Primary Care of the Family Units 1 & 2 Quiz
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Questions and Answers

What is the primary definition of primary care?

  • Continuous, person-centered, relationship-based care that considers the needs of individuals. (correct)
  • Crisis intervention and emergency treatment.
  • Specialized care focused solely on adult patients.
  • Care provided only by physicians, excluding nursing roles.

    • Which domain is NOT part of the core competencies for Advanced Practice Registered Nurses (APRNs)?

  • Information and Healthcare Technologies
  • Pharmaceutical Management (correct)
  • Population Health
  • Quality and Safety

    • What is a fundamental aspect of the CARING model in nursing?

  • The intentional and authentic presence of the nurse with the patient. (correct)
  • Technical proficiency in medical procedures.
  • A strict adherence to established protocols.
  • The use of advanced technology in patient care.

    • How are payment standards for APRNs primarily influenced in the United States?

    <p>By insurance companies managing Medicare and Medicaid.</p> Signup and view all the answers

    Which of the following is true regarding reimbursement for APRNs?

    <p>APRNs commonly receive reimbursement at 85% of physician rates by Medicare.</p> Signup and view all the answers

    What is one of the three themes for future success in nursing?

    <p>Increasing diversity in the nursing workforce.</p> Signup and view all the answers

    What aspect does 'incident to' billing refer to in APRN practices?

    <p>Care provided under the supervision of a physician for reimbursement purposes.</p> Signup and view all the answers

    Which of the following is NOT a recognized element of the diagnostic process?

    <p>Complementary treatment modalities.</p> Signup and view all the answers

    What is the percentage of the physician fee that Medicare pays for covered services?

    <p>80%</p> Signup and view all the answers

    What is the Medicare B deductible amount for the year 2021?

    <p>$203</p> Signup and view all the answers

    Which of the following statements about NP reimbursement is accurate?

    <p>Nurse Practitioners are reimbursed at 85% of the physician's fee.</p> Signup and view all the answers

    What is the purpose of collecting patient out-of-pocket expenses before rendering services?

    <p>To reduce the administrative costs of billing later.</p> Signup and view all the answers

    What is recommended as best practice for collecting out-of-pocket payments?

    <p>Verify patient payment responsibility at the beginning of the year.</p> Signup and view all the answers

    How much of the Medicare fee for services does the patient usually pay out-of-pocket after meeting their deductible?

    <p>20%</p> Signup and view all the answers

    When did the comments for the annual physician and nonphysician provider fee schedule take effect?

    <p>January 1, 2021</p> Signup and view all the answers

    Why is it important for practices to collect copayments and deductibles before rendering services?

    <p>To maintain a steady cash flow for the practice.</p> Signup and view all the answers

    What additional benefits do Medicare Advantage plans typically offer apart from the required Medicare benefits?

    <p>Drug coverage and dental care</p> Signup and view all the answers

    What is the main reason some Medicare Advantage plans are becoming financially unviable?

    <p>High medical utilization by beneficiaries</p> Signup and view all the answers

    Which of the following plans is NOT a type of Medicare Advantage plan?

    <p>Individual retirement account (IRA)</p> Signup and view all the answers

    Which income eligibility determination method for Medicaid was established by the ACA?

    <p>Modified Adjusted Gross Income (MAGI)</p> Signup and view all the answers

    Why do beneficiaries of Medicare Advantage plans have to use specific health providers?

    <p>To control healthcare costs effectively</p> Signup and view all the answers

    Who is eligible for Medicaid assistance?

    <p>Children and individuals with disabilities with limited resources</p> Signup and view all the answers

    What happens if a Medicare Advantage plan's payout exceeds the CMS payment they receive?

    <p>The plan incurs a loss and may leave the market</p> Signup and view all the answers

    Which group is exempt from meeting the Modified Adjusted Gross Income requirements for Medicaid?

    <p>Citizens who are blind or disabled, or older than 65</p> Signup and view all the answers

    What is the premium cost range for Medicare beneficiaries per month?

    <p>$12 to $195</p> Signup and view all the answers

    Which phase requires beneficiaries to pay 100% of drug costs until a certain limit is reached?

    <p>Deductible phase</p> Signup and view all the answers

    What percentage do Medicare Advantage plans generally offer for generic drug copayments?

