Medicare CORRECT ANSWER for clients over age 65 and/or with permanent disabilities. premiums applied as insurance program reimburses providers based on
... [Show More] DRGs. Premiums applied as Managed Care Organizations (MCOs) provide enrolled clients with comprehensive care overseen by a primary care provider. Is federally funded.
Medicaid CORRECT ANSWER for clients with low income. is federally funded and individual states determine eligibility requirements.
Traditional Insurance CORRECT ANSWER reimburses for services on fee-for-service basis.
Managed Care Organizations (MCOs) CORRECT ANSWER comprehensive care is overseen by a primary care provider & focuses on prevention and health promotion
Preferred Provider Organizations (PPOs) CORRECT ANSWER client chooses from a list of contracted providers. using non-contracted providers increases the client's out of pocket costs
Exclusive Provider Organizations (EPOs) CORRECT ANSWER the client chooses from a list of providers within a contracted organization
Long-Term Care Insurance CORRECT ANSWER provides for long-term care expenses not covered by Medicare
Preventive health care CORRECT ANSWER focuses on educating and equipping clients to reduce and control risk factors of disease. Examples include immunizations, stress management programs, and seat belt use
Primary health care CORRECT ANSWER emphasizes health promotion, and includes prenatal and well-baby care, nutrition counseling, and disease control. is based on a sustained partnership between client and provider. examples include office or clinic visits and scheduled school/work centered screenings (vision, hearing, obesity)
Secondary health care CORRECT ANSWER includes the diagnosis and treatment of emergency, acute illness, or injury. examples include care given in hospital settings (inpatient and EDs), diagnostic centers, or emergent care centers
Tertiary health care CORRECT ANSWER involves the provision of specialized highly technical care. examples include oncology centers and burn centers
Restorative health care CORRECT ANSWER involves intermediate follow-up care for restoring health. examples include home health care, rehab centers, and skilled nursing facilities
Continuing health care CORRECT ANSWER designed to address long-term or chronic health care needs. examples include hospice, adult day care, and in-home respite care
Health care regulatory agencies include: CORRECT ANSWER -US Dept. of Health and Human Services
-US FDA
-State and local public health agencies
-State licensing boards (to ensure providers & agencies comply with state regulations)
-the Joint Commission/JCAHO (set quality standards for accreditation of health care facilities)
-Professional Standards Review Organizations (PSROs)
-Utilization review committees (monitor for appropriate diagnosis and treatment of hospitalized clients)
Clergy CORRECT ANSWER Job: provide spiritual care to client (pastors, rabbis, priests)
Refer to when: the client requests communication or the family asks for prayer prior to client undergoing a procedure
Registered dietitian CORRECT ANSWER Job: assess, plan for, and educate the client reg. nutritional needs; direct care of nutritional aids
Refer to when: ex- the client has low nutrient levels and/or experienced a recent unexplained weight loss
Lab tech CORRECT ANSWER Job: obtain specimens of the client's body fluids and perform the necessary diagnostic tests
Refer to when: ex- the provider orders a CBC to be performed immediately
Occupational therapist CORRECT ANSWER Job: assess and plan for the client to regain ADLs, esp motor skills of the upper extremities; direct care of occupational therapy assistants
Refer to when: ex- client has difficulties using an eating utensil with dominate hand following a stroke
Pharmacist CORRECT ANSWER Job: provide & monitor meds for the client as prescribed by the provider; supervises pharm techs in states in which the practice is allowed
Refer to when: client concerns over meds; dosage concerns; etc.
Physical Therapist CORRECT ANSWER Job: assess and plan for client to increase musculoskeletal functions, esp of lower extremities, to maintain mobility; direct care of physical therapy assistants
Refer to when: ex- following a hip replacement, a client requires assistance learning to ambulate and regain strength
Provider CORRECT ANSWER Job: assess, diagnose, and treat client for disease and/or injury; includes MDs, DOs, APNs, and PAs
Refer to when: ex- client experiences change in vital signs
Rad Tech CORRECT ANSWER Job: position client and perform x-rays and other imaging procedures for providers to review for diagnosis of disorders of various body parts
Refer to when: ex- provider orders x-ray of client's hip after a fall
Respiratory therapist CORRECT ANSWER Job: evaluate resp status and provide prescribed resp treatments including O2 therapy, chest physiotherapy, inhalation therapy, and artificial mechanical ventilation
Refer to when: ex- client with resp disease experiences SOB and requests nebulizer treatment that is ordered PRN
Social Worker CORRECT ANSWER Job: work with client and client's family by coordinating inpatient and community resources to meet psychosocial and environmental needs that are necessary for recovery and/or discharge
Refer to when: ex- client dying of cancer wishes to go home but is unable to perform ADLs; the spouse needs med equipment in the home to care for client
Speech therapist CORRECT ANSWER Job: evaluate and make recommendations regarding the functions of speech, language, and swallowing impacted by various client disorders or injuries; teach client techniques and exercises to improve function when possible
Refer to when: ex- a client is having difficulty swallowing a regular diet after trauma to the head and neck [Show Less]