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ANCC Review > Non-Clinical > Flashcards

Non-Clinical Flashcards

1
Q

malpractice insurance:

Claims-Based Policy

A

This type of malpractice insurance covers claims only if

-the incident occurred when the NP paid the premium
-only if the NP is still enrolled with the same insurance company at the time the claim is filed in court.

The claim will not be covered (in the future) if they do not have the same insurance company as when the lawsuit was filed.

Buying “tail coverage” can help address this issue.

“you claim you still have the same insurance?”

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2
Q

malpractice insurance:

Occurrence-Based Policy

A

This type of malpractice policy is not affected by job changes or retirement.

It will cover a lawsuit in the future even if the NP no longer carries the policy, as long as the NP had an active policy during the alleged incident.

“OCCUUUUUrt- thats the coverage you want”

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3
Q

Malpractice Lawsuits:

Plaintiff:

A

The patient or whoever is acting on behalf of the patient (e.g., the patient’s representative) who files the lawsuit claiming injury and/or damage by another party

**Plaintiff has the “burden of proof” during The “discovery” phase (e.g., requesting of medical records, depositions, expert opinions) occurs

PP
Pt /Plaintiff

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4
Q

Malpractice Lawsuits:

Defendant:

A

The party who responds to the lawsuit filed by another party who claims an injury and/or damage (e.g., NP, hospital)

DD
i DID what now? no i Didnt/ Defendent

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5
Q

Budget Reconciliation Act of 1989 (HR 3299)

A

The first law allowing NPs to be reimbursed directly by Medicare.

“medicare doesn’t care if you reconcile”

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6
Q

“Incident-to” Billing and Medicare

A

“Incident-to” billing is a way to bill Medicare for outpatient services rendered by a nonphysician health provider (NP, physician assistant [PA]) and receive the 100% physician fee. The location of the services can be at the physician’s office, a separate or satellite office, or an institution or in the patient’s home.

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7
Q

Balance Budget Act of 1997

A

National Provider Identifier (NPI) number to bill Medicare and Medicaid. NPs can be reimbursed directly by Medicare Part B, Medicaid, Tricare, and some health insurance plans. Medicare will reimburse NPs at 85% of the Medicare Physician Fee Schedule.

“Balance the Numbers”

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8
Q

The ICD-10 is used for ______

The CPT code is used to _______

Both the ICD-10 and CPT codes are _____

A

The ICD-10 is used for diagnosis codes. “DIAs”

The CPT code is used to bill for outpatient office procedures and services.
“Cinco/ Cut and Paste Together”

Both the ICD-10 and CPT codes are required for each bill.

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9
Q

What Is the CPT?

A

The CPT is a five-digit code or alphanumeric code (letter with the digits) that is used to identify medical procedures (suturing, incision and drainage [I&D]) and other medical services. It is owned and maintained by the AMA.

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10
Q

What Are E&M Codes?

A

Evaluation and Management Service (E&M) codes are used to bill for patient visits and are part of the CPT.

**Identify a problem-focused visit

The provider must document that these three components have been met (or exceeded):
-history
-examination
-medical decision-making (complexity)

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11
Q

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was signed into law in 2009 as an incentive for

A

for healthcare providers to adopt the use of electronic health records (EHRs)

-mandate EMR’s in order to get paid

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12
Q

NPs receive their “right to practice” from

A

the state legislature.

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13
Q

The NPI contains

A

10 numbers/digits

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14
Q

Well-designed controlled experimental trials (double-blind RCTs) are considered to be grade_______

A

A (or level 1) evidence.

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15
Q

Confidence Interval

degree of c______

A

Confidence interval (CI) is a measure of the degree of certainty in a sampling method.

For example, a 95% CI is a range of values that you can be 95% certain contains the true mean of the population.

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16
Q

Absolute Risk Reduction

absolute tx based

A

Absolute risk reduction (ARR) is a measure of the difference between two different treatments in terms of their ability to reduce a particular outcome (e.g., myocardial infarction [MI], stroke).

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17
Q

Relative Risk Reduction

comparing groups

A

Relative risk reduction (RRR) is a measure of how much risk is reduced in the experimental group compared with the control group.

