WGU C425 CORE EXAM MANUAL QUESTIONS AND
ANSWERS GUARANTEE A+
✔✔deductibles - ✔✔amount the insured pay first before benefits are paid by the plan,
paid annually
✔✔copayment - ✔✔money paid out of pocket each time health services are recieved
✔✔HDHP - ✔✔combined with a health reimbursement arrangement
✔✔use of tax exempt payments - ✔✔qualified medical expensees
✔✔medicare - ✔✔65 years or older,disabled people who are entitled to SS
benefits,those with end stage renal disease
✔✔When do benefit periods begin? - ✔✔the day the beneficiary is hospitalized
✔✔When do benefits end? - ✔✔when the beneficiary has not been in a hospital or a
skilled nursing facility for 60 consecutive days
✔✔RBRVS- resource based relative value - ✔✔medicare developed the program to
reimburse physicians according to a value assigned to each service. Based on time,
skill, intensity
✔✔DRG diagnosis related groups - ✔✔for acute hospital inpatients
✔✔RUG Resource utilization groups - ✔✔a case mix method to reimburse skilled
nursing facilites
✔✔Home health resources group - ✔✔a fixed pre determined rate for each 60 day
episode of care regardless of service given
✔✔OASIS - ✔✔used to rate a patients functional status and clinical severity
✔✔Ambulatory care - ✔✔care rendered to patients who come to the physicians office,
clinics, outpatient surgery
✔✔adult health day care - ✔✔complements informal care provided at home at a center
during the day
✔✔Primary care - ✔✔prevention, diagnostic, theraputic services, health
education,counseling, and minor surgery, an approach to providing healthcare, not a
specific services
, ✔✔tertiary care - ✔✔most complex level of care for conditions that are uncommon,
usually institution based, highly specialized, technology driven, rendered in large
teaching hospitals, maybe long term care Ex: trauma, burn treatment, NICU,
transplants, open heart surgery
✔✔comprehensive - ✔✔addresses health problems at any stage of a patients life cycle
✔✔coordinated - ✔✔combines health services to best meet the patients needs
✔✔medical center - ✔✔a hospital that has achieved specialization and offers a wide
scope of services, engage in teaching and research
✔✔community - ✔✔a nonfederal short stay hospital whose services are available to the
general public,
85%
✔✔public - ✔✔government ownership (federal,state, local) 25% of us hospitals, only
state/local hospitals are open to general public
✔✔veterans administration - ✔✔the largest federal hospital system with 150 hospitals
✔✔general hospitals - ✔✔provide a variety and broad set of services for various
conditions, general and specialized medical, obstetrics, diagnostics, treatment, surgery,
most hospitals in the US
✔✔osteopathic - ✔✔community general hospitals, holistic approach to treatment, in
addition to traditional allopathic appproach
✔✔MCOs - ✔✔garnered enormous buyhing power by enrolling a large segment of the
insured population and taking responsibility to procedure cost effective health care for
enrollees
✔✔Managed care - ✔✔mechanism for providing health care services where a single
organization takes on the management of financing, insurance, delivery, payment
✔✔capitiaiton - ✔✔the provider is paid a fixed monthly sum per enrollee often called per
member per month PMPM
✔✔discounted fees - ✔✔a modified form of fee for service
✔✔MCOS - ✔✔accredited by the national committee for quality assurance
NCQA
ANSWERS GUARANTEE A+
✔✔deductibles - ✔✔amount the insured pay first before benefits are paid by the plan,
paid annually
✔✔copayment - ✔✔money paid out of pocket each time health services are recieved
✔✔HDHP - ✔✔combined with a health reimbursement arrangement
✔✔use of tax exempt payments - ✔✔qualified medical expensees
✔✔medicare - ✔✔65 years or older,disabled people who are entitled to SS
benefits,those with end stage renal disease
✔✔When do benefit periods begin? - ✔✔the day the beneficiary is hospitalized
✔✔When do benefits end? - ✔✔when the beneficiary has not been in a hospital or a
skilled nursing facility for 60 consecutive days
✔✔RBRVS- resource based relative value - ✔✔medicare developed the program to
reimburse physicians according to a value assigned to each service. Based on time,
skill, intensity
✔✔DRG diagnosis related groups - ✔✔for acute hospital inpatients
✔✔RUG Resource utilization groups - ✔✔a case mix method to reimburse skilled
nursing facilites
✔✔Home health resources group - ✔✔a fixed pre determined rate for each 60 day
episode of care regardless of service given
✔✔OASIS - ✔✔used to rate a patients functional status and clinical severity
✔✔Ambulatory care - ✔✔care rendered to patients who come to the physicians office,
clinics, outpatient surgery
✔✔adult health day care - ✔✔complements informal care provided at home at a center
during the day
✔✔Primary care - ✔✔prevention, diagnostic, theraputic services, health
education,counseling, and minor surgery, an approach to providing healthcare, not a
specific services
, ✔✔tertiary care - ✔✔most complex level of care for conditions that are uncommon,
usually institution based, highly specialized, technology driven, rendered in large
teaching hospitals, maybe long term care Ex: trauma, burn treatment, NICU,
transplants, open heart surgery
✔✔comprehensive - ✔✔addresses health problems at any stage of a patients life cycle
✔✔coordinated - ✔✔combines health services to best meet the patients needs
✔✔medical center - ✔✔a hospital that has achieved specialization and offers a wide
scope of services, engage in teaching and research
✔✔community - ✔✔a nonfederal short stay hospital whose services are available to the
general public,
85%
✔✔public - ✔✔government ownership (federal,state, local) 25% of us hospitals, only
state/local hospitals are open to general public
✔✔veterans administration - ✔✔the largest federal hospital system with 150 hospitals
✔✔general hospitals - ✔✔provide a variety and broad set of services for various
conditions, general and specialized medical, obstetrics, diagnostics, treatment, surgery,
most hospitals in the US
✔✔osteopathic - ✔✔community general hospitals, holistic approach to treatment, in
addition to traditional allopathic appproach
✔✔MCOs - ✔✔garnered enormous buyhing power by enrolling a large segment of the
insured population and taking responsibility to procedure cost effective health care for
enrollees
✔✔Managed care - ✔✔mechanism for providing health care services where a single
organization takes on the management of financing, insurance, delivery, payment
✔✔capitiaiton - ✔✔the provider is paid a fixed monthly sum per enrollee often called per
member per month PMPM
✔✔discounted fees - ✔✔a modified form of fee for service
✔✔MCOS - ✔✔accredited by the national committee for quality assurance
NCQA
