Nokea
A cost-efficient way to provide care to people who are confined to their homes because of illness or disability is the use of:
- A. the hospital outpatient department.
- B. a skilled nursing facility.
- C. the health department.
- D. home health care.
Correct Answer: D
Rationale: Home health care is a cost-effective option for providing care to homebound patients.
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Which of the following would NOT be considered medically necessary by an insurance company?
- A. Surgery to remove an infected gallbladder
- B. Breast implants to increase breast size
- C. Breast implants after breast cancer surgery
- D. Botox injections to decrease facial wrinkles
- E. Skin grafts to repair a spider bite injury
Correct Answer: B, D
Rationale: Cosmetic procedures like breast implants for enhancement and Botox for wrinkles are typically not deemed medically necessary.
Eligibility for the HIS is:
- A. based on having a CDIB.
- B. available to all people with at least 25% Indian blood.
- C. set by each tribe.
- D. determined by presenting a family genealogy.
- E. determined by blood type.
Correct Answer: A, C
Rationale: Eligibility for Indian Health Service (HIS) requires a Certificate of Degree of Indian Blood (CDIB) and is often determined by tribal enrollment criteria.
Payment to hospitals for the care of Medicare patients is based on:
- A. a specified amount per member per month.
- B. the actual costs of all supplies, equipment, tests, and nursing care.
- C. DRGs.
- D. a previously negotiated discount rate.
Correct Answer: C
Rationale: Medicare payments are based on Diagnosis-Related Groups (DRGs), which set reimbursement rates for specific conditions.
Which member of the therapy staff would be consulted if a patient had difficulty swallowing?
- A. Speech therapist
- B. Physical therapist
- C. Occupational therapist
- D. Respiratory therapist
Correct Answer: A
Rationale: Speech therapists specialize in treating swallowing difficulties.
A patient who is terminally ill with cancer is no longer being treated with radiation or chemotherapy (cancer-attacking medication). The most appropriate level of care for this patient would be:
- A. home health care.
- B. hospice.
- C. a skilled nursing facility.
- D. a long-term care acute hospital.
Correct Answer: B
Rationale: Hospice care is designed for terminally ill patients focusing on comfort and quality of life.