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18
Q

Number Needed to Treat

in order to

A

Number needed to treat (NNT) is the number of patients you have to treat to avoid one bad outcome (e.g., MI, stroke). For example, an NNT of seven means that it is necessary to treat seven patients to avoid one bad outcome.

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19
Q

Positive Predictive Value

probability that a person with a + screening test_____

A

Positive predictive value (PPV) is the probability that a person with a positive screening test result has the disease.

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20
Q

Negative Predictive Value

probability that a person with a - screening test_____

A

Negative predictive value (NPV) is the probability that a person with a negative test result does not have the disease.

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21
Q

Horizontal Transmission

Vertical Transmission

A

Transmission of an infecting agent from one individual to another. For example, horizontal transmission of HIV and other STDs or infections occurs through sexual intercourse.

Transmission of an infecting agent from mother to infant. Congenital infections from mother to infant can be passed through vertical transmission. Also, an HIV-positive mother who breastfeeds her infant can infect her infant with HIV through vertical transmission.

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22
Q

Endemic

Epidemic

Pandemic

A

Endemic

This refers to a baseline level of a particular disease in a population.

Epidemic

Refers to the rapid increase of a disease in a population that involves a large number of people.

Pandemic

This is an epidemic that occurs over a very large area (several countries or continents). It involves a large proportion of the global population.

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23
Q

Morbidity

Mortality

Infant Mortality

A

Morbidity

-This refers to an illness or any departure from physical and/or mental health.

Mortality
-Death.

Infant Mortality

-Refers to infant deaths per 100,000 live births. The leading cause of death in an infant’s first year of life is congenital malformations (including chromosomal abnormalities).

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24
Q

Sensitivity

Specificity

A

Sensitivity
-Refers to the ability of a screening test to correctly identify a person with the disease.

Specificity
-Refers to the ability of a screening test to correctly identify a person without the disease.

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25
Q

Primary data are the

A

preferred source in research (original study that produced the data).

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26
Q

Experimental studies use

A

randomization with subject selection.

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27
Q

Correlational studies search for

A

relationships between a minimum of two variables.

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28
Q

Deductive logic is used with ______, and inductive logic is used in _______

A

quantitative studies

qualitative studies.

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29
Q

The IRB’s role is to

A

protect the rights of the human subjects enrolled in a study.

30
Q

Assent refers to

A

minors because they legally cannot give consent (unless an emancipated minor).

31
Q

Know the definition of N vs n.

A

N (total number of subjects)

n (subgroup).

32
Q

A normal curve is the

A

“bell curve.”

33
Q

Muslim women who refuse to wear a gown can be

Jehovah’s Witnesses do not accept

Prolonged direct eye contact with males or strangers is considered rude by some cultures (e.g.,

Ramadan is a Muslim holiday that lasts for 30 days. ______ are forbidden from sunrise to sunset.

Orthodox Jewish patients may refuse to touch

A

examined through their clothing (modified or partial physical exam).

blood transfusions (including autologous), but some may accept blood components without RBCs (e.g., cryoprecipitate, immunoglobins).

Asians, female Muslim).

Both fluids and food

anything powered by electricity (e.g., light switch, call light, electronic pumps, cell phones) from sunset Friday to sunset Saturday (Sabbath). Do not schedule visits during the Sabbath. If you call during this time, observant patients will not answer the phone.

34
Q

Ombudsman

A

A person who acts as an intermediary (or as a liaison) between the patient and an organization (long-term care facilities or nursing homes, hospitals, governmental agencies, courts). The ombudsman investigates and mediates the complaint from both sides and attempts to reach a fair conclusion.

35
Q

Guardian Ad Litem

A

An individual who is assigned by a court (and has the legal authority) to act in the best interest of the ward.

The ward is usually a person who is a child or someone who is frail or vulnerable.

36
Q

What Is a Third-Party Administrator?

A

A third-party administrator (TPA) is the organization that does the processing of claims and administrative work for another company (health insurer, health plan, retirement plan).

37
Q

Consolidated Omnibus Budget Reconciliation Act

A

Also known as “COBRA coverage.”