    <p>25</p> Signup and view all the answers

    What was the intent of the ACA plan policy regarding the donut hole?

    <p>To fully close the donut hole by 2020</p> Signup and view all the answers

    What type of plans are Medicare Advantage plans also referred to as?

    <p>Medicare C or Medicare MA plans</p> Signup and view all the answers

    What is a restriction beneficiaries face when using Medicare Advantage plans?

    <p>They must use health providers that participate in the plan.</p> Signup and view all the answers

    What causes many Medicare Advantage carriers to find the market less financially viable?

    <p>Higher medical utilization and costs incurred by beneficiaries.</p> Signup and view all the answers

    What happens if a Medicare Advantage plan’s payout exceeds the fixed CMS payment they receive annually?

    <p>The plan incurs a loss.</p> Signup and view all the answers

    What does ethical knowing entail in nursing practice?

    <p>Considering values and morals in situations.</p> Signup and view all the answers

    Which pattern of knowing emphasizes the integration of personal experience with nursing practice?

    <p>Esthetic knowing</p> Signup and view all the answers

    Which of the following is NOT an element of the OLD CART diagnostic process?

    <p>Chief Complaint</p> Signup and view all the answers

    What is the primary role of a health care proxy?

    <p>To make medical decisions when a patient cannot.</p> Signup and view all the answers

    Which ethical principle emphasizes the importance of keeping promises and maintaining trust?

    <p>Fidelity</p> Signup and view all the answers

    Teleological ethics is primarily concerned with what aspect of actions?

    <p>The outcomes and consequences of actions.</p> Signup and view all the answers

    What is a key consideration when discussing a living will with family members?

    <p>Its legal status in the state.</p> Signup and view all the answers

    Which of the following best describes nonmaleficence?

    <p>The obligation to do no harm.</p> Signup and view all the answers

    Which of the following is a component of the CSOC diagnostic process?

    <p>Establishing a relationship with the patient</p> Signup and view all the answers

    What is the primary commitment of a nurse according to the ANA's code of ethics?

    <p>To the patient's safety and well-being</p> Signup and view all the answers

    Which element is essential for a claim of malpractice against a nurse?

    <p>A deviation from the standard of care occurred.</p> Signup and view all the answers

    What does the principle of justice in healthcare ethics pertain to?

    <p>Fair distribution of resources.</p> Signup and view all the answers

    In the context of differential diagnosis, what does 'Skin In' refer to?

    <p>Considering only skin-related issues as possible diagnoses.</p> Signup and view all the answers

    What is the out-of-pocket expense for Medicare beneficiaries during hospital stays from days 61 to 90?

    <p>$371 per day</p> Signup and view all the answers

    Which of the following correctly describes the deductible amount for Medicare Part A in 2021?

    <p>$1,484</p> Signup and view all the answers

    How are payments for health services determined for providers accepting Medicare assignments?

    <p>By CMS-approved amounts according to physician fee schedules</p> Signup and view all the answers

    What is the maximum daily coinsurance starting from day 91 of a hospital stay under Medicare?

    <p>$742</p> Signup and view all the answers

    What is the role of the nurse licensing board in state legislation regarding nurse practitioners?

    <p>To regulate Advanced Practice Registered Nurses (APRNs)</p> Signup and view all the answers

    What percentage of the approved Medicare rate does a patient typically pay for physician office visits and some diagnostic tests?

    <p>20%</p> Signup and view all the answers

    What happens if the out-of-pocket expenses are not collected before services are rendered?

    <p>They become the patient's direct responsibility.</p> Signup and view all the answers

    Which system can healthcare providers apply to in order to bill Medicare?

    <p>Provider Enrollment Chain and Ownership System (PECOS)</p> Signup and view all the answers

    What defines the payment responsibility of Medicare beneficiaries for postacute care in skilled nursing facilities?

    <p>$185.50 per day from days 21 to 100</p> Signup and view all the answers

    In which year was Medicare D added as part of the Medicare Modernization Act?

    <p>2003</p> Signup and view all the answers

    What is the maximum out-of-pocket payment for hospital stays after 90 days in a benefit period?

    <p>$742 per day for each lifetime reserved day used.</p> Signup and view all the answers

    What is the first cycle of costs that Medicare beneficiaries encounter concerning prescription drugs?

