WGU C425 OA EXAM 2024-2025 ACTUAL EXAM TEST BANK QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES (100% VERIFIE
ANSWERS)
Study online at https://quizlet.com/_g0g862
1. Which of the following is true in regards to health care There are more
today in the United States? specialty physi-
There are more primary care physicians than special- cians than primary
ty physicians. physicians.
Primary care receives a higher reimbursement in pro-
fessional fees.
There are more specialty physicians than primary
physicians.
Outpatient care is slowly decreasing.
2. What triggered the downsizing phase in the U.S. hos- Prospective pay-
pital industry during the 1980s? ment system
Hill-Burton Act
Managed care
Prospective payment system
Medicare and Medicaid
3. Designated Related Groups (DRG) -based reimburse- Reduce the length
ment necessitated hospitals to do what? of stay for hospital-
Admit new patients at a faster rate than before ized patients
Admit a greater number of Medicare patients than
before
Reduce the length of stay for hospitalized patients
Admit a smaller number of Medicare patients than
before
4. In which type of utilization management is a primary Gatekeeping
care physician's opinion necessary in referring or not
referring a patient to a specialist?
Concurrent
Retrospective
Gatekeeping
Precertification
5. What is one aspect in which managed care differs Responsibility for
from conventional insurance? delivery of ser-
Collection of premiums vices
Assumption of risk
, WGU C425 OA EXAM 2024-2025 ACTUAL EXAM TEST BANK QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES (100% VERIFIE
ANSWERS)
Study online at https://quizlet.com/_g0g862
Responsibility for delivery of services
Payments to providers
6. What is the purpose of Skilled Nursing Facilities (SNF) It enables a facility
certification? to serve Medicare
It enables a facility to be operated as a skilled nursing clients.
facility.
It is required to legally operate a nursing home.
It enables a facility to serve Medicare clients.
It enables a facility to serve both Medicare and Med-
icaid clients.
7. What is the main goal of long-term care as it relates to Promote indepen-
a patient's function? dence
Restore function
Provide assistance
Promote independence
Adapt to change
8. The U.S. government plays a limited role in the health being the re-
delivery system. The government's role in the arena of sponsible party
health care delivery consists of: for health care
developing private hospital organizations. delivery through
regulating public and private programs at the local Medicare and
levels. Medicaid pro-
being the responsible party for health care delivery grams.
through Medicare and Medicaid programs.
aiding in competition among managed care organiza-
tions.
9. The ideology system that emphasizes the well-being social justice sys-
of the community over an individual is called the: tem.
social justice system.
market justice system.
money market system.
universal health care system.
10.
AND CORRECT DETAILED ANSWERS WITH RATIONALES (100% VERIFIE
ANSWERS)
Study online at https://quizlet.com/_g0g862
1. Which of the following is true in regards to health care There are more
today in the United States? specialty physi-
There are more primary care physicians than special- cians than primary
ty physicians. physicians.
Primary care receives a higher reimbursement in pro-
fessional fees.
There are more specialty physicians than primary
physicians.
Outpatient care is slowly decreasing.
2. What triggered the downsizing phase in the U.S. hos- Prospective pay-
pital industry during the 1980s? ment system
Hill-Burton Act
Managed care
Prospective payment system
Medicare and Medicaid
3. Designated Related Groups (DRG) -based reimburse- Reduce the length
ment necessitated hospitals to do what? of stay for hospital-
Admit new patients at a faster rate than before ized patients
Admit a greater number of Medicare patients than
before
Reduce the length of stay for hospitalized patients
Admit a smaller number of Medicare patients than
before
4. In which type of utilization management is a primary Gatekeeping
care physician's opinion necessary in referring or not
referring a patient to a specialist?
Concurrent
Retrospective
Gatekeeping
Precertification
5. What is one aspect in which managed care differs Responsibility for
from conventional insurance? delivery of ser-
Collection of premiums vices
Assumption of risk
, WGU C425 OA EXAM 2024-2025 ACTUAL EXAM TEST BANK QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES (100% VERIFIE
ANSWERS)
Study online at https://quizlet.com/_g0g862
Responsibility for delivery of services
Payments to providers
6. What is the purpose of Skilled Nursing Facilities (SNF) It enables a facility
certification? to serve Medicare
It enables a facility to be operated as a skilled nursing clients.
facility.
It is required to legally operate a nursing home.
It enables a facility to serve Medicare clients.
It enables a facility to serve both Medicare and Med-
icaid clients.
7. What is the main goal of long-term care as it relates to Promote indepen-
a patient's function? dence
Restore function
Provide assistance
Promote independence
Adapt to change
8. The U.S. government plays a limited role in the health being the re-
delivery system. The government's role in the arena of sponsible party
health care delivery consists of: for health care
developing private hospital organizations. delivery through
regulating public and private programs at the local Medicare and
levels. Medicaid pro-
being the responsible party for health care delivery grams.
through Medicare and Medicaid programs.
aiding in competition among managed care organiza-
tions.
9. The ideology system that emphasizes the well-being social justice sys-
of the community over an individual is called the: tem.
social justice system.
market justice system.
money market system.
universal health care system.
10.