Provides for the continuation of coverage of preexisting group health insurance (from the employer) for workers and their families who lose their coverage (between jobs, quit job, or are fired) for a fixed period of time.

COBRA coverage is generally offered for 18 months (up to 36 months in some cases).

38
Q

Root Cause Analysis

A

RCA is a structured, facilitated team process used in healthcare to identify the contributing factors that result in an error

The goal is to identify the system breakdowns that resulted in an inadvertent mistake and to propose at least one corrective action to reduce or eliminate each root cause.

When an SE (sentinel event) occurs, an RCA is recommended.

The focus is on the system and not on blaming individuals.

39
Q

Hospice is covered under

Hospice patients are allowed to have

A

Medicare Part A, Medicaid, and most health insurance plans.

physical therapy (PT), occupational therapy (OT), and speech therapy if prescribed

40
Q

Hospice Eligibility Criteria

A

hospice physician and the patient’s physician certify that the patient is

-terminal and has 6 months (or less) to live. -the hospice physician approves of admission.
-Patient is rapidly declining or exhibits worsening symptoms.
-Patient needs assistance with two or more activities of daily living (ADL).
-Patient accepts palliative care, not curative care.
-***If they do not want to be in hospice (even if all criteria are met), then patient is not eligible.

41
Q

Respite Care

“respect the caregiver”

A

Short-term respite care for the primary caregiver that is reimbursed by Medicare.

This gives the primary caregiver a break, even if it is only a few hours.

For example, respite care gives the caregiver a chance to go see a movie and to “relax” and rest.

42
Q

The symbol for a healthy male is

for a diseased/affected male

The symbol for a healthy female is

for a diseased/affected female

A diagonal dash across a symbol means

A

an empty square

a filled square.

an empty circle

a filled circle.

that the person is dead.

43
Q

If the patient meets the criteria for hospice care,_______will reimburse hospice

A

Medicare Part A

44
Q

________will pay for an ambulance for emergency care.

A

Medicare Part B

If transport in any other vehicle will endanger the patient’s health, transport by ambulance is allowed.

45
Q

Medicare Part B does not reimburse for

A

dentures, eyeglasses, or hearing aids.

46
Q

No separate consent is required for

A

entities that pay or process the patient’s health bills, such as health insurance companies, HMOs, medical billers, or collection agencies (or third-party contractors hired by the company to pay or to process claims).

47
Q

The “medical home”

A

is a method of primary healthcare delivery.

Healthcare providers and therapists (physical, occupational, speech) deliver care in the patient’s home, with the family.

These patients have chronic long-term illness.

To communicate, technology is used, such as phone, video chat, or email.

48
Q

A patient with private insurance presents to their primary care provider to get a referral to see an allergist for more in-depth allergy testing. Which of the following regarding their insurance plan is correct?

A

Correct Answer: They most likely have a health maintenance organization insurance

Rationale: This patient likely is covered under an HMO (health maintenance organization) insurance as they are required to have a gate-keeper (such as their primary care physician) and must get a referral to see a specialist. HMO’s require that patients see providers who are in network and are typically cheaper for the patient. Preferred provider organizations (PPOs) provide more flexibility for care and do not require a primary care provider, but patients often pay higher premiums for this type of insurance in exchange for this flexibility. Medicare and medicaid are public health insurances.

49
Q

Which act required nurse practitioners to acquire an NPI number in order to bill Medicare?

A

Correct Answer: Balanced Budget Act

50
Q

Emancipated minors are

A

minors (<18 years old) that are
-legally married,
-active duty military,
-or have been emancipated by the courts.

Although patients who are pregnant are not considered emancipated, they do not need parental consent for care related to pregnancy.

Additionally, minors do not need parental consent for care regarding sexually transmitted infections or contraception.

51
Q

Family systems theory

A

The family systems theory revolves around the fact that a family acts as a cohesive unit. Therefore, when one member falters, another member will step in their place to fulfill that role. This theory is based in the belief that the family works together as an emotional unit with complex interactions.

52
Q

What is the goal of the Transitional Care Model?

