APRN Practice Study Guide Questions with
Distinction level Marking scheme version
2024/2025
Risk management - correct answer -systems and activities
designed to recognize and intervene to decrease risk of injury to
patients and subsequent claims against healthcare providers,
based on the assumption that many injuries to patients are
preventable
Sources of legal liability - correct answer
-patients
-procedures
-quality of record keeping
Areas of liability risk - correct answer -practitioner-client
relationship
-communication and informed consent
-clinical expertise
-self-evaluation by professionals of need to stay current
-documentation
-consultation and referral
-policies, procedures, and protocols
-supervision of others
Malpractice - correct answer -professional misconduct,
unreasonable lack of skill
,-infidelity in professional or fiduciary duties
-illegal, immoral conduct resulting in patient harm
-alleged professional failure to render services with degree of
care, diligence, and precaution that another member of same
profession in similar circumstances would render to prevent
patient injury
-doesn't protect APRN from charges of practicing medicine
without a license if APRN is practicing outside legal scope of
practice for that state
Occurrence coverage (malpractice insurance) - correct answer
covers malpractice event that occurred during policy period,
regardless of date of discovery or when claim filed
Claims made coverage (malpractice insurance) - correct answer
-covers only claims filed during policy coverage period,
regardless of when event occurred
-optional tail coverage contract extends the coverage of a claims
made policy into the future to cover all claims filed after the
basic claims made coverage
Negligence - correct answer -failure of individuals to do what a
reasonable person would do that results in injury to another
Medicaid - correct answer -authorized in 1965 as Title XIX of
Social Security Act
-financed through federal and state taxes, with it mostly being
covered by federal government
-ACA of 2010 created national medicaid minimum eligibility level
of 133% of the federal poverty level
,State medicaid programs are required by federal government to
cover - correct answer -aid to families with dependent chidlren
-people older than 65, blind or totally disabled
-pregnant women and children under 6 with family incomes up to
133% of poverty leve
-children enrolled in Medicaid, foster children, or children with
certain disabilities
CHIP income eligibility level - correct answer -241% of federal
poverty level
Medicare - correct answer -federally mandated program
established in 1965, provides health insurance for aged and
disabled individuals, and people of all ages with ESRD
-covers hospital service, physician services, and other services
-income doesn't impact eligibility
-people >65 who have paid into SSI
Medicare part A covers - correct answer -hospital care
-skilled nursing facility care
-nursing home care
-hospice
-home health services
Medicare part B - correct answer -monthly premium charged
-financed by general federal revenues and by part B premiums
, -covers all medically necessary services- 80% of an approved
amount after annual deduction
Medicare part C - correct answer -private insurance plans
approved by medicare
-covers all part A and B services and can offer extra coverage
-pays fixed amount each month
-includes a prescription drug benefit
Medicare part D - correct answer -prescription drug benefits
-can be added to other parts of the medicare plans
-each medicare drug plan has a formulary
APRN- medicaid/medicare coverage - correct answer -Omnibus
Budget Reconciliation Act mandated medicaid reimbursement for
CPNP
-level of payment is determined by states
-can bill medicaid directly after attaining provider number from
state medicaid agency
-states can elect to pass laws allowing them to extend medicaid
payment to other types of nps not identified in federal statues
APRN medicare reimbursement - correct answer -85% of
physician fee schedule when billing independently using APRN
billing number
-direct physician supervision not required
-when employed by physician, physician practice may receive
100% with "incident to" rules
Distinction level Marking scheme version
2024/2025
Risk management - correct answer -systems and activities
designed to recognize and intervene to decrease risk of injury to
patients and subsequent claims against healthcare providers,
based on the assumption that many injuries to patients are
preventable
Sources of legal liability - correct answer
-patients
-procedures
-quality of record keeping
Areas of liability risk - correct answer -practitioner-client
relationship
-communication and informed consent
-clinical expertise
-self-evaluation by professionals of need to stay current
-documentation
-consultation and referral
-policies, procedures, and protocols
-supervision of others
Malpractice - correct answer -professional misconduct,
unreasonable lack of skill
,-infidelity in professional or fiduciary duties
-illegal, immoral conduct resulting in patient harm
-alleged professional failure to render services with degree of
care, diligence, and precaution that another member of same
profession in similar circumstances would render to prevent
patient injury
-doesn't protect APRN from charges of practicing medicine
without a license if APRN is practicing outside legal scope of
practice for that state
Occurrence coverage (malpractice insurance) - correct answer
covers malpractice event that occurred during policy period,
regardless of date of discovery or when claim filed
Claims made coverage (malpractice insurance) - correct answer
-covers only claims filed during policy coverage period,
regardless of when event occurred
-optional tail coverage contract extends the coverage of a claims
made policy into the future to cover all claims filed after the
basic claims made coverage
Negligence - correct answer -failure of individuals to do what a
reasonable person would do that results in injury to another
Medicaid - correct answer -authorized in 1965 as Title XIX of
Social Security Act
-financed through federal and state taxes, with it mostly being
covered by federal government
-ACA of 2010 created national medicaid minimum eligibility level
of 133% of the federal poverty level
,State medicaid programs are required by federal government to
cover - correct answer -aid to families with dependent chidlren
-people older than 65, blind or totally disabled
-pregnant women and children under 6 with family incomes up to
133% of poverty leve
-children enrolled in Medicaid, foster children, or children with
certain disabilities
CHIP income eligibility level - correct answer -241% of federal
poverty level
Medicare - correct answer -federally mandated program
established in 1965, provides health insurance for aged and
disabled individuals, and people of all ages with ESRD
-covers hospital service, physician services, and other services
-income doesn't impact eligibility
-people >65 who have paid into SSI
Medicare part A covers - correct answer -hospital care
-skilled nursing facility care
-nursing home care
-hospice
-home health services
Medicare part B - correct answer -monthly premium charged
-financed by general federal revenues and by part B premiums
, -covers all medically necessary services- 80% of an approved
amount after annual deduction
Medicare part C - correct answer -private insurance plans
approved by medicare
-covers all part A and B services and can offer extra coverage
-pays fixed amount each month
-includes a prescription drug benefit
Medicare part D - correct answer -prescription drug benefits
-can be added to other parts of the medicare plans
-each medicare drug plan has a formulary
APRN- medicaid/medicare coverage - correct answer -Omnibus
Budget Reconciliation Act mandated medicaid reimbursement for
CPNP
-level of payment is determined by states
-can bill medicaid directly after attaining provider number from
state medicaid agency
-states can elect to pass laws allowing them to extend medicaid
payment to other types of nps not identified in federal statues
APRN medicare reimbursement - correct answer -85% of
physician fee schedule when billing independently using APRN
billing number
-direct physician supervision not required
-when employed by physician, physician practice may receive
100% with "incident to" rules