    <p>Donut hole phase</p> Signup and view all the answers

    How much does Medicare reimburse NPs compared to physicians?

    <p>85% of the physician's fee.</p> Signup and view all the answers

    What triggers the availability of catastrophic coverage for Medicare D beneficiaries?

    <p>Exceeding out-of-pocket expenses of $6,350.</p> Signup and view all the answers

    What was the initial coverage limit for Medicare D in 2021?

    <p>$4,120</p> Signup and view all the answers

    What are beneficiaries responsible for paying in postacute care after 20 days in a skilled nursing facility?

    <p>$185.50 per day copayment.</p> Signup and view all the answers

    What was the Medicare Part B deductible for the year 2021?

    <p>$203 annually.</p> Signup and view all the answers

    Which aspect of Medicare D allows beneficiaries to choose a plan based on their needs?

    <p>Formulary flexibility.</p> Signup and view all the answers

    For shared services, what percentage of the fee is paid by the patient after Medicare covers its share?

    <p>20%</p> Signup and view all the answers

    How much patient copayment is required after catastrophic coverage is activated?

    <p>5%</p> Signup and view all the answers

    Which of the following categories of drugs must be covered by all Medicare D plans?

    <p>Cancer treatment medications.</p> Signup and view all the answers

    Which of the following correctly describes the payment policy for hospital stays under Medicare Part A?

    <p>No out-of-pocket cost for the first 60 days.</p> Signup and view all the answers

    Which domain emphasizes the integration of various healthcare services to improve patient outcomes in APRN practice?

    <p>Systems-Based Practice</p> Signup and view all the answers

    How often does the physician and nonphysician provider fee schedule take effect?

    <p>Annually after January 1.</p> Signup and view all the answers

    In the CIRCLE OF CARING MODEL, which element is least likely to be associated with the intentional presence of a nurse?

    <p>Isolation</p> Signup and view all the answers

    What is the total out-of-pocket cost for a Medicare beneficiary who has had a hospital stay lasting 97 days?

    <p>$2,607.</p> Signup and view all the answers

    What best describes the role of the APRN in the context of healthcare data utilization?

    <p>To utilize data for continuous improvement in practice</p> Signup and view all the answers

    Which statement about the reimbursement rates for APRNs compared to physicians is inaccurate?

    <p>APRN reimbursement rates are consistently higher than those of physicians.</p> Signup and view all the answers

    Which element is NOT part of the primary definition of primary care?

    <p>Focus solely on individual clinical symptoms</p> Signup and view all the answers

    What is a significant challenge that APRNs face in the landscape of managed care contracts?

    <p>Limited reimbursement opportunities from private insurance</p> Signup and view all the answers

    Which nursing competence domain is essential for understanding public health trends and improving healthcare for specific populations?

    <p>Population Health</p> Signup and view all the answers

    How do APRNs primarily enhance their role in healthcare leadership according to the future themes presented?

    <p>By embracing diversity and advocating for inclusivity</p> Signup and view all the answers

    Which pattern of knowing emphasizes ethical principles and values in nursing practice?

    <p>Ethical knowing</p> Signup and view all the answers

    What is the role of a healthcare proxy in medical decisions?

    <p>To make medical decisions when a patient cannot</p> Signup and view all the answers

    Which ethical principle requires healthcare providers to act positively and balance potential harm against benefits?

    <p>Beneficence</p> Signup and view all the answers

    In the context of the diagnostic process, which of the following does not pertain to the OLD CART elements?

    <p>Treatment history</p> Signup and view all the answers

    What does the principle of nonmaleficence primarily advocate in healthcare?

    <p>Preventing harm</p> Signup and view all the answers

    Which of the following is associated with deontological ethics in healthcare?

    <p>Duty-based obligations</p> Signup and view all the answers

    What factor does a living will specifically address concerning medical treatment?

    <p>Personal preference in how nutrition is provided</p> Signup and view all the answers

    Which element of the nursing diagnostic process is focused solely on refining hypotheses about potential diagnoses?

    <p>Medical history</p> Signup and view all the answers

    In the ethical principles of nursing, what does the principle of fidelity emphasize?

    <p>Commitment to keeping promises</p> Signup and view all the answers

    Which role does patient patience play in nursing care?

