NUR 204 Module A Questions With Complete Solutions
3 Types of Managed-Care correct answers Preferred Provider
Organizations (PPO)
Health Maintenance Organizations (HMO)
Exclusive Provider Organizations (EPO)
Acuity data correct answers Is used to predict the staff mix
needed to care for a group of pts. (Ex. acuity level 1 may require
5 RNs,level 2 may require 6)
Case Management correct answers (Now a certified nursing
specialty) Refers to the assignment of a health care provider to a
pt so that the care of that pt is overseen by one individual.
Centers for Medicare and Medicaid Services (CMS) correct
answers Federal Agency which controls Medicare, Medicaid,
and the state Children's Health Insurance Program (in
Baltimore). Mission: to ensure effective up-to-date HC coverage
and to promote quality care for beneficiaries
Certification correct answers • Nursing License- MINIMUM
competency.
• Certification- indicates preparation BEYOND the minimal
level, on a voluntary basis, by a NONGOVERNMENTAL
agency.
• Nurses who are certified (credentialed) tend to have fewer
healthcare errors
Children's Health Insurance Program (CHIP) correct answers
Insurance for children under 18 whose parents earn too much to
, qualify for Medicaid, but not enough to afford private insurance.
Each state sets requirements.
Computerized documentation correct answers Computerized
Patient Records (CPR) - electronic file used to store pt's
database, add new data, create and revise care plans, and
document pt progress.
Computerized documentation: Advantages correct answers
Readable, organized, access at more than one location, decision
trees, access to historical as well as current data, less space, and
a decreased chance of misplacing records.
Computerized documentation: Disadvantages correct answers
People are stupid and resistance is common. HC workers feel
overwhelmed when asked to learn anything new.
Diagnostic Related Groups (DRG's) correct answers Hospital is
paid a PRE-ESTABLISHED fixed price-per-case (468
categories)
-If costs to care exceed the amt, the hospital loses money.
-If costs are less the hospital makes a profit
Exclusive Provider Organizations (EPO) correct answers
Individual providers or groups of providers who have entered
into written agreements with an insurer to provide HC services
to subscribers. There will be greater discounts on HC.
Explain how accessibility, cost, and quality of services are
affected by ability or inability to pay. correct answers
Uninsured or underinsured have either limited or no financial
3 Types of Managed-Care correct answers Preferred Provider
Organizations (PPO)
Health Maintenance Organizations (HMO)
Exclusive Provider Organizations (EPO)
Acuity data correct answers Is used to predict the staff mix
needed to care for a group of pts. (Ex. acuity level 1 may require
5 RNs,level 2 may require 6)
Case Management correct answers (Now a certified nursing
specialty) Refers to the assignment of a health care provider to a
pt so that the care of that pt is overseen by one individual.
Centers for Medicare and Medicaid Services (CMS) correct
answers Federal Agency which controls Medicare, Medicaid,
and the state Children's Health Insurance Program (in
Baltimore). Mission: to ensure effective up-to-date HC coverage
and to promote quality care for beneficiaries
Certification correct answers • Nursing License- MINIMUM
competency.
• Certification- indicates preparation BEYOND the minimal
level, on a voluntary basis, by a NONGOVERNMENTAL
agency.
• Nurses who are certified (credentialed) tend to have fewer
healthcare errors
Children's Health Insurance Program (CHIP) correct answers
Insurance for children under 18 whose parents earn too much to
, qualify for Medicaid, but not enough to afford private insurance.
Each state sets requirements.
Computerized documentation correct answers Computerized
Patient Records (CPR) - electronic file used to store pt's
database, add new data, create and revise care plans, and
document pt progress.
Computerized documentation: Advantages correct answers
Readable, organized, access at more than one location, decision
trees, access to historical as well as current data, less space, and
a decreased chance of misplacing records.
Computerized documentation: Disadvantages correct answers
People are stupid and resistance is common. HC workers feel
overwhelmed when asked to learn anything new.
Diagnostic Related Groups (DRG's) correct answers Hospital is
paid a PRE-ESTABLISHED fixed price-per-case (468
categories)
-If costs to care exceed the amt, the hospital loses money.
-If costs are less the hospital makes a profit
Exclusive Provider Organizations (EPO) correct answers
Individual providers or groups of providers who have entered
into written agreements with an insurer to provide HC services
to subscribers. There will be greater discounts on HC.
Explain how accessibility, cost, and quality of services are
affected by ability or inability to pay. correct answers
Uninsured or underinsured have either limited or no financial
