N108: Transition to the Registered Professional Nurse

N108: Transition to the Registered Professional Nurse Role Study Guide of 171 purchasers including employers, managed-care companies, and insurance companies. A PHO could become part of an integrated health system (IHS) to provide a range of services that could include home care, acute care, and rehabilitative care. An IHS works to provide a “one-stop” service resulting in multiple avenues of cost savings. Medical Savings Accounts (MSA) MSAs provide insured care using money taken from a person’s account. If the money is not used, the person may keep it but expenses over the amount in the account is covered by an insurance policy. Worker’s Compensation Worker’s Compensation is a federally mandated program designed to ensure that workers do not pay for healthcare services resulting from an injury on the job. These programs can reduce the costs both to the employee and the company after a work-related injury. The injured worker must report any injury according to company procedures. The employee may be seen by an occupational health nurse or the employee health nurse. The nurse may arrange further care and the employee will most likely see a provider hired by the company to assess and treat any injury. Nurses may become involved in worker’s compensation in their role as provider of care but may also be injured on the job. Lifting injuries, transmission of infectious disease, and injuries related to medical and surgical instruments are possible injuries that could happen to nurses. Nurses are also travelling more to provide home health or hospice care leading to greater risk for travel-related injuries. Government Programs The federal government is deeply involved in healthcare financing. Federal programs cover the elderly, the poor, federal workers, the military, the veterans, and Native Americans and Native Alaskans, some through special programs and some through Medicare and Medicaid. Medicare In 1965, after years of testimony and effort by many health-related groups (including the ANA), and widespread public support, an amendment to the Social Security Act was passed. Title XVIII of the act, which was termed Medicare, provided payment for hospitalization (Part A) and insurance that could be purchased to meet physicians’ fees and outpatient costs (Part B) for people over the age of 65 and certain others who were receiving Social Security payments. In 2004, Medicare Part D, which covers prescription drugs, was approved, and it took effect in 2006. Medicare provides national and state administered health insurance programs for older adults, as well as people with permanent disabilities and their dependents. Medicare works like other insurance plans. The patient pays a co-payment for all services received. Medicare pays the majority of reasonable charges. Participation in Medicare Part A is automatic for those on Social Security, whereas participation in Medicare Part B is optional and a premium is deducted from the Social Security check to pay for Part B. Medicare Part A pays only for acute hospitalization and a limited ©2017 Achieve Test Prep Page 98

Made with FlippingBook - Online Brochure Maker