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What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? A. Copayment B. Deductible C. Secondary Payment D. Coinsurance Answer B. Deductible Which type of insurance covers physicians and other healthcare professionals for liability as to claims arising from patient treatment? A. Business liability B. Bonding C. Medical malpractice D. Workers' compensati...

EPO Answer ...provides benefits to subscribers who are required to receive services from network providers IDS Answer ...organizations of affiliated providers sites that offer joint healthcare services to subscribers HMO Answer ...providers comprehensive healthcare services to voluntarily enrolled members on a prepaid basis POS Answer ...patients can use the managed care panel of providers (paying discounted healthcare cost) or self-refer to out-of-network providers (and pay higher cost...

answers The office policy for claims follow-up is to prioritize the insurance balance accounts past 90 days by highest outstanding balance. Based on the A/R report provided, which payer type and aging category would be one of the top priorities on which to focus collection efforts? Answer workers' compensation, 121+ days Using the fee schedule and the payment policy provided, what is the expected reimbursement (including patient responsibility) when a provider performs a nasal endoscopy and...

Abuse Answer Actions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment Answer Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable Answer The amount owed to a business for services or goods provided. Accounts Receivable Aging Report Answer Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients. Acco...

A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? A. Mother's insurance plan B. Father's insurance plan C. The policy that has the best benefits D. Either mother's or father's insurance plan depending who brings the child in for medical care. Answer A. Mother's insurance plan Which managed care plan has the patient receiving care from pa...

Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: Answer covered entity Which of the following is not a covered entity in the Privacy Rule Answer healthcare consulting firm A request for medical records is received for a specific date of service from patient's insurance company with regards to a submitted claim. No authorization for release of information is provided. What action should be taken? Answer release reqt to i...

Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd. C. Mary, because her birth year is before Joe's birth year. D. Joe, because his birth month and day are before...

Who is covered by champva? A) veterans with service - connected disabilities and their families B) active duty military and their families C) retired military and their families D) active duty military over the age of 65 answer a) veterans with service - connected disabilities and their families Rationale: the civilian health and medical program of the department of veterans affairs (champva) covers veterans who are permanently and totally disabled due to a service-related disability a...

1. You are a network administrator for a company that maintains LANs in Los Angeles and Paris. You want to use PPTP to create a VPN connection between the LAN in Paris and the LAN in Los Angeles. A PPTP server has been configured on each LAN. Which protocol should you use to establish a connection between the PPTP servers? a) HTTP b) PPP c) SLIP d) Telnet Answer b) PPP 2. What is the advantage of using wireless bridges over E1/T1 leased lines? a) Wireless bridges generate less nois...

A nurse is monitoring a client who is to our postop and a prescription for opioid analgesics. Which of the following actions provides the nurse with the priority data to determine the clients need for analgesia? Answer Ask the client to rate their pain level A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse include in the teaching? Answer Increase fluid intake A nurse is re...

A nurse is monitoring a client who is to our postop and a prescription for opioid analgesics. Which of the following actions provides the nurse with the priority data to determine the clients need for analgesia? Answer Ask the client to rate their pain level A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse include in the teaching? Answer Increase fluid intake A nurse is re...

Lumbar Puncture Answer Needle inserted into subarachnoid space. Position client in lateral recumbent fetal position at edge of bed. Arthroplasty (x2) Answer Surgical replacement of joint with artificial joint. Hemiarthroplasty: replacement of the head of femur - position leg in abduction (pillows btwn legs) Knee: encourage deep breathing and coughing after procedure. Medications: Antianxiety Answer Contraindications: narrow-angle glaucoma, shock, coma, combination with other depressiv...

A nurse is caring for a group of clients who are taking herbal medications at home. Which of the following clients should be instructed not to take herbal medications? Answer A 10-year-old female client with a urinary tract infection. Children should not be given herbal therapies, especially in the home and without professional supervision. The nurse is reviewing the health records of assigned clients. The nurse plans care knowing that which client is at risk for a potassium deficit? Answer P...

A nurse is monitoring a client who has type 2 diabetes Molite us and is receiving repaglinide. Which of the laboratory test should the nurse plan to review to obtain information about the long-term therapeutic effect of this medication? Answer Glycosylated HbA1c A nurse is reinforcing teaching with a client who is the start therapy using a nitroglycerin transdermal patch. Which of the following instruction should the nurse include? Answer Place the patch on a different site for each applicati...

A hospice nurse is caring for a preschooler who has a terminal illness. One of the child's parents tells the nurse that it is too difficult to cope any longer and has decided to move out of the house. Which of the following responses should the nurse make? A: "Let's talk about a few ways you have dealt with stress in the past." B: "I believe that you will regret that decision. Your family needs your support." C: "I agree that you have to do what is best for your well-being at this time...

1. The nurse cares for the client diagnosed as being in the manic phase of bipolar disorder. Which behavior indicates to the nurse the client condition is improving? Answer The client sits and eats with other clients on unit 2. The health care provider orders a continuous intravenous aminophylline infusion for a two year old client. It is most important for the nurse to intervene for which situation? c. The clients serum theophylline level is 25 mcg/mL Answer C 3. The nurse teaches th...

A nurse is admitting a client who has alcohol use disorder. Which of the following statements by the client indicates that the client is using denial as a defense mechanism? Answer "I am able to go to work every day, so I don't have a problem." A nurse in the emergency department is caring for a client who has alcohol toxicity and is unresponsive. Which of the following interventions should the nurse take? Answer Gather supplies for endotracheal intubation. A nurse is caring for a clien...

The licensing agency shall conduct an inspection of a newly licensed facility within how many days of issuance of a license. Answer 60 days Each applicant shall submit a financial plan of operation that shall document the availability of start-up funds to finance the first Answer 3 months of operation All community care facilities shall be inspected and evaluated for quality of care by licensing agency personnel at least Answer Twice per year In facilities with a licensed capacity of 16...

It will be most important for the nurse to check pulse oximetry for which of these patients? a. A patient with emphysema and a respiratory rate of 16 b. A patient with massive obesity who is refusing to get out of bed c. A patient with pneumonia who has just been admitted to the unit d. A patient who has just received morphine sulfate for postoperative pain Answer C Rationale: Hypoxemia and hypoxemic respiratory failure are caused by disorders that interfere with the transfer of oxygen into...

Disaster Drills to be conducted Answer At least every 6 months Licensing will conduct a follow-up inspection of a facility for which a license was issued within ____ days. Answer 90 Days How long does the licensee have to report by telephone a special incident to licensing? Answer By the next business morning during regular business hours Who can change a label on a prescribed medication? Answer The dispensing pharmacist Centrally stored medication records must be maintained for how ...