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Nursing 102 ch6-10
Terms in this set (82)
Who finances a health reimbursement arrangement (HRA)?
Medicare Part A is primarily financed through which of the following?
What is referred to as the amount that the insured has to pay out of pocket each time health services are received.
Part A deductible must be paid at what point of care
For each benefit period
How many days of hospitalization is required before Medicare pays for services in a skilled nursing facility?
What is Medicare B primarily financed through
Taxes and premiums
Which of the following requires payroll taxes to be paid equally by employers and employees
Medicare Part A
Which part does not include any specific medical benefits mandated under Medicare
What is the Medicaid program financed by
State and federal government
CHIP is available to families with incomes up to
200% of the federal poverty level
What type of physician reimbursement is based on individually distinct services that are separately billed?
Fee of service
What is based on the time, skill, and intensity it takes to provide a service?
Resource-based relative value scale
With which of the following is PMPM associated
As a method of reimbursement, PPOs use
In which of the following is the amount of reimbursement established in advance?
In order to make a profit under the DRG method of reimbursement a hospital must do which of the following?
Control its costs.
DRG codes are an extension of which Medicare reimbursement payment system?
Which of the following is used to compare health care expenditures to total economic consumption?
Gross domestic product
True or false? Enrollment in Part D of Medicare is based on a person's income.
True or false? Each state administers its own Medicaid program.
True or false? Risk is predictable for providers.
Who assumes the bulk of the risk in managed care plans?
What does Medicare part A pay for?
Hospitalization, short term skilled nursing care, home health, and hospice.
What healthcare services would NOT be covered under Medicare Part A or B?
Under Medicare Part A, a benefit period begins during what period?
The beneficiary is hospitalized.
Who finances a health reimbursement arrangement (HRA)?
True or false? Community health centers, church health centers, primarily serve as safety net providers.
Which of the following is NOT a domain of primary care?
Lower hospitalization rates are strongly associated with receiving increased:
What are unique attributes of primary care?
Comprehensiveness of services
What is the key difference between primary care and specialty care?
Primary care focuses on patients as persons and specialty care focuses on patients as diseases.
True or false? Continuity of care refers to care over time by a single provider or team of healthcare professionals.
True or false? An example of tertiary care would be immunizations.
Which of the following would be classified as a public hospital?
What is a proprietary hospital?
a for profit hospital
What is the main focus of a rehabilitation hospital?
Improve physical function.
What is the main distinguishing characteristic of a teaching hospital?
It must train physicians.
Whats the only hospital that is not a voluntary hospital?
Accreditation is carried out by...
the federal government
The Magnet Recognition Program is sponsored by what body?
The American Nurses Association
Issues related to medical ethics in hospitals are generally resolved by which of the following?
Who is responsible for managing a hospital?
What is the primary mission for nonprofit hospitals?
The mission is to benefit the communities in which they are located by providing some public good.
True or false? The average number of days a patient stays in the hospital is called days of care.
True or false? Most physicians in the U.S. are employees of hospitals.
What is the term for the number of patients in a hospital on a given day?
What is not considered a community hospital?
Department of Veterans Affairs (VA) hospitals.
In a short-stay hospital the average length of stay is how many days?
25 days or less
what is an example of retrospective utilization review?
Medical records are examined to assess the appropriateness of care.
Which managed care plan typically has lower copayments and deductibles?
Which of the following involves risk sharing with providers?
Which type of HMO model employs its own salaried physicians?
Which of the following is not a fundamental characteristic of HMOs?
out of network option
Which HMO model has the greatest ability to exercise control over the practice patterns of physicians?
Which HMO model is particularly suited for operations across widespread geographic regions?
Which HMO model generally offers the greatest choice of providers to the enrollees?
What is NOT a characteristic of PPO plans?
Gatekeeping is always in effect.
What was the main factor that led to the development of integrated health networks?
Growth of managed care
Two or more organizations open an independent, jointly-owned home health agency. This is an example of which of the following?
An alliance does not involve which of the following?
If Simmons rehabilitation hospital decides to purchase Butler rehabilitation hospital in order to expand target market share, what type of integration would this be considered?
Which of the following is not a strategy for diversification into new services?
True or false? Formation of health networks requires vertical integration.
Which of the following is designed to provide partial respite to family caregivers?
adult day care
Community senior centers generally offer all but one of the following services. Which service do they not offer?
To qualify for meals-on-wheels, a person must be at least how many years of age?
what services comprise case management?
Linking, managing, and coordinating various services
Who authorizes the plan of treatment for skilled nursing care?
What is the role of paraprofessionals in the delivery of long-term care?
they render direct care related to ADLs.
What is Life Safety Code?
National building and fire safety rules.
If a nursing home wants to provide services to people on public assistance, which of the following is necessary?
After a patient has qualified for skilled nursing care and is admitted to a nursing facility, Medicare will pay the full cost for how many days of care?
What is the purpose of NF certification?
It allows a facility to admit Medicaid patients.
A certified nursing home is required to comply with which set of standards?
Which is the primary source of payment for nursing home services?
What activities doe Instrumental activities of daily living (IADL) scale measure?
using a telephone
what is a Medicare requirement to qualify for home health care?
Have a plan of treatment that is reviewed by a physician
Require part-time skilled nursing or rehabilitation therapies
Restorative care is also referred to as what?
Which of the following is not part of long-term care services?
Treatments for acute illness
Which of the following enables family caregivers to take some time off while their loved ones' care needs are being met?
True or false? Retirement facilities do not deliver nursing care services but emphasize privacy, security, and active lifestyles.
True or false? The largest share of nursing home expenditures is attributed to government sources.
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