Nokea
Match the following Key Term(s) or italicized words from your text with the correct description: Primary care physician
- A. The federal government's health insurance program for people older than 65 years or those with certain disabilities or conditions
- B. A federally and state-funded health insurance program for individuals who are poor and medically indigent, pregnant women, individuals with disabilities, and children meeting income level requirements
- C. A system of health-care delivery aimed at managing the cost and quality of access to health care
- D. The insurance company that finances health care provided to a beneficiary
- E. A cost-containment program featuring a primary care physician (PCP) as the gatekeeper to eliminate unnecessary testing and procedures
- F. A classification of illnesses and diseases that is then used to determine the amount of money paid to a hospital by Medicare
- G. The gatekeeper for access to medical services
Correct Answer: G
Rationale: The primary care physician controls access to medical services as a gatekeeper.
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Cross-training of staff is more important in primary care than it is in client-centered care.
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: Cross-training is not specifically more important in primary care than client-centered care.
Which of the following represents a benefit of home health care?
- A. Allows people to stay in their own homes instead of being in a facility
- B. Prevents fragmentation of care
- C. Is more cost effective than inpatient care
- D. Prevents complications
Correct Answer: A,C
Rationale: Home health care allows patients to stay home and is more cost-effective than inpatient care.
Match the following Key Term(s) or italicized words from your text with the correct description: Case management
- A. Patient care approach aimed at coordinating the care of patients who are vulnerable, at risk, or cost intensive so that their specific needs are met in the most cost-effective manner while still bringing them to optimum health
- B. A federally and state-funded health insurance program for individuals who are poor and medically indigent, pregnant women, individuals with disabilities, and children meeting income level requirements
- C. A system of health-care delivery aimed at managing the cost and quality of access to health care
- D. The insurance company that finances health care provided to a beneficiary
- E. A cost-containment program featuring a primary care physician (PCP) as the gatekeeper to eliminate unnecessary testing and procedures
- F. A classification of illnesses and diseases that is then used to determine the amount of money paid to a hospital by Medicare
- G. A group of health-care providers who contract with a health insurance company to provide services to a specific group of patients on a discounted basis
Correct Answer: A
Rationale: Case management coordinates care for vulnerable or high-cost patients to ensure cost-effectiveness and optimal health outcomes.
TRICARE for retired military personnel and their families and CHAMPVA for veterans are examples of
- A. preferred provider organizations (PPOs).
- B. point-of-service (POS) insurance plans.
- C. insurance for special populations.
- D. insurance through charitable organizations.
Correct Answer: C
Rationale: TRICARE and CHAMPVA are specialized insurance programs for military personnel and veterans.
Fill in the blank with the correct Key Term(s) or italicized words from your text: When a primary care physician cannot successfully treat a patient's condition, he or she makes a(n) ___ to a specialist.
- A. Referral
- B. Consultation
- C. Transfer
- D. Admission
Correct Answer: A
Rationale: A referral is made when a primary care physician cannot treat a condition and refers to a specialist.