A

To prevent hospital readmissions and exacerbations of their condition

53
Q

Taking positive health actions to avoid negative health consequences is the

A

Health Belief Model.

54
Q

The HITECH Act

A

It protects patient information and alerts patients to any potential out of care team breaches. Other aspects of the HITECH Act include alerts to abnormal labs and abnormal vitals.

55
Q

Secondary prevention is all about

A

screening and early detection of disease.

-Mammograms,
-colonoscopies
-routine blood pressure screening

Asking a patient about their smoking use is recommended at every visit, but is NOT screening or detecting a disease.

56
Q

The state nursing practice act ____ a nurse practitioner’s _____

The state board of nursing _____ a nurse practitioner’s ______

A

determines a nurse practitioner’s scope of practice

enforces a nurse practitioner’s scope of practice

57
Q

Which of the following cultures believe that the “evil eye” is responsible for illness?

A

In Latin Americans culture, it is the “evil eye” or Mal de Ojo that is responsible for illness. They believe that young children and babies are especially vulnerable to this.

58
Q

Incident to Billing, where nurse practitioners can bill under the physician’s name to receive 100% reimbursement instead of 85%, can only be used when

A

the NP is seeing the patient for the same thing the physician has already seen them for
AND
if the physician is currently in the building and immediately available.

-It is not appropriate to use this while the physician is out of office.

59
Q

The Budget Reconciliation Act was_____

The balanced budget act required that all NP’s_____

Under-billing and overbilling our patients can both be __________

A

the first law that allowed NPs to get paid by medicare.

get an NPI number in order to bill medicare and medicaid and determined that NPs could bill at 85% of what the physician charges.

considered fraudulent

60
Q

Lewin’s Change Model. The three components are

“Lewis and Clark- traveling in the snow, get stuck in the ice”

A

Unfreezing:
Unfreezing is before the change occurs and is determining what exactly needs to change while getting support for that change.

Changing (or driving forces):
Changing (or driving forces) is the actual change process where change occurs.

Refreezing:
Refreezing is ensuring the change sticks as a new habit.

61
Q

“Stages of Change”

Pre-contemplation:

Contemplation:

Preparation:

Action:

Maintenance:

A

Precontemplation: When the patient does not want to change or does not see a need to change a behavior.

Contemplation: When they are starting to think about the change, but have not taken any concrete steps towards planning for the change

Preparation: When a patient is taking small steps to prepare for the change, it is considered the preparation stage

Action: When the patient’s plans are taking effect and the patient has taken actual action into the change itself.

Maintenance: When this change is sustained overtime, typically at least 6 months.

62
Q

Medicare part B covers the following vaccines:

A

annual influenza, COVID vaccines, Pneumococcal vaccines, and Hep B vaccines.

63
Q

A 70 year old patient is requesting his annual routine TDaP vaccine that he is due for. The nurse practitioner understands that this will be covered under which part of Medicare?

A

Medicare Part D is prescription drug coverage, including things like recommended immunizations

64
Q

Which of the following cultures believe illness is caused due to punishment from spirits?

A

Native Americans

65
Q

The HITECH Act was enacted in 2009. Which of the following represents implementation of this act within the healthcare setting?

A

Smoking status should be recorded for all patients who are older than 13 years of age

66
Q

The Health Belief Model states that

A

people will take positive health actions to prevent negative health outcomes. In order to prevent being placed on insulin, the patient is taking positive actions like increasing his diet and exercise.

67
Q

Stages of Change model includes The

A

precontemplation, contemplation, preparation, action and maintenance.

68
Q

Transitional Care Model revolves around the

A

continuity of care to prevent readmissions and exacerbations of their disease. This could look like sending a patient from a hospital admission to a rehab facility before discharging them home into our care.

69
Q

Motivational interviewing is a communication approach used where

A

providers involve their patients as a part of their care.

It can encourage patients to take responsibility for their care and suggest what changes they can make and why.

70
Q

The difference between a true experiment and a quasi-experimental design is

A

In a Quasi design- randomization of the subjects amongst various treatment groups is NOT a requirement of the study

71
Q
A

ANCC Review (19 decks)

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