When asked to explain how a health maintenance organization changes for its services. The nurse’s best answer is:
a. Services are billed based on the client’s ability to pay
b. Clients are required to pay for all routine services completely out of their own pocket
c. A predetermined set of service is provided for a fixed, prepaid charge
d. Only charges incurred while an inpatient will be covered by an HMO
Answer C. The HMO establishes the specific services that are covered at a fixed level of reimbursement to the provider and cost to the participant.
a. Services are billed based on the client’s ability to pay
b. Clients are required to pay for all routine services completely out of their own pocket
c. A predetermined set of service is provided for a fixed, prepaid charge
d. Only charges incurred while an inpatient will be covered by an HMO
Answer C. The HMO establishes the specific services that are covered at a fixed level of reimbursement to the provider and cost to the participant.
