Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

The organizations that negotiate for better rates with Medicare, Medicaid, and other insurers are what?

1. Provider-sponsored organizations

2. Health care cost coalitions

3. Preferred provider organizations

4. Prudent buyer systems

The correct answer is: Health care cost coalitions

Health care cost coalitions are groups formed by various stakeholders that unite to negotiate better reimbursement rates and terms with Medicare, Medicaid, and private insurers. These coalitions often consist of healthcare providers, hospitals, and sometimes employers, pooling their resources and negotiating power to achieve more favorable contractual obligations. By working together, these organizations are able to leverage collective bargaining to address the rising costs of healthcare and improve payment structures. In contrast, provider-sponsored organizations primarily focus on managing care while being run by providers themselves. Preferred provider organizations (PPOs) are a type of health plan that offers a network of preferred providers but do not specifically exist solely to negotiate on behalf of providers. Prudent buyer systems generally refer to strategies or systems that promote cost-effective care but do not focus on collective negotiation with insurers. Thus, the identification of health care cost coalitions as the answer underscores their role in negotiating financial terms in the healthcare market.