The insurance company's practice of monitoring an insured individual's treatment to ensure it adheres to a predetermined schedule is known as utilization review or utilization management. This process helps control healthcare costs and ensures that services provided are medically necessary and cost-effective.
When an insurance company monitors the treatment and progress of an insured individual to ensure that everything proceeds according to a predetermined schedule, this is known as utilization review or utilization management. This process is implemented to control costs and manage the quality of care by reviewing the necessity, appropriateness, and efficiency of the medical services provided. It is a common practice in both fee-for-service and managed care plans, such as Health Maintenance Organizations (HMOs), to ensure that the healthcare services authorized are medically necessary and within the terms of the insurance policy.
In the case of the insured with a herniated disk, the insurance company's utilization review aims to make certain that the hospital stay, surgical procedure, and any follow-up treatments align with the best practices and cost-effectiveness standards established by the insurer. This process may involve pre-authorization of services, concurrent review during the hospital stay, and retrospective review after the services have been provided. It's a balance between providing necessary medical interventions and preventing unnecessary medical spending that could arise from a moral hazard.
An adolescent who has had type 1 diabetes for 5 years stops adhering to the therapeutic regimen. in light of the client's developmental level, the nurse concludes that the behavior is a reflection of a:
A client’s dose of sinemet has recently been increased due to an exacerbation of the client’s parkinsonian symptoms. what assessment finding would suggest that the client is experiencing adverse effects?
A doctor gives you three pills telling you to take one every half hour. how many minutes would the pills last??
The pills would last for 60 minutes.
To solve this problem, one must understand the frequency at which the pills are to be taken. The doctor instructs the patient to take one pill every half hour. Since there are three pills, we can calculate the total duration by multiplying the frequency (half hour) by the number of pills (three).
First, we convert half an hour to minutes because the question asks for the duration in minutes. There are 60 minutes in an hour, so half an hour is 30 minutes.
Now, we have three pills to be taken at intervals of 30 minutes each. Therefore, the total time covered by the three pills is:
3 pills x 30 minutes/pill = 90 minutes
However, since the first pill is taken at the start, we only need to calculate the time between the first and the last pill, which is two intervals of 30 minutes each. So we subtract one interval from the total:
90 minutes - 30 minutes = 60 minutes
Thus, the pills would last for 60 minutes in total.
Lauren was spending more time alone, and when she did see friends, she was irritable and got angry very easily. Her best friend Anna noticed this change and wanted to help. Which of these strategies would best help Anna positively influence Lauren?
Reduce the time she spends with Lauren so she gets the message that her attitude needs to change
Talk to Lauren and accompany her to see the school counselor if she feels uncomfortable going alone
Talk to her other friends and see if they think Lauren is acting that way on purpose
Plan to spend the day with Lauren doing all of her favorite things to see if it helps improve her mood
Answer:
B.
Explanation:
Talk to Lauren and accompany her to see the school counselor if she feels uncomfortable going alone
Elaine wakes up in the hospital with a head injury. she gets to know her doctors and nurses over time, but it soon becomes clear that she has no memories from before she woke up in the hospital. elaine has ________ amnesia.
Elaine has retrograde amnesia, a condition characterized by the loss of past memories due to a head injury.
Elaine wakes up in the hospital with a head injury and has no memories from before this event. The type of amnesia Elaine is experiencing is called retrograde amnesia. This is a form of memory loss where individuals are unable to recall past events that occurred before the trauma. Elaine's ability to form new memories is not necessarily impacted, which often remains intact in cases of retrograde amnesia. This condition can result from physical trauma or disease, though in Elaine's case, it is due to her head injury.
Famous cases of retrograde amnesia, such as former NFL player Scott Bolzan, illustrate the severe nature of this condition, where individuals can lose years of their lives from their memory. Unlike many Hollywood movies' dramatic depictions, real-life amnesia can be more complex and does not typically resolve with a sudden return of all past memories.