    <p>An active openness to support patient growth</p> Signup and view all the answers

    Which provision in ANA's code of ethics emphasizes the need for nurses to advance the profession?

    <p>Individual and collective action</p> Signup and view all the answers

    Which concept refers to the idea that ethical actions should strive toward the greatest overall good?

    <p>Teleology</p> Signup and view all the answers

    Which of the following best describes the usage of diagnostic tests in the healthcare setting?

    <p>Used to confirm, rule out or screen for conditions</p> Signup and view all the answers

    What is the concept behind universalizability in ethical decision-making?

    <p>Ensuring every action can become universal law</p> Signup and view all the answers

    What was the Medicare Part A deductible amount in 2021?

    <p>$1,484</p> Signup and view all the answers

    How much is the coinsurance per day for days 61 to 90 of a hospital stay under Medicare?

    <p>$371</p> Signup and view all the answers

    What is the copayment per day for postacute care in a skilled nursing facility from days 21 to 100 under Medicare?

    <p>$185.50</p> Signup and view all the answers

    What percentage of the physician's fee do nurse practitioners receive for covered services from CMS?

    <p>85</p> Signup and view all the answers

    During a benefit period, what is the patient's payment responsibility after the Medicare deductible is met?

    <p>20</p> Signup and view all the answers

    What was the Medicare B deductible amount for the year 2021?

    <p>$203</p> Signup and view all the answers

    How much can a beneficiary use as lifetime reserved days after 90 days of hospital care in a benefit period?

    <p>60</p> Signup and view all the answers

    What is the charge for each 'lifetime reserved day' used beyond 90 days under Medicare?

    <p>$742</p> Signup and view all the answers

    What is the deductible amount for Medicare Part A in 2021?

    <p>$1,484</p> Signup and view all the answers

    What is the coinsurance rate for days 61 to 90 of a hospital stay under Medicare?

    <p>$371 per day</p> Signup and view all the answers

    What is the maximum daily coinsurance rate for lifetime reserve days after the 90th day of a hospital stay?

    <p>$742</p> Signup and view all the answers

    What must Medicare providers agree to regarding payments for health services?

    <p>They must accept the CMS-approved amount as full payment.</p> Signup and view all the answers

    What is the copayment for beneficiaries in a skilled nursing facility after the 20th day of care?

    <p>$185.50 per day</p> Signup and view all the answers

    How are payments to providers for services under Medicare generally determined?

    <p>Based on the current Medicare fee schedule and guidelines.</p> Signup and view all the answers

    Which system allows healthcare providers to apply to bill Medicare online?

    <p>Provider Enrollment Chain and Ownership System (PECOS)</p> Signup and view all the answers

    What percentage of the Medicare fee schedule rate do carriers typically use to base payments for NPs credentialed as providers?

    <p>85%</p> Signup and view all the answers

    Which of the following is NOT a type of Medicare Advantage plan?

    <p>Basic health insurance (BHI) plans</p> Signup and view all the answers

    What is the primary purpose of Medicaid?

    <p>To assist individuals with low incomes and limited resources</p> Signup and view all the answers

    Who is exempt from meeting the Modified Adjusted Gross Income (MAGI) requirements for Medicaid eligibility?

    <p>Senior citizens over 65 years</p> Signup and view all the answers

    What does the federal government do to assist states in providing Medicaid?

    <p>Matches dollar spending for qualifying mandatory services</p> Signup and view all the answers

    Which method established by the ACA determines income eligibility for Medicaid?

    <p>Modified Adjusted Gross Income (MAGI)</p> Signup and view all the answers

    What is a requirement for providers accepting Medicaid payments?

    <p>They must accept Medicare payment rates as payment in full</p> Signup and view all the answers

    Medicaid, combined with CHIP, provided coverage in 2020 to over how many Americans?

    <p>72.5 million</p> Signup and view all the answers

    Which of the following is an exception to Medicaid's payment model?

    <p>Disproportionate-share hospital payments</p> Signup and view all the answers

    What is the maximum deductible amount per year that beneficiaries might face in the deductible phase of drug coverage?

    <p>$435</p> Signup and view all the answers

    In the catastrophic phase of Medicare drug coverage, what is the copay rate that beneficiaries must pay?

