NUR 2868 ROLE AND SCOPE EXAM PRACTICE
QUESTIONS AND ANSWERS 2026
◉ What can and can't a nurse share through social media such as
Facebook? What does the nurse need to know about social media?
How does HIPPA impact what a nurse can post? Answer: Anything
posted online exists forever on a server somewhere, even if it is
deleted from the site. This information is forever discoverable in a
court of law and can be used in a trial. Friends might find your story
so touching or endearing that they repost to their friends, and the
story takes on a life of its own with no available control of
dissemination on your part.
◉ What is Capitation? Answer: A method of reimbursing providers
in which the insurance company pays the provider a set payment
each month to provide a defined set of health care services for the
patient enrolled in the insurance company's heath plan. The
payment is typically expressed as a per-member-per-month
payment. The defined health care services generally include
preventive, diagnostic, and treatment services.
◉ What are DRGs? Answer: refers to reimbursement for health care
services based on a predetermined fixed price-per-case or diagnosis.
To control rapidly rising health care costs, a helth care financing
revolution began in 1983 when Medicare moved from a
retrospective fee for service reimbursement to a prospective
,payment system based on diagnosis related groups (DRG's). This
shift was critical for hospitals because Medicare is the largest single
payer of hospital charges. Under DRGs, each Medicare patient is
assigned to a diagnostic grouping based on his or her primary
diagnosis at hospital admission. Medicare limits total payment to the
hospital to the amount pre established for that DRG, unlike the
previous approach in which hospital patient incurred costs and
Medicare reimbursed these charges with a generous payment
schedule.
◉ What is a prospective payment system? (PPS) Answer: A method
of reimbursing health care providers in which the total amount of
payment for care is predetermined based on the patient's diagnosis
provides for a set price per diagnosis payment system. In contrast to
the retrospective fee for service system. It encourages increased
efficiency in the use of health care services because providers are
reimbursed at a set level regardless of how many services are
rendered or procedures performed to treat a particular diagnostic
category. THE MOST COMMON METHOD OF PAYMENT IN TODAY'S
HEALTH CARE SYSTEM.
◉ Give an example of a prospective payment system? Answer: A
Prospective Payment System (PPS) is a method of reimbursement in
which Medicare payment is made based on a predetermined, fixed
amount? The payment amount for a particular service is derived
based on the classification system of that service (for example,
diagnosis-related groups for inpatient hospital services). CMS uses
separate PPSs for reimbursement to acute inpatient hospitals, home
,health agencies, hospice, hospital outpatient, inpatient psychiatric
facilities, inpatient rehabilitation facilities, long-term care hospitals,
and skilled nursing facilities.
◉ What is a retrospective payment system? Answer: A method of
reimbursing health care providers in which professional services are
rendered and charges are billed based on each individual service
provided. Also known as the "fee-for-service" payment system. This
system may encourage overuse of health care services because the
more services rendered or procedures performed, the more revenue
received by providers. Not good!!!!
◉ Give an example of a retrospective payment system? Answer:
Retrospective payments keep the choice of medical treatments and
service in the hands of qualified healthcare professionals, aligned
with the comfort level of the patient. Rather than having unqualified
professional in finance companies decide on the treatment plan for a
patient, based on economic assumptions, healthcare professionals
and patients can put healthcare concerns first. Yet, no system is
perfect and inefficiencies can result.
◉ What is a single payer system? Answer: a method of
reimbursement in which one payer, usually the government pays all
health care expenses for citizens, funded by taxes. Decisions about
covered treatments, drugs and services are made by the
government.
, ◉ Give an example of a single payer system? Answer: Though there
is considerable debate about how a single-payer system
fundamentally works, by many accounts a single-payer system
operates much like the Veterans Administration works today in the
United States: Hospitals receive a general budget from the
government, doctors receive a salary from the hospitals, and the
government pays for the cost of care. However, single-payer systems
can also work like Medicare, which allows patients and doctors to
operate in the private markets while receiving negotiated payments
from the federal and state governments.
◉ What is Universal health? Answer: The goal of universal health
coverage is to ensure that all people obtain the health services they
need without suffering financial hardship when paying for them. For
a community or country to achieve universal health coverage,
several factors must be in place, including:
◉ What factors must be in place to achieve universal health?
Answer: 1. A strong, efficient, well-run health system that meets
priority health needs through people-centered integrated care
(including services for HIV, tuberculosis, malaria, no communicable
diseases, maternal and child health) by:
• informing and encouraging people to stay healthy and prevent
illness;
• detecting health conditions early;
• having the capacity to treat disease; and
• helping patients with rehabilitation.
