The nurse is caring for a patient whose insurance coverage is Medicare. The nurse should consider which information when planning care for this patient?

A) Capitation provides the hospital with a means of recovering variable charges.
B) The hospital will be paid for the full cost of the patient's hospitalization.
C) Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost.
D) Medicare will pay the national average for the patient's condition.

Medicare

Federally funded national health insurance program in the United States for people over 65 years of age. The program is administered in two parts. Part A provides basic protection against costs of medical, surgical, and psychiatric hospital care. Part B is a voluntary medical insurance program financed in part from federal funds and in part from premiums contributed by people enrolled in the program.

Diagnosis-Related Groups

A system used to classify hospital cases into groups based on diagnosis, treatment difficulty, and resource use, to determine how much hospitals get paid.

Capitation

Payment mechanism in which a provider (e.g., health care network) receives a fixed amount of payment per enrollee.