    <p>5%</p> Signup and view all the answers

    What additional benefits may Medicare Advantage plans typically offer beyond required Medicare benefits?

    <p>Vision and dental care</p> Signup and view all the answers

    Why must beneficiaries use specific health providers in Medicare Advantage plans?

    <p>To receive CMS subsidies for services</p> Signup and view all the answers

    What impact did the Bipartisan Budget Act of 2018 have on the ACA's plan to close the donut hole?

    <p>Delayed the closure</p> Signup and view all the answers

    What is a potential financial risk for Medicare Advantage plans regarding their member payouts?

    <p>Exceeding fixed CMS payments</p> Signup and view all the answers

    What do Medicare Advantage plans aim to achieve through economic efficiencies?

    <p>Lower costs based on volume discounts</p> Signup and view all the answers

    How are Medicare Advantage plans categorized in relation to traditional Medicare plans?

    <p>Medicare C or MA plans</p> Signup and view all the answers

    What is the primary focus of ethical knowing in nursing practice?

    <p>Values and morals related to patient care</p> Signup and view all the answers

    Which pattern of knowing includes a nurse's personal experiences as part of their practice?

    <p>Practitioner knowing</p> Signup and view all the answers

    Which of the following is a key component of the OLD CART diagnostic process?

    <p>Location</p> Signup and view all the answers

    What does the ethical principle of nonmaleficence entail?

    <p>Avoiding harm to patients</p> Signup and view all the answers

    What is the purpose of a living will?

    <p>To outline preferences for treatments during serious illness</p> Signup and view all the answers

    Which ethical principle involves fairness in healthcare?

    <p>Justice</p> Signup and view all the answers

    What is a key characteristic of teleological ethics?

    <p>Is concerned with the consequences of actions</p> Signup and view all the answers

    In the differential diagnosis process, what does the approach 'Skin In' suggest?

    <p>Considering only skin-related diseases</p> Signup and view all the answers

    What reflects the nurse’s commitment to their profession?

    <p>A lifelong commitment to service</p> Signup and view all the answers

    Which is a function of a health care proxy?

    <p>To make medical decisions if the patient is unable</p> Signup and view all the answers

    What is a primary consideration when creating a living will?

    <p>Defining preferences for treatment in specific medical scenarios</p> Signup and view all the answers

    Which is an important aspect of patient trust according to nursing ethics?

    <p>Veracity</p> Signup and view all the answers

    What does the term 'empiric knowing' refer to in nursing practice?

    <p>Knowledge gained through scientific observation</p> Signup and view all the answers

    Study Notes

    Chapter One: Scope and Practice in Nursing

    • State-specific inconsistencies affect the scope of nursing practice.
    • Future nursing success hinges on:
      • Full integration of nurses in practice, education, and leadership.
      • Increased diversity within the nursing workforce.
      • Improved data collection to assess progress.
    • Healthy People 2030 requires significant enhancements.
    • Primary care is defined as continuous, relationship-based care tailored to individuals, families, and communities.

    Core Competencies for APRNs

    • Knowledge for Nursing Practice
    • Person-Centered Care
    • Population Health
    • Scholarship for Nursing Practice
    • Quality and Safety
    • Interprofessional Partnerships
    • Systems-Based Practice
    • Information and Healthcare Technologies
    • Professionalism
    • Personal, Professional, and Leadership Development

    Chapter Two: The APRN Role and Caring

    • APRN roles are founded on deep knowledge, skills, and caring practices.
    • The Circle of Caring Model emphasizes:
      • Courage
      • Authentic Presence
      • Advocacy
      • Knowing
      • Commitment
      • Patience

    Chapter Five: Diagnostic Process

    • Key elements of the diagnostic process include:
      • Onset, location, duration, characteristics, aggravating and relieving factors, treatment.
    • Reimbursement structures are influenced by insurance, especially Medicare and Medicaid.
    • APRN reimbursement is notably at 85% of physician rates, impacting service provision.

    Medicare and Medicaid Overview

    • Medicare B reimbursement policies dictate payment structures, often requiring patient copayments.
    • Medicare Advantage plans (MA) offer alternatives to traditional Medicare, often with both additional benefits and limitations.
    • Medicaid is federally and state-funded, designed to assist individuals with low income and chronic disabilities.