An older adult patient had a hip replacement. when should the patient begin with assisted ambulation with a walker? 2 to 3 weeks 72 hours 1 week 24 hours
Answer:
The answer is 2 to 3 weeks
Explanation:
This stage is known as cemented rehabilitation from 0 to 3 weeks and is the first objective, among which is:
-Decreased pain.
-Reduction of edema.
-Prepare the patient in sensitivity work.
-Prepare the patient in the work of cardiovascular conditioning.
-Prepare the elderly patient for the use of the walker.
A nurse is interviewing a parent regarding the 2-year-old child's recent illness. the nurse would like the parent to elaborate about any symptoms of the illness noticed. which would be the most effective question for the nurse to ask the parent in this situation?
Even if you refuse to submit to a test for the presence of alcohol or drugs, you can still be arrested for DUI and taken to jail
A. True
B. False
Answer:
A true
Explanation:
Yes, even if you refuse to take an alcohol or drug test, you can still be arrested for DUI and taken to jail, because law enforcement has the authority to arrest individuals they believe to be under the influence.
Explanation:The answer to the question, "Even if you refuse to submit to a test for the presence of alcohol or drugs, you can still be arrested for DUI and taken to jail?" is A. True. Law enforcement officials are granted the power to arrest individuals who they reasonably believe to be operating a vehicle under the influence of substances such as alcohol or drugs. Refusing to comply with testing processes does not exempt an individual from legal actions, and in many states, refusing a test can be used as evidence of guilt and may have additional penalties. Therefore, it is very likely that even if you refuse a test for the presence of alcohol or drugs, you can still be arrested.
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The nurse has reinforced instructions to a client regarding the method for instilling eye drops into the left eye. the nurse determines that the client needs further teaching if the client does which during a return demonstration?
A client who is being treated for nonhealing diabetic foot ulcers tells the nurse angrily, “i am so frustrated with my doctors. the wound care doctor tells me this will not heal and i need to have my toes amputated and another doctor tells me i need to keep going with the antibiotics and dressing changes so i can save my foot. i just want to go home!” after listening to the client’s concerns, the nurse should:
What manifest and latent functions might exist for a health club?
A health club's obvious function is to improve the physical well-being of those who work out there. It is intended to be a place where people can exercise.
What is health club?Health clubs, also known as fitness centers or gyms, provide a variety of services to help individuals achieve their fitness goals.
Increased physical activity aids in the prevention of cardiometabolic disease and type 2 diabetes, among other widely accepted health risks. Health clubs are an excellent way to diversify your routine.
A health club's essential purpose is to boost the physical well-being of those who collaborate out there.
It is destined to be a location where individuals can exercise. A health club's latent function would be to reduce healthcare costs, resulting in increased profits for the insurance industry.
Thus, this manifest and latent functions might exist for a health club.
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If your workout exceeds an hour, you should substitute _______ for water
A. a sports drink B. whole milk C. diet soda D. fruit juice
A qualifying dimension for people who consider purchasing a pill for pain relief:
A person who stays calm during difficult situations is exhibiting characteristics of _____.
A person who stays calm during difficult situations exhibits the psychological trait of being stable and displays high self-regulation, according to Eysencks' theory and Rothbart's research on adult personality.
Explanation:A person who stays calm during difficult situations is exhibiting characteristics of being stable. According to the Eysencks' theory in psychology, people who score high on neuroticism tend to exhibit anxiety and have difficulty staying calm in challenging situations. On the contrary, individuals who show stability are likely to remain calm during such situations.
Moreover, these individuals exhibit the trait of self-regulation, a significant aspect of our adult personality according to the research. Self-regulation refers to our ability to control our emotional responses to environmental stimuli. So, in stressful or challenging circumstances, individuals with high self-regulation can manage to stay calm while others may easily get anxious.
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What is a strong interest inventory
All of the following are sexually transmitted diseases except...
