Community Chapter 9 NCLEX Questions
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a health care provider has charged C
more than what is allowed by a third-
party payer. Which would most likely Client service use reflects a greater emphasis on
be the result? health care costs. Third-party payers evaluate the
a. Provider may be removed from appropriate use and costs of health care
the list of providers for the third- resources. Therefore, at least on the first occasion,
party payer. the most probable result would be that the
b. The third-party payer will provider gets the listed payment, not what the
reexamine the payment for that provider charged.
procedure.
c. Provider would get the typical
payment instead of what was
charged to the third-party payer.
d. The third-party payer would be
forced to increase its typical
payment for that procedure.
, A nurse is explaining case D
management to a client. Which
statement would be the most There is no single definition of case management.
appropriate for the nurse to make? But it is a collaborative process to meet an
a. "We assess, plan, facilitate, and individual's health needs through communication
advocate to save money as much as and available resources to promote quality cost-
possible." effective outcomes. The response "with you" shows
b. "We coordinate your care so you a collaborative approach to coordinating care for
obtain needed services without the best outcome.
incurring undue costs."
c. "We seek the lowest cost provider
to give you what care is necessary."
d. "We collaborate with you to
coordinate your care for the best
outcome."
A hospital is going to start a care C
management program. Which group
of clients would most likely be The overall goal of care management is to improve
selected to first receive such the coordination of services provided to clients
services? who are enrolled in a care management program.
a. Clients who represent the most Examples of groups of people who may be served
common diagnosis group to be by care management services include the elderly,
admitted children from low-income families who receive
b. Clients who request such services Medicaid services, and groups of people with
from their local hospital chronic illnesses. The other groups do not
c. Clients with chronic illnesses represent groups who are typically enrolled in a
d. Clients with the least education care management program.
Leave the first rating
Save
Terms in this set (20) Hide definitions
a health care provider has charged C
more than what is allowed by a third-
party payer. Which would most likely Client service use reflects a greater emphasis on
be the result? health care costs. Third-party payers evaluate the
a. Provider may be removed from appropriate use and costs of health care
the list of providers for the third- resources. Therefore, at least on the first occasion,
party payer. the most probable result would be that the
b. The third-party payer will provider gets the listed payment, not what the
reexamine the payment for that provider charged.
procedure.
c. Provider would get the typical
payment instead of what was
charged to the third-party payer.
d. The third-party payer would be
forced to increase its typical
payment for that procedure.
, A nurse is explaining case D
management to a client. Which
statement would be the most There is no single definition of case management.
appropriate for the nurse to make? But it is a collaborative process to meet an
a. "We assess, plan, facilitate, and individual's health needs through communication
advocate to save money as much as and available resources to promote quality cost-
possible." effective outcomes. The response "with you" shows
b. "We coordinate your care so you a collaborative approach to coordinating care for
obtain needed services without the best outcome.
incurring undue costs."
c. "We seek the lowest cost provider
to give you what care is necessary."
d. "We collaborate with you to
coordinate your care for the best
outcome."
A hospital is going to start a care C
management program. Which group
of clients would most likely be The overall goal of care management is to improve
selected to first receive such the coordination of services provided to clients
services? who are enrolled in a care management program.
a. Clients who represent the most Examples of groups of people who may be served
common diagnosis group to be by care management services include the elderly,
admitted children from low-income families who receive
b. Clients who request such services Medicaid services, and groups of people with
from their local hospital chronic illnesses. The other groups do not
c. Clients with chronic illnesses represent groups who are typically enrolled in a
d. Clients with the least education care management program.
