The population health nurse is explaining to a patient about the ...

[jlmhmf]

The population health nurse is explaining to a patient about the type of health services that are paid for by a third party such as private health insurance. What is the nurse explaining to this patient?
 
  1. Capitation payment.
  2. Deductible payment.
  3. Prospective reimbursement.
  4. Retrospective reimbursement.

Question 2

The population health nurse is preparing material for an educational seminar on the differences between Medicare and Medicaid. What should the nurse include in this teaching?
 
  1. Medicare only covers health care services for people over age 65.
  2. Medicare does not cover preventive services, but Medicaid provides such coverage.
  3. Medicare funding is solely on the federal level and Medicaid has no federal funding.
  4. Medicare provides partial coverage for health services when eligible for Social Security benefits and Medicaid provides health services to the indigent.

[Sophiapenny]

Answer to Question 1

Answer: 3
Explanation: 3. Third party payment is made through reimbursement for services rendered. Prospective payment is most commonly utilized today, with payment given at a predetermined fixed rate for a specific set of services. Retrospective reimbursement was formerly the primary form of third party payment for services rendered based on the cost of the services. Rising health prices and spiraling insurance health care costs now limit this form of reimbursement because some services were given solely for reimbursement purposes and not for health reasons. Deductible payments are those payments the person makes out of pocket until a limit is reached where the insurance company will take over responsibility for payment. Capitation refers to a prospective payment system that pays health plans or providers a fixed amount per enrollee per month for providing a defined set of health needs.

Answer to Question 2

Answer: 4
Explanation: 4. As originally legislated, Medicare provided partial coverage of health services to the population who reached the age for receiving Social Security benefits at age 65. Medicaid was established to provide health services to the medically needy, categorically needy, and certain special groups who fell outside of the mainstream for any health care services. Medicare does not cover all health care services, nor does Medicaid. While Medicare traditionally does not cover preventive care, it has started to provide limited coverage of preventive services, as does Medicaid in such services as immunizations. Funding for Medicare comes from the federal level. Medicaid funding is administered by the states but with block grants given by the federal government.