ATI CMS FUNDAMENTALS CERTIFICATION
EVALUATION COMPLETE QUESTIONS AND
ANSWERS GRADED A PLUS
●● Medicaid
Answer: for clients with low income. is federally funded and individual
states determine eligibility requirements.
●● Traditional Insurance
Answer: reimburses for services on fee-for-service basis.
●● Managed Care Organizations (MCOs)
Answer: comprehensive care is overseen by a primary care provider &
focuses on prevention and health promotion
●● Preferred Provider Organizations (PPOs)
Answer: client chooses from a list of contracted providers. using non-
contracted providers increases the client's out of pocket costs
●● Exclusive Provider Organizations (EPOs)
Answer: the client chooses from a list of providers within a contracted
organization
,●● Long-Term Care Insurance
Answer: provides for long-term care expenses not covered by Medicare
●● Preventive health care
Answer: focuses on educating and equipping clients to reduce and
control risk factors of disease. Examples include immunizations, stress
management programs, and seat belt use
●● Primary health care
Answer: emphasizes health promotion, and includes prenatal and well-
baby care, nutrition counseling, and disease control. is based on a
sustained partnership between client and provider. examples include
office or clinic visits and scheduled school/work centered screenings
(vision, hearing, obesity)
●● Secondary health care
Answer: includes the diagnosis and treatment of emergency, acute
illness, or injury. examples include care given in hospital settings
(inpatient and EDs), diagnostic centers, or emergent care centers
●● Tertiary health care
Answer: involves the provision of specialized highly technical care.
examples include oncology centers and burn centers
,●● Restorative health care
Answer: involves intermediate follow-up care for restoring health.
examples include home health care, rehab centers, and skilled nursing
facilities
●● Continuing health care
Answer: designed to address long-term or chronic health care needs.
examples include hospice, adult day care, and in-home respite care
●● Health care regulatory agencies include:
Answer: -US Dept of Health and Human Srvcs
-US FDA
-State and local public health agencies
-State licensing boards (to ensure providers & agencies comply with
state regulations)
-the Joint Commission/JCAHO (set quality standards for accreditation of
health care facilities)
-Professional Standards Review Organizations (PSROs)
-Utilization review committees (monitor for appropriate diagnosis and
treatment of hospitalized clients)
●● Clergy
Answer: Job: provide spiritual care to client (pastors, rabbis, priests)
, Refer to when: the client requests communication or the family asks for
prayer prior to client undergoing a procedure
●● Registered dietitian
Answer: Job: assess, plan for, and educate the client reg. nutritional
needs; direct care of nutritional aids
Refer to when: ex- the client has low nutrient levels and/or experienced
a recent unexplained weight loss
●● Lab tech
Answer: Job: obtain specimens of the client's body fluids and perform
the necessary diagnostic tests
Refer to when: ex- the provider orders a CBC to be performed
immediately
●● Occupational therapist
Answer: Job: assess and plan for the client to regain ADLs, esp motor
skills of the upper extremities; direct care of occupational therapy
assistants
Refer to when: ex- client has difficulties using an eating utensil with
dominate hand following a stroke
EVALUATION COMPLETE QUESTIONS AND
ANSWERS GRADED A PLUS
●● Medicaid
Answer: for clients with low income. is federally funded and individual
states determine eligibility requirements.
●● Traditional Insurance
Answer: reimburses for services on fee-for-service basis.
●● Managed Care Organizations (MCOs)
Answer: comprehensive care is overseen by a primary care provider &
focuses on prevention and health promotion
●● Preferred Provider Organizations (PPOs)
Answer: client chooses from a list of contracted providers. using non-
contracted providers increases the client's out of pocket costs
●● Exclusive Provider Organizations (EPOs)
Answer: the client chooses from a list of providers within a contracted
organization
,●● Long-Term Care Insurance
Answer: provides for long-term care expenses not covered by Medicare
●● Preventive health care
Answer: focuses on educating and equipping clients to reduce and
control risk factors of disease. Examples include immunizations, stress
management programs, and seat belt use
●● Primary health care
Answer: emphasizes health promotion, and includes prenatal and well-
baby care, nutrition counseling, and disease control. is based on a
sustained partnership between client and provider. examples include
office or clinic visits and scheduled school/work centered screenings
(vision, hearing, obesity)
●● Secondary health care
Answer: includes the diagnosis and treatment of emergency, acute
illness, or injury. examples include care given in hospital settings
(inpatient and EDs), diagnostic centers, or emergent care centers
●● Tertiary health care
Answer: involves the provision of specialized highly technical care.
examples include oncology centers and burn centers
,●● Restorative health care
Answer: involves intermediate follow-up care for restoring health.
examples include home health care, rehab centers, and skilled nursing
facilities
●● Continuing health care
Answer: designed to address long-term or chronic health care needs.
examples include hospice, adult day care, and in-home respite care
●● Health care regulatory agencies include:
Answer: -US Dept of Health and Human Srvcs
-US FDA
-State and local public health agencies
-State licensing boards (to ensure providers & agencies comply with
state regulations)
-the Joint Commission/JCAHO (set quality standards for accreditation of
health care facilities)
-Professional Standards Review Organizations (PSROs)
-Utilization review committees (monitor for appropriate diagnosis and
treatment of hospitalized clients)
●● Clergy
Answer: Job: provide spiritual care to client (pastors, rabbis, priests)
, Refer to when: the client requests communication or the family asks for
prayer prior to client undergoing a procedure
●● Registered dietitian
Answer: Job: assess, plan for, and educate the client reg. nutritional
needs; direct care of nutritional aids
Refer to when: ex- the client has low nutrient levels and/or experienced
a recent unexplained weight loss
●● Lab tech
Answer: Job: obtain specimens of the client's body fluids and perform
the necessary diagnostic tests
Refer to when: ex- the provider orders a CBC to be performed
immediately
●● Occupational therapist
Answer: Job: assess and plan for the client to regain ADLs, esp motor
skills of the upper extremities; direct care of occupational therapy
assistants
Refer to when: ex- client has difficulties using an eating utensil with
dominate hand following a stroke