    Important Aspects of Plans and Payment Structures

    • Medicare covers multiple healthcare costs, with provisions for patient deductibles and copayments.
    • The ACA established the Modified Adjusted Gross Income (MAGI) for Medicaid eligibility.
    • Annual deductible for Medicare B in 2021 was $203, with additional monthly insurance premium costs.

    Health Directives

    • Power of Attorney (POA) in healthcare allows designated individuals to make medical decisions on behalf of patients unable to do so.
    • A Living Will outlines medical treatment preferences if a patient cannot communicate their wishes, covering specific medical actions and preferences.
    • Health care proxies can access medical records, approve treatment, and make significant decisions when needed.

    Ethics in Nursing

    • Ethical dilemmas arise where conflicting values exist, rooted in bioethics concerning healthcare decisions.
    • Nine ANA codes of ethics prioritize values such as compassion, patient commitment, advocacy, and collaborative practice.
    • Deontology focuses on duty-based, rule-following ethics, differentiated from teleological ethics, which values outcomes.

    Ethical Principles

    • Autonomy: Respecting individuals' rights to make informed choices.
    • Beneficence: Positive obligation to act for the benefit of others.
    • Nonmaleficence: Core principle of "do no harm."
    • Veracity: Emphasizes honesty and truth-telling in patient care.
    • Confidentiality and fidelity maintain trust and promise-keeping.
    • Justice promotes fairness in healthcare delivery.

    APRN Establishments and Malpractice

    • LACE framework: Licensure, Accreditation, Certification, and Education confirms professional standards.
    • Disparities exist in reimbursement for APRNs, particularly in Medicare and Medicaid contexts.
    • Malpractice claims necessitate:
      • Duty of care
      • Deviation from standard practices
      • Causation of harm as a result of negligence.
    • Insurance policies vary:
      • Claims-based policy: Coverage contingent on active enrollment.
      • Occurrence-based policy: Coverage active as long as the policy was in effect at the time of the incident.

    Chapter One: Scope and Role of APRNs

    • Scope of practice varies significantly from state to state.
    • Key themes for nursing future success include full participation in practice, education, leadership, diversity in workforce, and improved data evaluation.
    • Healthy People 2030 is identified as needing substantial development.
    • Primary care is defined as continuous, person-centered, and relationship-based, addressing needs of individuals, families, and communities.
    • Core competencies for Advanced Practice Registered Nurses (APRNs) include:
      • Knowledge for Nursing Practice
      • Person-Centered Care
      • Population Health
      • Scholarship for Nursing Practice
      • Quality and Safety
      • Interprofessional Partnerships
      • Systems-Based Practice
      • Information and Healthcare Technologies
      • Professionalism
      • Personal, Professional, and Leadership Development

    Chapter Two: The Art of Caring in Nursing

    • APRN role emphasizes knowledge, skills, and the essence of caring.
    • Caring is characterized by intentional and authentic presence with others.
    • The Circle of Caring Model includes essential elements: Courage, Authentic Presence, Advocacy, Knowing, Commitment, and Patience.

    Chapter Five: Diagnostic Process and Healthcare Reimbursement

    • Elements of the diagnostic process focus on onset, duration, location, characteristics, aggravating and relieving factors, and treatment.
    • Reimbursement issues are influenced by insurance, particularly Medicare and Medicaid.
    • APRNs receive third-party reimbursement in most cases, commonly at 85% of physician rates.
    • Managed care contracts specify fixed payment rates for providers.
    • Medicare consists of four main parts:
      • Part A: Covers hospital inpatient services.
        • 2021 deductible was $1,484.
        • No additional payment for stays up to 60 days; coinsurance for longer stays applies.
      • Part B: Covers outpatient and physician services.
        • In 2021, deductible was $203, with 20% co-insurance after the deductible is met.
      • Part C: Medicare Advantage plans.
      • Part D: Provides prescription drug coverage, with a coverage gap known as the "donut hole."