A. HIV
B. Herpes
C. hepatitis
D. Pelvic Inflammatory Disease
alex has evaluated her skills and determined that she has excellent power. She wants to sign up for two sports that will play to her strengths. Which two sports will be best for her?
Given her powerful skills, Alex would find shot put and boxing to be suitable sports. Both sports demand significant power and would play well to her strengths.
Explanation:Alex, who has excellent power, will benefit from participating in sports that require explosive strength and power. One suggestion would be the shot put, a sport that demands a burst of power to throw a heavy object. This sport could be an excellent match for Alex's strengths. The second sport might be boxing, where punching power plays a significant role. This sport also requires good power and can be a great fit for Alex.
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A client at 10 weeks' gestation tells the nurse in the maternity clinic that she is worried because she is voiding frequently. how should the nurse respond?
Frequent urination at 10 weeks' gestation is normal and primarily caused by the pressure on the bladder from the growing fetus, along with increased workload on the maternal urinary system. Other concerns like intestinal blockages and circulatory problems in the legs may also occur. Regular prenatal care is crucial to monitor and manage such conditions.
A client at 10 weeks' gestation is experiencing frequent urination, which is a common concern during this trimester. It is important to reassure the client that this is normal and usually due to the pressure on the bladder from the enlarging uterus as the fetus grows. Additionally, the maternal urinary system is handling the task of processing both maternal and fetal wastes, leading to increased urine production and frequency.
It is also important to educate the client about other potential reasons for increased urinary frequency, such as intestinal blockage and circulatory problems, particularly in the legs where clots may develop due to pressure from the fetus on returning veins as they enter the abdominal cavity. Encouraging regular checkups and monitoring for signs of complications can help manage these concerns effectively.
The uterus is signaled by________ to maintain its thickened lining.
Which of the following foods does not belong to the dairy group? Eggs Ice cream Sour cream Milk
A patient is ordered desmopressin (ddavp) for the treatment of diabetes insipidus. what therapeutic response does the nurse anticipate the patient will experience?
The answer to this question is that the patient will experience a decrease in urine output. The diabetes insipidus is a condition where the patient experienced having large amount of urine which makes the person urinate more and the patient also experience being thirsty all the time. This condition can be treated by just drinking sufficient fluid intake. Desmopressin is the medicine that can treat / cure the diabetes insipidus.
Answer:
c. decrease in urine outputWhich of the following
is a primary rather than learned emotion
explain three things you will not do while driving
Which is the safest and most effective way to get a deeper stretch? massage the muscles being stretched inhale and push the stretch until it hurts lean into the stretch as you exhale place ice on your muscles before stretching
c. lean into the stretch as you exhale
hope this helps!
The safest and most effective way to get a deeper stretch is:
Lean into the stretch as you exhale.StretchingStretching is known to be a form of exercising whereby the muscles and tendons are deliberately flexed with the aim of improving the elasticity of the muscle.
When we stretch ourselves, our muscles become:
stronghealthyflexible.Stretching is very good for our muscles.
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A bag of Apple chips say it contains five servings in each serving is 100 cal if you can consume 200 snack calories in maintain daily calorie balance how many servings can you consume and remain within your limits
Answer:
Two
Explanation:
A type of infection spread in conjunction with the delivery of health care services is termed ______________________ infection.
During your assessment of a patient with blunt chest trauma, you note that the patient has shallow breathing and paradoxical movement of the left chest wall. you should:
An elevated HDL is considered a?
Answer: less harmful form of cholesterol found in the body.
Explanation:
High-density lipoprotein (HDL) cholesterol is known as the "good" cholesterol because it helps remove other forms of cholesterol from your bloodstream. Higher levels of HDL cholesterol are associated with a lower risk of heart disease.
The act of pulling on a body structure in the direction of its normal alignment is called:
A client has been ordered anthralin (drithrocreme) treatment for psoriasis. what does the nurse teach the client about self-management of this drug?