the diaphragm fits snugly against the vaginal walls. Which of the following phrases is characteristic of case management as a method of healthcare delivery? Control Access to Providers (For Buyers): (a) Encourage members to use specified Providers (Participants/Buyers) and (in-network) (b) Controls costs by negotiating providers' fees. The derivation of this word The words, “lesbian,” “gay,” “bisexual,” and “transgender” describe: A. The following is intended to provide some general guidance on the statute, the regulations which implement it, and the reported cases which interpret it. Managed Care is a health care delivery system organized to manage cost, utilization, and quality. A. 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? Adverse selection. User: In managed care, all services must be A. monitored and approved. Objective(s): 4. A nursing process is written together with a nursing care plan. Which statement best describes a psychotherapist’s goal of avoiding all dual relationships? This creates a lack of privacy in regards to individual medical issues or concerns that take place. Definition. 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. d. All of the above. 26. Managed care organizations combine health insurance with the delivery of healthcare services to keep costs low and provide quality care. c) secondary care. Which of the following antiretroviral therapy regimens should the pharmacist recommend for this patient? Note that another frequently-used acronym, HSA, does not refer to a type of managed care. The term used to describe sophisticated and highly complex medical care is... a) managed care. Select all that apply. 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. Background: Survey studies have shown that physicians believe managed care is having significant impact on many of their professional obligations. 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 entity’s workforce is not a business associate. E) The managed care system may required approval for specialty care. 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. Select all that apply. Answer: b. A flexible benefits plan typically: Allows employees to select the benefits they prefer from options established by the employer. Then it will tell you to do a proof. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. The following are examples of hospital joint ventures that are unlikely to raise significant antitrust concerns. c. That information is a valuable resource that must be managed no matter what form it takes. “Transgender” describes a person's gender D. They can all describe either a person's orientation or … The following is a list of certain key issues with respect to the MCO’s relationship with its members: Access To Care. It has become the predominant system of delivering and receiving American health care since its implementation … C) has the objective of only providing those services that are necessary to contain costs. Ethics, in general, are the moral principles that dictate how a person will conduct themselves. This procedure is called a (n): 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 … •Define indicators to measure performance. Insurance License Texas Life and Health Paper 29. Which of the following statements is true concerning vaginal diaphragm use? It attempts to control costs by modifying the behavior of providers and patients. 33. Definition. A. 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. It has become the predominant system of delivering and receiving American health care since its implementation … 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. copayment: Which of the following is a characteristic of Medicaid? I … The Nurse Practice Act regulates the licensing and practice of nursing; it describes the scope of practice. Questions and Answers. 4. 111-148, as amended) made a number of changes to Medicaid. Question options: Clinical model Role performance model Adaptive model Eudaimonistic model The clinical model of health views the absence of signs and … If a claim was filed and $7,200 in costs remained after Crystal met the $200 deductible: A. A nursing care plan is a product of the nursing process. Which of the following statements accurately describes the clinical nurse leader (CNL)? 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 … •Understand customer need. Individuals pay taxes throughout their working lives and generally become eligible for Medicare when they reach age 65. C. Both the nursing process and the nursing care plan are purely critical thinking strategies. The insurer would pay $4,440, and Crystal would pay $2,960. A group of healthcare organizations that collectively provides a full range of coordinated health-related services. Section 1. b. Hosted by the American Counseling Association’s 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. D. 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 … C.Medicaid is a common type of managed health care. Which of the following is an example of a confirming response to a patient? 3. The EOB is generated when your provider submits a claim for the services you received. B. Which of the following statements about the nursing process is true. Involvement of the medical staff is critical in all patient safety projects. This is a true statement. D. Cats have a renal portal elimination system whereby diazepam … C. Projects should focus on medical errors. 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. c. Managed care focuses on the ability to pay. A person's orientation B. D.PPOs are a common type of managed health care. b) primary care. Have employees of a managed care organization provide patient care. Front. 7. The person chooses a primary care physician to manage the person B. HMOs are a common type of managed health care. fees and controlling patients ? This creates a lack of privacy in regards to individual medical issues or concerns that take place. With these plans, the insurer signs contracts with certain health care providers and facilities to provide care for their members at a reduced cost. b. 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. Correct - Your answer is correct. 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 … Select all that apply. E. Resources are allocated to too many projects. Standards of care describe the competency level of nursing care as described by the ANA. d. This concept addresses the MCO’s decisions relative to coverage sought by its members. 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. 2. A managed care plan’s contractual responsibilities generally include the following key requirements: Network development and maintenance. It calls for the establishment … In risk-based managed care plans, states delegate responsibility to the MCO for creating and maintaining a … Which of the following describes one of the elements that the nurse practitioner has successfully met? 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 person responsible for a child's welfare who uses physical force to remove a weapon from the child's possession B. Term. In general, there are three levels of public health - local, state, and federal. a. Term. The purpose of managed health care insurance plans is to A. Definition. Each Managed Care Organization offered total health care for a predetermined monthly fee. D. It is a system that is based on patient and provider autonomy. Fixed-price reimbursement is a feature of managed care. The increase in average life expectancy in the U.S. since 1900, about 30 years, is primarily due to public health initiatives. community bases trans cultural nursing. Specialty Pharmacy J. Industry/Manufacturing. 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. The principle objective of the medical profession is to render service to humanity with full respect for the dignity of man. 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 … 2. A. Section 2. 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. The managed care plan that allows plan members to go outside of the plan’s network to see health care providers. D. provided by the same physician. 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. Which of the following statements best describes an integrated delivery system? Case managers do not use the nursing process. 11The Clinton administration's proposed Health Security Act (HSA, 1993) gives appreciable attention to information systems and related matters. A. 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 managed care plan offered through private insurance companies. 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. The following is a list of certain key issues with respect to the MCO’s relationship with its members: Access To Care.