PMHNP Boards ALREADY PASSED
Medicare Part A Coverage - ✔✔Hospital insurance that covers inpatient and most skilled care.
Mandatory copays for hospital days 21-150, getting higher with each period of time.
Medicare Part A Eligibility - ✔✔>65 in social security automatic enrollment
Medicare Part A Cost - ✔✔No cost if automatically qualified. 30-39 work quarters: ~$250/mo <30
work quarters: ~$450/mo
Medicare Part B Coverage - ✔✔Supplemental medical insurance. Outpatient services, care,
physical/speech therapy, some home health care, medical equipment
Medicare Part B Eligibility - ✔✔Voluntary if >65
Medicare Part B Cost - ✔✔Deducted from monthly social security check. *Enroll 3 months before
65th birthday or 4 months after, otherwise increased costs to enroll*
Medicare Part C - ✔✔Medicare Advantage. Get all their medical services through that plan.
Medicare Part D coverage - ✔✔Prescription drug coverage
Medicare Part D Cost - ✔✔Varies depending on how extensive drug benefit is. Different plans have
different benefits.
Medigap Plans - ✔✔Fill gaps in coverage that occur with Medicare
Medicare Advantage Plan - ✔✔Will likely eliminate need for medigap insurance?
Medicaid Eligibility - ✔✔Automatic coverage not guaranteed except for poor pregnant women and
children. States can refuse to cover adults/head of households who lose Temporary Assistance to
Needy Families d/t refusal to work. Generally covers poor people.
,Medicaid funding - ✔✔Federal + state. States determine how much they want to pay in, different
states have different qualities of Medicaid
HMO - ✔✔Four components: Enrolled population, prepayment of premiums, coverage of
comprehensive medical svcs, centralization of medical and hospital svcs
Closed-panel HMO - ✔✔Specific providers identified by plan to provide the medical services to
members. Staff can be salaried by HMO or an agency/group contracted by the HMO.
Open-panel HMO - ✔✔Network HMO, Individual Practice Association, Point of Service Plans
Network HMO - ✔✔HMO contracts with more than one group of practices
Individual Practice Association - ✔✔Insurance coverage. Contract with an association of physicians to
provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) - ✔✔Insurance coverage. Patients
allowed to self-refer to specialist but pay higher premium to do so. POS requires PCP is gatekeeper
but pt can see a provider outside of HMO for more $$. PPOs contract to a selected group of
participating providers and give discount for using a selected group of providers. Financial risk held
by insurer in PPO, held by providers in POS
Managed indemnity - ✔✔Traditional model insurance coverage.. Pre-certification, catastrophic case
management, minimal contract arrangement with providers. Provider groups and health plans can
use quality control, utilization review, bundling of services, incentives for health behaviors. MUST
seek National Committee on Quality Assurance (NCQA) accreditation
Licensure - ✔✔Member of profession is granted ability to practice
Accreditation - ✔✔Formal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related programs.
, Certification - ✔✔Tests knowledge, skills, abilities for entry into practice. Formal recognition of the
knowledge, skills, and experience
demonstrated by the achievement of standards identified by the profession
Education - ✔✔Formal preparation of APRNs in graduate degree-granting or postgraduate
certificate programs
Factors facilitating NP growth - ✔✔Demand for svcs, acceptance of role, emphasis on integrated
healthcare svcs, emergence of PMHNP and decreasing stigmatization
Factors constraining NP growth - ✔✔Growth competition, reimbursement struggles, overlapping
scopes with other NPs, concerns about reimbursement fraud/abuse, scope of practice requiring
physician supervision/collab
Exceptions to confidentiality - ✔✔Information given to attorneys involved in litigation, records to
insurance companies, answering court orders, mandatory state reporting, harm to self or others or
child/elder abuse, determined need for info outweighs principle of confidentiality
Deontological Theory - ✔✔Action is judged as good or bad based on the act itself regardless of the
consequences
Teleological Theory - ✔✔An action is judged as good or bad based on the consequence or outcome
Virtue Ethics - ✔✔Actions are chosen based on moral virtues (honesty, courage, compassion, etc) or
the character of the person making the decision
Elements of negligence that must be established to prove malpractice - ✔✔Duty, breach of duty,
proximate cause, damages
Duty (negligence) - ✔✔NP had a duty to exercise reasonable care when undertaking and providing
treatment to the client
Breach of duty (negligence) - ✔✔The NP violated the applicable standard of care in treating the
client's condition
Medicare Part A Coverage - ✔✔Hospital insurance that covers inpatient and most skilled care.
