Government

Question 1

Diagnosis related groups

Answer 1

system to classify hospital cases in one of 467 groups based on the services/products they offer

Allows Medicare to determine how much each service/product will be reimbursed based on grouping

Question 2

Critical pathway contains

Answer 2

a blueprint for planning and managing care delivered by all disciplines

IE: structure after cardiac surgery such as vital signs, labs,, and diagnostic tests

Question 3

Medicare Part A covers

Answer 3

Inpatient services
Skilled Nursing facilities
Hospice
LTAC
Inpatient rehab
Home health care
obesity-bariatric surgery

Question 4

Medicare Part B covers

Answer 4

NP can reimburse under this as long as it is “physician like” cares and not “nursing like” cares

outpatient hospital care
physician visits
home care
lab services
radiology services

Question 5

Managed Care Networks

Answer 5

contractually agree to provide services for certain patient groups

Question 6

“Incident to” billing

Answer 6

NP was a ble to perform services ordinarily performed by physician

Cannot be used with new patients
Must be in a defined office/suite
Cannot be used in inpatient setting

Question 7

NPs can be reimbursed nationally by

Answer 7

CHAMPUS

Question 8

Preferred Provider Organizations (PPO)

Answer 8

type of managed care system

partnership between group of preferred physicians and insurance companies to provide specific medical and hospital care at prearranged costs

Question 9

National Practitioner Data Bank

Answer 9

Compiles information on medical-legal actions taken against healthcare professionals

Includes malpractice settlements and adverse actions that influence clinical privileges/licensure

Hospitals are required to quirky the NPDB

Question 10

Confidentiality and privacy

Answer 10

privacy breach is using patients name or identifiers without permission

Confidentiality is priority over privacy
Confidentiality protects sharing of information

Question 11

ACNP practice models

Answer 11

Service based
Practice based
Population based

Question 12

Service based practice model

Answer 12

clinical management by group

IE: medical/surgical team; surgical oncology/neurology

Question 13

Practice based practice model

Answer 13

clinical management by setting/unit

Question 14

Population based practice model

Answer 14

management of specific disease

IE: diabetes

Question 15

Goals of Healthy People 2020

Answer 15

1. long lives of preventable diseases
2. Achieve healthy equity, eliminate disparity
3. Create social/physical environment to promote health
4. promote quality of life, healthy development

Question 16

Medicaid

Answer 16

federally supported/funded
State based and administered
Medicaid pays last

Question 17

Patient Self Determination Act of 1990

Answer 17

right to execute advanced directive
Must provide patient rights at admission
Ask if patient has advanced directives
Prohibits institution to require advanced directive

Question 18

Prescription authority and death certificate is regulated by

Answer 18

state

Question 19

ANA essential roles of ACNPs

Answer 19

RECCC

researcher
educator
clinician
collaborator
consultant

Question 20

Advanced directives are

Answer 20

are guidelines and not typically legally binding

Must seek attorney

Question 21

Patient components of Informed consent

Answer 21

Capacity to make decision
Comprehension of information
Can ask questions

Question 22

Occurrence based insurance

Answer 22

covers injuries that occur during period policy was active regardless if it was renewed

best coverage, most expensive

Question 23

Claims-made insurance

Answer 23

covers the clinician only if the injury occurs within the policy period and if claim is filled during policy period

Typically want tail cover for this

Question 24

Tail coverage insurance

Answer 24

policy that covers period of expiration claims made to end of statute of limitations (2 years)

Expensive but safe after leaving job

Question 25

Malpractice must include

Answer 25

duty to patient (your patient)
violated standard of care
Caused damages

Question 26

Medicare Part C

Answer 26

offered by private companies

provide PPO or HMO serives

Question 27

Medicare Part D

Answer 27

Drug prescription coverage

Must have part A and B to have part D

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