Author Question: A nurse works as a reviewer of Medicare claims. In this capacity, the nurse frequently denies these ... (Read 59 times)

Mr. Wonderful · **on:** Jul 8, 2018

A nurse works as a reviewer of Medicare claims. In this capacity, the nurse frequently denies these claims. What is the primary rationale for this action?

1. It helps to protect the Medicare Trust Fund.
2. It serves to control unnecessary testing.
3. It keeps physician practice from becoming too independent.
4. It helps ensure that nursing care is safe.

Question 2

What are the determinants in Healthy People 2020 that impact health outcomes? Select all that apply.

1. Social environment
2. Health services
3. Physical environment
4. Biology and genetics
5. Individual behavior

epscape · **Reply #1 on:** Jul 8, 2018

Answer to Question 1

1
Explanation: 1. The rationale for reviewing claims for Medicare payment is to be certain that the claims are valid and for necessary procedures. This validation helps to protect the money in the Medicare Trust Fund from being used inappropriately.
2. This is a side benefit from this action, but is not the primary rationale.
3. This is not associated with the review process.
4. Review does not serve to ensure safety of nursing care.

Answer to Question 2

1, 2, 3, 4, 5
Explanation: 1. This is a determinant that impacts health outcomes.
2. This is a determinant that impacts health outcomes.
3. This is a determinant that impacts health outcomes.
4. This is a determinant that impacts health outcomes.
5. This is a determinant that impacts health outcomes.