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 - answ...
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PMHNP
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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
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