CPNRE prep (Timby and Smith) Exam 2024

CPNRE prep (Timby and Smith) Exam 2024 Healthcare team -Answer-consists of specially trained personnel who work together to help clients meet their healthcare needs Healthcare delivery system -Answer-refers to the full range of services available to people seeking prevention, identification, treatment, or rehabilitation of health problems. Primary care -Answer-first health care worker or agency to assess a person with a health need; emphasis on prevention and education, promoting health secondary care -Answer-Care by a physician (specialist) who can perform out-of-the- ordinary procedures in outpatient facilities; includes doctor referrals for further treatment/ tests, potential diagnosis. Tertiary care -Answer-intensive care, subacute care; more complex situations related to chronic problems. PPACA -Answer-Patient Protection and Affordable Care Act of 2010 (aka obamacare) meant to provide affordable healthcare to US citizens Medicare -Answer-A federal program of health insurance for persons 65 years of age and older or on disability; primarily financed through employee payroll taxes Medicare- Part A -Answer--covers hospital care, skilled care, hospice, home health services, and nursing homes (may need some monthly coverage fee if they didn't pay in taxes) Medicare- Part B -Answer-covers medically necessary services like physician visits, outpatient care, home health, preventative services; requires annual deductible and if met the participant pays 20% of amount unless they have other insurance Medicare Part C (Medicare Advantage Plans) -Answer-Health coverage option includes part A & part b & operated by private insurance companies that are approved by & under contract w medicare Medicare—Part D Prescription Drug Coverage -Answer-helps cover and possibly reduce prescription drug costs Medigap insurance -Answer-insurance provided by private insurance companies to cover medical expenses that are not covered by Medicare Medicaid -Answer-A federal and state assistance program that pays for health care services for people who cannot afford them. Including: -inpatient/ outpatient hospital services -screening, diagnostic, and treatment services -home health services -physician services -rural health clinics -federally qualified health centre services -lab/ x- ray -family planning services -nurse/ midwifery -pediatric/ family NP services -birth centers -transportation to medical care -tobacco cessation counselling for pregnant women PPS -Answer-Prospective Payment System -a method of reimbursing hcps for their services based on a predetermined fixed rate DRGs -Answer-Diagnostic related groups that pay providers of care for medicare patients a set amount regardless of actual cost, paying a group with similar diagnoses Managed Care Organization (MCO) -Answer-A type of medical plan that pays for and manages the medical care a patient receives. Referred to as capitation which refers to the actual head or person count. Preferred Provider Organization (PPO) -Answer-operates on the principle that competition can control costs; acts as agents for health insurance companies Point of Service (POS) -Answer-insurance plan in which a patient may choose an HMO or a non-HMO provider but must pay a deductible for using a non-HMO provider Physician hospital organizations (PHOs) -Answer-Consist of hospital and physician practices that merge into vertically integrated structures. They negotiate fees for services for their self-insured employees through MCO. UAPs -Answer-Unlicensed Assistive Personnel; help nurses provide direct care to patients. As defined by individual state boards of nursing, UAPs may have the title of certified nursing assistants (Cna), orderlies, attendants, or technicians. 1. A client with chronic illness always reports feeli