WGU D391 Healthcare Ecosystems OA
Actual Exam Style 2026/2027 | Questions
with Verified Answers 100% Correct |
Pass Guaranteed | Grade A
Q01 Which organization is responsible for accrediting hospitals and other healthcare facilities in
the United States? Answer: The Joint Commission Rationale: The Joint Commission
(formerly JCAHO) is the primary accrediting body for hospitals, ambulatory care centers,
behavioral health organizations, and other healthcare entities in the U.S.
Q02 What is the primary purpose of the Centers for Medicare & Medicaid Services (CMS)?
Answer: Administer the Medicare and Medicaid programs and enforce federal health
policy Rationale: CMS is the federal agency within HHS that manages Medicare, Medicaid,
CHIP, and enforces many provisions of the Affordable Care Act.
Q03 Which payment model rewards healthcare providers for quality and efficiency rather than
volume of services? Answer: Value-Based Purchasing (VBP) Rationale: VBP programs tie a
portion of Medicare payments to quality and cost performance metrics.
Q04 What is the primary role of Accountable Care Organizations (ACOs)? Answer: Coordinate
care for Medicare beneficiaries and share in savings achieved through improved quality
and lower costs Rationale: ACOs are groups of doctors, hospitals, and other providers who
voluntarily take responsibility for the quality and cost of care for a defined population.
Q05 Which federal law requires healthcare providers to protect the privacy and security of
protected health information (PHI)? Answer: Health Insurance Portability and
Accountability Act (HIPAA) Rationale: HIPAA's Privacy Rule and Security Rule establish
national standards for protecting individuals' medical records and other PHI.
, Q06 What is the primary function of the Health Information Technology for Economic and
Clinical Health (HITECH) Act? Answer: Promote the adoption and meaningful use of
electronic health records (EHRs) Rationale: HITECH provided financial incentives through
the Medicare and Medicaid EHR Incentive Programs (now Promoting Interoperability) to
encourage EHR adoption.
Q07 Which organization develops and maintains the Current Procedural Terminology (CPT)
coding system? Answer: American Medical Association (AMA) Rationale: The AMA owns
and updates the CPT code set used for reporting physician services.
Q08 Which coding system is used for inpatient hospital procedures and diagnoses? Answer:
ICD-10-PCS and ICD-10-CM Rationale: ICD-10-CM is for diagnoses, and ICD-10-PCS is for
inpatient procedures.
Q09 What is the purpose of the Prospective Payment System (PPS) for hospitals? Answer: To
reimburse hospitals a fixed amount per diagnosis-related group (DRG) Rationale: The
Inpatient Prospective Payment System (IPPS) pays a predetermined rate per DRG rather than
fee-for-service.
Q10 Which act expanded Medicaid eligibility and established health insurance marketplaces?
Answer: Patient Protection and Affordable Care Act (ACA) Rationale: The ACA (2010)
created marketplaces, subsidies, and Medicaid expansion to increase insurance coverage.
Q11 What is the primary goal of the Medicare Access and CHIP Reauthorization Act
(MACRA)? Answer: Replace the Sustainable Growth Rate formula and transition
Medicare to value-based payment Rationale: MACRA created the Quality Payment Program
(QPP) with two tracks: MIPS and Advanced APMs.
Q12 Which quality reporting program applies to eligible clinicians under Medicare? Answer:
Merit-based Incentive Payment System (MIPS) Rationale: MIPS combines PQRS, Value-
Based Modifier, and MU into one program with four performance categories.
Actual Exam Style 2026/2027 | Questions
with Verified Answers 100% Correct |
Pass Guaranteed | Grade A
Q01 Which organization is responsible for accrediting hospitals and other healthcare facilities in
the United States? Answer: The Joint Commission Rationale: The Joint Commission
(formerly JCAHO) is the primary accrediting body for hospitals, ambulatory care centers,
behavioral health organizations, and other healthcare entities in the U.S.
Q02 What is the primary purpose of the Centers for Medicare & Medicaid Services (CMS)?
Answer: Administer the Medicare and Medicaid programs and enforce federal health
policy Rationale: CMS is the federal agency within HHS that manages Medicare, Medicaid,
CHIP, and enforces many provisions of the Affordable Care Act.
Q03 Which payment model rewards healthcare providers for quality and efficiency rather than
volume of services? Answer: Value-Based Purchasing (VBP) Rationale: VBP programs tie a
portion of Medicare payments to quality and cost performance metrics.
Q04 What is the primary role of Accountable Care Organizations (ACOs)? Answer: Coordinate
care for Medicare beneficiaries and share in savings achieved through improved quality
and lower costs Rationale: ACOs are groups of doctors, hospitals, and other providers who
voluntarily take responsibility for the quality and cost of care for a defined population.
Q05 Which federal law requires healthcare providers to protect the privacy and security of
protected health information (PHI)? Answer: Health Insurance Portability and
Accountability Act (HIPAA) Rationale: HIPAA's Privacy Rule and Security Rule establish
national standards for protecting individuals' medical records and other PHI.
, Q06 What is the primary function of the Health Information Technology for Economic and
Clinical Health (HITECH) Act? Answer: Promote the adoption and meaningful use of
electronic health records (EHRs) Rationale: HITECH provided financial incentives through
the Medicare and Medicaid EHR Incentive Programs (now Promoting Interoperability) to
encourage EHR adoption.
Q07 Which organization develops and maintains the Current Procedural Terminology (CPT)
coding system? Answer: American Medical Association (AMA) Rationale: The AMA owns
and updates the CPT code set used for reporting physician services.
Q08 Which coding system is used for inpatient hospital procedures and diagnoses? Answer:
ICD-10-PCS and ICD-10-CM Rationale: ICD-10-CM is for diagnoses, and ICD-10-PCS is for
inpatient procedures.
Q09 What is the purpose of the Prospective Payment System (PPS) for hospitals? Answer: To
reimburse hospitals a fixed amount per diagnosis-related group (DRG) Rationale: The
Inpatient Prospective Payment System (IPPS) pays a predetermined rate per DRG rather than
fee-for-service.
Q10 Which act expanded Medicaid eligibility and established health insurance marketplaces?
Answer: Patient Protection and Affordable Care Act (ACA) Rationale: The ACA (2010)
created marketplaces, subsidies, and Medicaid expansion to increase insurance coverage.
Q11 What is the primary goal of the Medicare Access and CHIP Reauthorization Act
(MACRA)? Answer: Replace the Sustainable Growth Rate formula and transition
Medicare to value-based payment Rationale: MACRA created the Quality Payment Program
(QPP) with two tracks: MIPS and Advanced APMs.
Q12 Which quality reporting program applies to eligible clinicians under Medicare? Answer:
Merit-based Incentive Payment System (MIPS) Rationale: MIPS combines PQRS, Value-
Based Modifier, and MU into one program with four performance categories.
