Author Question: A very skilled baccalaureate-prepared clinical nurse was asked to assume a case manager role. Which ... (Read 59 times)

mynx · **on:** Jul 8, 2018

A very skilled baccalaureate-prepared clinical nurse was asked to assume a case manager role. Which of the following will be most difficult for the nurse new to this role?

a. Having the ability to be a leader and work autonomously
b. Obtaining knowledge of community resources
c. Gaining knowledge of reimbursement structures and financial strategies
d. Getting practice at evaluating patient outcomes

Question 2

Which of the following actions would help decrease the total health care costs in the United States?

a. Consolidate major health care facilities while expanding neighborhood primary care clinics
b. Continue the move to computer-based medical records and other efficiencies in informatics
c. Decrease current fraud and abuse
d. Streamline and make more consistent all documents needed for third-party reimbursement

hramirez205 · **Reply #1 on:** Jul 8, 2018

Answer to Question 1

ANS: C
Skills to ensure success in the role of case manager include sound knowledge of reimbursement structures, knowledge of available resources within the community, ability to evaluate patient outcomes, and an understanding of financial strategies. Such a nurse would have to be flexible, be creative, communicate well, and be able to work autonomously. Although the text does not discuss this, the typical baccalaureate program does not include courses in reimbursement and financial implications of clinical decisions.

Answer to Question 2

ANS: C
The billions of dollars spent on health care and struggles for control between providers, consumers, and health care organizations have increased the risk of fraud and abuse. The Federal Bureau of Investigation (FBI) estimates that health care fraud costs the U.S. 80 billion annually (FBI, 2012). Thus, decreasing the fraud and abuse in the system would have the largest impact over any of the other proposed actions.