QUESTIONS AND ANSWERS 2026
◉ What can and can't a nurse share through social media such as
Facebook? What does the nurse need to know about social media?
How does HIPPA impact what a nurse can post? Answer: Anything
posted online exists forever on a server somewhere, even if it is
deleted from the site. This information is forever discoverable in a
court of law and can be used in a trial. Friends might find your story
so touching or endearing that they repost to their friends, and the
story takes on a life of its own with no available control of
dissemination on your part.
◉ What is Capitation? Answer: A method of reimbursing providers
in which the insurance company pays the provider a set payment
each month to provide a defined set of health care services for the
patient enrolled in the insurance company's heath plan. The
payment is typically expressed as a per-member-per-month
payment. The defined health care services generally include
preventive, diagnostic, and treatment services.
◉ What are DRGs? Answer: refers to reimbursement for health care
services based on a predetermined fixed price-per-case or diagnosis.
To control rapidly rising health care costs, a helth care financing
revolution began in 1983 when Medicare moved from a
retrospective fee for service reimbursement to a prospective
,payment system based on diagnosis related groups (DRG's). This
shift was critical for hospitals because Medicare is the largest single
payer of hospital charges. Under DRGs, each Medicare patient is
assigned to a diagnostic grouping based on his or her primary
diagnosis at hospital admission. Medicare limits total payment to the
hospital to the amount pre established for that DRG, unlike the
previous approach in which hospital patient incurred costs and
Medicare reimbursed these charges with a generous payment
schedule.
◉ What is a prospective payment system? (PPS) Answer: A method
of reimbursing health care providers in which the total amount of
payment for care is predetermined based on the patient's diagnosis
provides for a set price per diagnosis payment system. In contrast to
the retrospective fee for service system. It encourages increased
efficiency in the use of health care services because providers are
reimbursed at a set level regardless of how many services are
rendered or procedures performed to treat a particular diagnostic
category. THE MOST COMMON METHOD OF PAYMENT IN TODAY'S
HEALTH CARE SYSTEM.
◉ Give an example of a prospective payment system? Answer: A
Prospective Payment System (PPS) is a method of reimbursement in
which Medicare payment is made based on a predetermined, fixed
amount? The payment amount for a particular service is derived
based on the classification system of that service (for example,
diagnosis-related groups for inpatient hospital services). CMS uses
separate PPSs for reimbursement to acute inpatient hospitals, home
,health agencies, hospice, hospital outpatient, inpatient psychiatric
facilities, inpatient rehabilitation facilities, long-term care hospitals,
and skilled nursing facilities.
◉ What is a retrospective payment system? Answer: A method of
reimbursing health care providers in which professional services are
rendered and charges are billed based on each individual service
provided. Also known as the "fee-for-service" payment system. This
system may encourage overuse of health care services because the
more services rendered or procedures performed, the more revenue
received by providers. Not good!!!!
◉ Give an example of a retrospective payment system? Answer:
Retrospective payments keep the choice of medical treatments and
service in the hands of qualified healthcare professionals, aligned
with the comfort level of the patient. Rather than having unqualified
professional in finance companies decide on the treatment plan for a
patient, based on economic assumptions, healthcare professionals
and patients can put healthcare concerns first. Yet, no system is
perfect and inefficiencies can result.
◉ What is a single payer system? Answer: a method of
reimbursement in which one payer, usually the government pays all
health care expenses for citizens, funded by taxes. Decisions about
covered treatments, drugs and services are made by the
government.
, ◉ Give an example of a single payer system? Answer: Though there
is considerable debate about how a single-payer system
fundamentally works, by many accounts a single-payer system
operates much like the Veterans Administration works today in the
United States: Hospitals receive a general budget from the
government, doctors receive a salary from the hospitals, and the
government pays for the cost of care. However, single-payer systems
can also work like Medicare, which allows patients and doctors to
operate in the private markets while receiving negotiated payments
from the federal and state governments.
◉ What is Universal health? Answer: The goal of universal health
coverage is to ensure that all people obtain the health services they
need without suffering financial hardship when paying for them. For
a community or country to achieve universal health coverage,
several factors must be in place, including:
◉ What factors must be in place to achieve universal health?
Answer: 1. A strong, efficient, well-run health system that meets
priority health needs through people-centered integrated care
(including services for HIV, tuberculosis, malaria, no communicable
diseases, maternal and child health) by:
• informing and encouraging people to stay healthy and prevent
illness;
• detecting health conditions early;
• having the capacity to treat disease; and
• helping patients with rehabilitation.
