PMHNP Boards #1 Exam With Questions And Answers 2026
Medicare Part A Coverage - ANSWER-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 - ANSWER->65 in social security automatic
enrollment
Medicare Part A Cost - ANSWER-No cost if automatically qualified. 30-39 work
quarters: ~$250/mo <30 work quarters: ~$450/mo
Medicare Part B Coverage - ANSWER-Supplemental medical insurance.
Outpatient services, care, physical/speech therapy, some home health care,
medical equipment
Medicare Part B Eligibility - ANSWER-Voluntary if >65
Medicare Part B Cost - ANSWER-Deducted from monthly social security check.
*Enroll 3 months before 65th birthday or 4 months after, otherwise increased
costs to enroll*
,Medicare Part C - ANSWER-Medicare Advantage. Get all their medical services
through that plan.
Medicare Part D coverage - ANSWER-Prescription drug coverage
Medicare Part D Cost - ANSWER-Varies depending on how extensive drug
benefit is. Different plans have different benefits.
Medigap Plans - ANSWER-Fill gaps in coverage that occur with Medicare
Medicare Advantage Plan - ANSWER-Will likely eliminate need for medigap
insurance?
Medicaid Eligibility - ANSWER-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 - ANSWER-Federal + state. States determine how much they
want to pay in, different states have different qualities of Medicaid
HMO - ANSWER-Four components: Enrolled population, prepayment of
premiums, coverage of comprehensive medical svcs, centralization of medical
and hospital svcs
,Closed-panel HMO - ANSWER-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 - ANSWER-Network HMO, Individual Practice Association,
Point of Service Plans
Network HMO - ANSWER-HMO contracts with more than one group of practices
Individual Practice Association - ANSWER-Insurance coverage. Contract with an
association of physicians to provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) - ANSWER-
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 - ANSWER-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 - ANSWER-Member of profession is granted ability to practice
, Accreditation - ANSWER-Formal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related
programs.
Certification - ANSWER-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 - ANSWER-Formal preparation of APRNs in graduate degree-granting
or postgraduate
certificate programs
Factors facilitating NP growth - ANSWER-Demand for svcs, acceptance of role,
emphasis on integrated healthcare svcs, emergence of PMHNP and decreasing
stigmatization
Factors constraining NP growth - ANSWER-Growth competition, reimbursement
struggles, overlapping scopes with other NPs, concerns about reimbursement
fraud/abuse, scope of practice requiring physician supervision/collab
Exceptions to confidentiality - ANSWER-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
Medicare Part A Coverage - ANSWER-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 - ANSWER->65 in social security automatic
enrollment
Medicare Part A Cost - ANSWER-No cost if automatically qualified. 30-39 work
quarters: ~$250/mo <30 work quarters: ~$450/mo
Medicare Part B Coverage - ANSWER-Supplemental medical insurance.
Outpatient services, care, physical/speech therapy, some home health care,
medical equipment
Medicare Part B Eligibility - ANSWER-Voluntary if >65
Medicare Part B Cost - ANSWER-Deducted from monthly social security check.
*Enroll 3 months before 65th birthday or 4 months after, otherwise increased
costs to enroll*
,Medicare Part C - ANSWER-Medicare Advantage. Get all their medical services
through that plan.
Medicare Part D coverage - ANSWER-Prescription drug coverage
Medicare Part D Cost - ANSWER-Varies depending on how extensive drug
benefit is. Different plans have different benefits.
Medigap Plans - ANSWER-Fill gaps in coverage that occur with Medicare
Medicare Advantage Plan - ANSWER-Will likely eliminate need for medigap
insurance?
Medicaid Eligibility - ANSWER-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 - ANSWER-Federal + state. States determine how much they
want to pay in, different states have different qualities of Medicaid
HMO - ANSWER-Four components: Enrolled population, prepayment of
premiums, coverage of comprehensive medical svcs, centralization of medical
and hospital svcs
,Closed-panel HMO - ANSWER-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 - ANSWER-Network HMO, Individual Practice Association,
Point of Service Plans
Network HMO - ANSWER-HMO contracts with more than one group of practices
Individual Practice Association - ANSWER-Insurance coverage. Contract with an
association of physicians to provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) - ANSWER-
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 - ANSWER-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 - ANSWER-Member of profession is granted ability to practice
, Accreditation - ANSWER-Formal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related
programs.
Certification - ANSWER-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 - ANSWER-Formal preparation of APRNs in graduate degree-granting
or postgraduate
certificate programs
Factors facilitating NP growth - ANSWER-Demand for svcs, acceptance of role,
emphasis on integrated healthcare svcs, emergence of PMHNP and decreasing
stigmatization
Factors constraining NP growth - ANSWER-Growth competition, reimbursement
struggles, overlapping scopes with other NPs, concerns about reimbursement
fraud/abuse, scope of practice requiring physician supervision/collab
Exceptions to confidentiality - ANSWER-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
