Test Bank for Fundamentals of Nursing, 9e 9th Edition
1. The nurse is caring for a patient whose insurance coverage is Medicare. The nurse should consider which information when planning care for this patient? a. Capitation provides the hospital with a means of recovering variable charges. b. The hospital will be paid for the full cost of the patient’s hospitalization. c. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost. d. Medicare will pay the national average for the patient’s condition. ANS: C In 1983, Congress established the prospective payment system (PPS), which grouped inpatient hospital services for Medicare patients into diagnosis-related groups (DRGs), each of which provides a fixed reimbursement amount based on assigned DRG, regardless of a patient’s length of stay or use of services. Capitation means that providers receive a fixed amount per patient or enrollee of a health care plan. DRG reimbursement is based on case severity, rural/urban/regional costs, and teaching costs, not national averages. DIF:Understand (comprehension)REF:15 OBJ: Compare the various methods for financing health care. TOP: Planning MSC:Management of Care 2. A nurse is teaching the staff about managed care. Which information should the nurse include in the teaching session? a. Managed care insures full coverage of health care costs. b. Managed care only assumes the financial risk involved.
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