    Ethical Considerations in Nursing

    • A healthcare Power of Attorney (POA) allows an individual to make medical decisions on behalf of another when they are unable.
    • A living will outlines medical preferences during severe illness or incapacity, addressing treatment directions and organ donation.
    • A healthcare proxy can access medical records and make treatment decisions if the patient is incapacitated.
    • Ethics in nursing is guided by standards, including the ANA Code of Ethics which emphasizes compassion, respect, and patient advocacy.
    • Key ethical principles include:
      • Autonomy: Respect for self-determination and informed consent.
      • Beneficence: Positive action balancing harm and benefits.
      • Nonmaleficence: Obligation to "do no harm."
      • Veracity: Truthfulness in all interactions.
      • Confidentiality: Protection of privileged patient information.
      • Fidelity: Commitment to keeping promises.
      • Justice: Ensuring fairness in healthcare delivery.

    Malpractice and Professional Standards

    • For malpractice claims, elements must include duty to patient, deviation from standard of care, and resultant harm.
    • Reimbursement structures often present challenges for APRNs, with notable disparities in payment compared to physician counterparts.
    • The LACE framework establishes expectations for APRNs related to licensure, accreditation, certification, and education.

    Medicare Overview

    • Medicare is a health insurance program for individuals aged 65 and older.
    • It consists of four parts: Part A (Hospital Services), Part B (Physician Services), Part C (Medicare Advantage), and Part D (Prescription Drugs).

    Medicare Part A (Hospital Services)

    • Providers wishing to bill Medicare can enroll via PECOS or CMS-855I paper form.
    • Providers receive a National Provider Identifier (NPI) for billing, mandatory for HIPAA transactions.
    • In 2021, Part A deductible: $1,484; Out-of-pocket costs vary based on hospitalization duration.
    • Hospital stay charges:
      • Days 1-60: No additional charge.
      • Days 61-90: $371 coinsurance per day.
      • Days 91+: $742 coinsurance per "lifetime reserved day."
    • Post-acute care incurs a $185.50 daily copayment from days 21 to 100 in a skilled nursing facility.

    Medicare Part B (Physician Services)

    • In 2021, Part B deductible: $203 yearly.
    • CMS reimburses physicians at 100% of the Physician Fee Schedule (PFS), with patients paying 20% of allowed rates.
    • Nurse Practitioners (NPs) receive 85% reimbursement of the physicians' fees and typically charge 15% less than physicians.
    • Many patients obtain secondary insurance to cover the 20% out-of-pocket expense.

    Medicare Advantage Plans (Part C)

    • Private insurance companies offer these plans, which include coverage for parts A and B.
    • Plans can provide additional benefits like drug coverage, eye care, and dental care.
    • Out-of-pocket expense limits exist to protect beneficiaries from unexpected costs.
    • Financial viability challenges exist due to high medical utilization by beneficiaries.

    Medicaid Overview

    • Medicaid provides medical assistance to low-income individuals and families, with joint funding from federal and state governments.
    • In 2020, over 72.5 million Americans benefited from Medicaid and CHIP.
    • Eligibility is based on income and includes specific categories, like children, pregnant women, and individuals with disabilities.
    • Providers accept Medicaid's lower payment as full compensation, with specific exceptions for certain types of care.

    Ethical Considerations in Nursing

    • Ethics determine moral obligations, particularly in healthcare settings (bioethics).
    • Key ethical principles include:
      • Autonomy: Respect for personal choice and informed consent.
      • Beneficence: Positive actions to benefit others.
      • Nonmaleficence: Obligation to do no harm.
      • Veracity: Commitment to truthfulness.
      • Confidentiality: Protection of patient information.
      • Fidelity: Keeping promises and commitments.
      • Justice: Fairness in treatment and resource distribution.

    Advanced Practice Registered Nurses (APRNs)

    • Defined by LACE: Licensure, Accreditation, Certification, Education.
    • Encounter reimbursement challenges compared to physicians and variations across Medicare and Medicaid.

    Malpractice

    • Essential elements include:
      • Duty to the patient.
      • Deviation from the standard of care.
      • Harm/damages occurring as a result.
    • Policies can be claims-based (coverage during premium payment) or occurrence-based (coverage for incidents occurring during the policy's effectiveness).

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    Description

    Test your knowledge on the primary care of families as discussed in chapters 1, 2, 4, 5, 85, 86, and 88. This quiz covers the scope of practice, the importance of diversity in the nursing workforce, and the impact of Healthy People 2030 initiatives. Prepare to assess your understanding of essential nursing roles and future trends in primary care.

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