NR 511 Week 1: Quiz1 Questions and answers,100% CORRECT

NR 511 Week 1: Quiz1 Questions and answers The phrase usual and customary refers to: The success rate of a specified procedure. How much an insurer will charge to provide coverage. Correct Answer How charges for a service compares with charges made to other persons receiving similar services and supplies. How an insurer evaluates the need for an ordered diagnostic test. The phrase usual and customary refers to the comparison of charges with other like charges for services and supplies received in the immediate vicinity as well as in a broader geographic area. What must you do as an advanced practice registered nurse (APRN) before billing for visits? Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer. Provide evidence of continuing medical education Obtain a Drug Enforcement Administration (DEA) number. Establish a collaborative agreement with a physician. To bill your clients for services, you must obtain a provider number and familiarize yourself with the rules and policies of each payor. Which one of the following is true regarding the importance of documentation? It allows you to communicate your findings to other providers and serves as a record for the visit. It is only important in order to bill the patient for your service. It is only important for defending yourself in the event of a law suit. It allows you to communicate your findings with the general public. The purposes of documentation are to record the patient's report of symptoms, PMH, lifestyle and family factors, positive and negative findings on physical exam and the provider's plan. Documentation is important for billing purposes, communication with other providers and in the case litigation. Which of the following statements does not belong in the past medical history portion of your chart note? Correct Answer Your patient had lab work done at their last appointment; CBC was normal. Your patient’s father passed away from lung cancer. Your patient had a cholecystectomy 3 years prior. Your patient has an allergy to penicillin. Allergies, family history and surgical history all belong in the history portion of your note. Test results are objective findings and should be in the diagnostic tests (objective) section of the note. In relation to writing a patient encounter note, the acronym SOAP stands for which of the following? Subjective, objective, assessment, plan. Symptoms, observations, assessment, plan. Symptoms, objective findings, assessment, plan. Subjective, outward findings, assessment, plan. The acronym SOAP stands for subjective, objective, assessment and plan. Most health maintenance organizations (HMOs) use a reimbursement mechanism called capitation. What does this mean? The HMO reimburses the provider on a fee-for-service basis. The HMO is not responsible for provider reimbursement. The HMO reimburses the provider only if the patient has paid their deductible. Correct Answer The HMO reimburses the provider a predetermined fee per client per month based on the client’s age and sex. The reimbursement mechanism called capitation that some HMOs use is one in which the HMO reimburses the provider a set fee per client per month based on the client's age and sex. HMOs are prepaid, comprehensive systems of health benefits that combine both financing and delivery of services to subscribers. They may pay providers on a capitated or fee-for-service basis. Question 7 1 / 1 pts A screening test identified correctly identified 80 individuals who did not have breast cancer out of 100 individuals that were known to be free of the disease (true negatives). Thus, the test failed to recognize 20 individuals who did not have breast cancer. What is the specificity of the screening test? 40%. 60%. 20%. 80%. Specificity measures a screening test's ability to recognize individuals who are non-diseased or those with negative reactions (true negatives). It can be represented by a reaction of tested negatives to the total number of known, or true, negatives. In this case, the number of negatives that the test recognized was 80, with the total number of known, or true, negatives being 100. 80 out of 100=80%. What is an Accountable Care Organization (ACO)? A bundling of pilot organizations. A payment system for episodes of care to save money for the health care system. Correct Answer A group of providers and suppliers who come together voluntarily to give coordinated, high-quality care to Medicare patients. A risk pool that saves the overall organization money and maximizes reimbursement. ACOs are groups of doctors, hospitals and other health care providersd who come together voluntarily to give coordinated, high-quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeeds in delivering high quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. Denial of provider status is something that seriously impedes a nurse practitioner’s ability to practice. If that occurs, some steps one can take include: “Bashing” the organization to others and contacting an attorney. lobby on your behalf, and reapplying after a 6-month period. Requesting that your clients lobby on your behalf by going to the newspapers. Requesting that your physician colleagues intervene on your behalf by writing critical letters to the organization in question. There are many steps a nurse practitioner can take if denied provider status by a 3rd party reimburser. First, one should ascertain the reasons for this stance and determine whether it is the same across the board regarding nurse practitioners. If it is a consistent policy, attempt to find out why and begin marshaling evidence to overturn this stance in a constructive way. This may include having both clients and physician colleagues “lobby” on your behalf. Find out who the decision maker in the organization is and attempt to communicate directly with that person. Ascertain if there is a law in the state mandating this policy. Be prepared to testify at hearings and speak out at community meetings about this issue. Request language changes that specify “ask your doctor” and lobby to have these changes adopted. Reapplication in 6 months is reasonable. Which of the following statements about Medicaid is true? Medicaid pays for family planning services, dental care, and eyeglasses. Medicaid is a federal plan created to provide care for indigent persons. Eligibility requirements for Medicaid are mandated by the Health Care Financing Administration. Medicaid is a program for the indigent financed jointly by the federal and state governments. Financed jointly by the federal and state governments, Medicaid is a program created to pay for health care services for the indigent. Minimally, Medicaid must provide inpatients, skilled nursing facility, and home care; physician services, outpatients care; family planning services; and periodic sreening, detection, and treatment of children under age 12.