Mandatory copays for hospital days 21-150, getting higher with each period of time.
Medicare Part A Eligibility - ✔✔>65 in social security automatic enrollment
Medicare Part A Cost - ✔✔No cost if automatically qualified. 30-39 work quarters: ~$250/mo <30
work quarters: ~$450/mo
Medicare Part B Coverage - ✔✔Supplemental medical insurance. Outpatient services, care,
physical/speech therapy, some home health care, medical equipment
Medicare Part B Eligibility - ✔✔Voluntary if >65
Medicare Part B Cost - ✔✔Deducted from monthly social security check. *Enroll 3 months before
65th birthday or 4 months after, otherwise increased costs to enroll*
Medicare Part C - ✔✔Medicare Advantage. Get all their medical services through that plan.
Medicare Part D coverage - ✔✔Prescription drug coverage
Medicare Part D Cost - ✔✔Varies depending on how extensive drug benefit is. Different plans have
different benefits.
Medigap Plans - ✔✔Fill gaps in coverage that occur with Medicare
Medicare Advantage Plan - ✔✔Will likely eliminate need for medigap insurance?
Medicaid Eligibility - ✔✔Automatic coverage not guaranteed except for poor pregnant women and
children. States can refuse to cover adults/head of households who lose Temporary Assistance to
Needy Families d/t refusal to work. Generally covers poor people.
,Medicaid funding - ✔✔Federal + state. States determine how much they want to pay in, different
states have different qualities of Medicaid
HMO - ✔✔Four components: Enrolled population, prepayment of premiums, coverage of
comprehensive medical svcs, centralization of medical and hospital svcs
Closed-panel HMO - ✔✔Specific providers identified by plan to provide the medical services to
members. Staff can be salaried by HMO or an agency/group contracted by the HMO.
Open-panel HMO - ✔✔Network HMO, Individual Practice Association, Point of Service Plans
Network HMO - ✔✔HMO contracts with more than one group of practices
Individual Practice Association - ✔✔Insurance coverage. Contract with an association of physicians to
provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) - ✔✔Insurance coverage. Patients
allowed to self-refer to specialist but pay higher premium to do so. POS requires PCP is gatekeeper
but pt can see a provider outside of HMO for more $$. PPOs contract to a selected group of
participating providers and give discount for using a selected group of providers. Financial risk held
by insurer in PPO, held by providers in POS
Managed indemnity - ✔✔Traditional model insurance coverage.. Pre-certification, catastrophic case
management, minimal contract arrangement with providers. Provider groups and health plans can
use quality control, utilization review, bundling of services, incentives for health behaviors. MUST
seek National Committee on Quality Assurance (NCQA) accreditation
Licensure - ✔✔Member of profession is granted ability to practice
Accreditation - ✔✔Formal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related programs.
, Certification - ✔✔Tests knowledge, skills, abilities for entry into practice. Formal recognition of the
knowledge, skills, and experience
demonstrated by the achievement of standards identified by the profession
Education - ✔✔Formal preparation of APRNs in graduate degree-granting or postgraduate
certificate programs
Factors facilitating NP growth - ✔✔Demand for svcs, acceptance of role, emphasis on integrated
healthcare svcs, emergence of PMHNP and decreasing stigmatization
Factors constraining NP growth - ✔✔Growth competition, reimbursement struggles, overlapping
scopes with other NPs, concerns about reimbursement fraud/abuse, scope of practice requiring
physician supervision/collab
Exceptions to confidentiality - ✔✔Information given to attorneys involved in litigation, records to
insurance companies, answering court orders, mandatory state reporting, harm to self or others or
child/elder abuse, determined need for info outweighs principle of confidentiality
Deontological Theory - ✔✔Action is judged as good or bad based on the act itself regardless of the
consequences
Teleological Theory - ✔✔An action is judged as good or bad based on the consequence or outcome
Virtue Ethics - ✔✔Actions are chosen based on moral virtues (honesty, courage, compassion, etc) or
the character of the person making the decision
Elements of negligence that must be established to prove malpractice - ✔✔Duty, breach of duty,
proximate cause, damages
Duty (negligence) - ✔✔NP had a duty to exercise reasonable care when undertaking and providing
treatment to the client
Breach of duty (negligence) - ✔✔The NP violated the applicable standard of care in treating the
client's condition
