©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
PMHNP Boards Exam Questions and
Answers 100% Solved
Medicare Part A Coverage - ✔✔Hospital insurance that covers inpatient
and most skilled care. Mandatory copays for hospital days 21-150, getting
higher with each period of time.
Medicare Part A Eligibility - ✔✔>65 in social security automatic enrollment
Medicare Part A Cost - ✔✔No cost if automatically qualified. 30-39 work
quarters: ~$250/mo <30 work quarters: ~$450/mo
Medicare Part B Coverage - ✔✔Supplemental medical insurance.
Outpatient services, care, physical/speech therapy, some home health
care, medical equipment
Medicare Part B Eligibility - ✔✔Voluntary if >65
Medicare Part B Cost - ✔✔Deducted from monthly social security check.
*Enroll 3 months before 65th birthday or 4 months after, otherwise
increased costs to enroll*
,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Medicare Part C - ✔✔Medicare Advantage. Get all their medical services
through that plan.
Medicare Part D coverage - ✔✔Prescription drug coverage
Medicare Part D Cost - ✔✔Varies depending on how extensive drug benefit
is. Different plans have different benefits.
Medigap Plans - ✔✔Fill gaps in coverage that occur with Medicare
Medicare Advantage Plan - ✔✔Will likely eliminate need for medigap
insurance?
Medicaid Eligibility - ✔✔Automatic coverage not guaranteed except for
poor pregnant women and children. States can refuse to cover adults/head
of households who lose Temporary Assistance to Needy Families d/t
refusal to work. Generally covers poor people.
Medicaid funding - ✔✔Federal + state. States determine how much they
want to pay in, different states have different qualities of Medicaid
HMO - ✔✔Four components: Enrolled population, prepayment of
premiums, coverage of comprehensive medical svcs, centralization of
medical and hospital svcs
,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Closed-panel HMO - ✔✔Specific providers identified by plan to provide the
medical services to members. Staff can be salaried by HMO or an
agency/group contracted by the HMO.
Open-panel HMO - ✔✔Network HMO, Individual Practice Association,
Point of Service Plans
Network HMO - ✔✔HMO contracts with more than one group of practices
Individual Practice Association - ✔✔Insurance coverage. Contract with an
association of physicians to provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) -
✔✔Insurance coverage. Patients allowed to self-refer to specialist but pay
higher premium to do so. POS requires PCP is gatekeeper but pt can see a
provider outside of HMO for more $$. PPOs contract to a selected group of
participating providers and give discount for using a selected group of
providers. Financial risk held by insurer in PPO, held by providers in POS
Managed indemnity - ✔✔Traditional model insurance coverage.. Pre-
certification, catastrophic case management, minimal contract arrangement
with providers. Provider groups and health plans can use quality control,
utilization review, bundling of services, incentives for health behaviors.
, ©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
MUST seek National Committee on Quality Assurance (NCQA)
accreditation
Licensure - ✔✔Member of profession is granted ability to practice
Accreditation - ✔✔Formal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related
programs.
Certification - ✔✔Tests knowledge, skills, abilities for entry into practice.
Formal recognition of the knowledge, skills, and experience
demonstrated by the achievement of standards identified by the profession
Education - ✔✔Formal preparation of APRNs in graduate degree-granting
or postgraduate
certificate programs
Factors facilitating NP growth - ✔✔Demand for svcs, acceptance of role,
emphasis on integrated healthcare svcs, emergence of PMHNP and
decreasing stigmatization
Factors constraining NP growth - ✔✔Growth competition, reimbursement
struggles, overlapping scopes with other NPs, concerns about
PMHNP Boards Exam Questions and
Answers 100% Solved
Medicare Part A Coverage - ✔✔Hospital insurance that covers inpatient
and most skilled care. Mandatory copays for hospital days 21-150, getting
higher with each period of time.
Medicare Part A Eligibility - ✔✔>65 in social security automatic enrollment
Medicare Part A Cost - ✔✔No cost if automatically qualified. 30-39 work
quarters: ~$250/mo <30 work quarters: ~$450/mo
Medicare Part B Coverage - ✔✔Supplemental medical insurance.
Outpatient services, care, physical/speech therapy, some home health
care, medical equipment
Medicare Part B Eligibility - ✔✔Voluntary if >65
Medicare Part B Cost - ✔✔Deducted from monthly social security check.
*Enroll 3 months before 65th birthday or 4 months after, otherwise
increased costs to enroll*
,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Medicare Part C - ✔✔Medicare Advantage. Get all their medical services
through that plan.
Medicare Part D coverage - ✔✔Prescription drug coverage
Medicare Part D Cost - ✔✔Varies depending on how extensive drug benefit
is. Different plans have different benefits.
Medigap Plans - ✔✔Fill gaps in coverage that occur with Medicare
Medicare Advantage Plan - ✔✔Will likely eliminate need for medigap
insurance?
Medicaid Eligibility - ✔✔Automatic coverage not guaranteed except for
poor pregnant women and children. States can refuse to cover adults/head
of households who lose Temporary Assistance to Needy Families d/t
refusal to work. Generally covers poor people.
Medicaid funding - ✔✔Federal + state. States determine how much they
want to pay in, different states have different qualities of Medicaid
HMO - ✔✔Four components: Enrolled population, prepayment of
premiums, coverage of comprehensive medical svcs, centralization of
medical and hospital svcs
,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Closed-panel HMO - ✔✔Specific providers identified by plan to provide the
medical services to members. Staff can be salaried by HMO or an
agency/group contracted by the HMO.
Open-panel HMO - ✔✔Network HMO, Individual Practice Association,
Point of Service Plans
Network HMO - ✔✔HMO contracts with more than one group of practices
Individual Practice Association - ✔✔Insurance coverage. Contract with an
association of physicians to provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) -
✔✔Insurance coverage. Patients allowed to self-refer to specialist but pay
higher premium to do so. POS requires PCP is gatekeeper but pt can see a
provider outside of HMO for more $$. PPOs contract to a selected group of
participating providers and give discount for using a selected group of
providers. Financial risk held by insurer in PPO, held by providers in POS
Managed indemnity - ✔✔Traditional model insurance coverage.. Pre-
certification, catastrophic case management, minimal contract arrangement
with providers. Provider groups and health plans can use quality control,
utilization review, bundling of services, incentives for health behaviors.
, ©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
MUST seek National Committee on Quality Assurance (NCQA)
accreditation
Licensure - ✔✔Member of profession is granted ability to practice
Accreditation - ✔✔Formal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related
programs.
Certification - ✔✔Tests knowledge, skills, abilities for entry into practice.
Formal recognition of the knowledge, skills, and experience
demonstrated by the achievement of standards identified by the profession
Education - ✔✔Formal preparation of APRNs in graduate degree-granting
or postgraduate
certificate programs
Factors facilitating NP growth - ✔✔Demand for svcs, acceptance of role,
emphasis on integrated healthcare svcs, emergence of PMHNP and
decreasing stigmatization
Factors constraining NP growth - ✔✔Growth competition, reimbursement
struggles, overlapping scopes with other NPs, concerns about
