WGU C425 - Healthcare Delivery Systems, Regulation and Compliance QUESTION AND CORRECT ANSWER

WGU C425 - Healthcare Delivery Systems, Regulation and Compliance QUESTION AND CORRECT ANSWER Which important change in the U.S. healthcare system was made with the enactment of the Social Security Act? - CORRECT ANSWER-It funded payments through the federal government and the states. Why is the federally sponsored health insurance program known as Medicare important in the development of delivery of care in the U.S.? - CORRECT ANSWER-It provides persons over age 65 with benefits for inpatient hospital services. Medicaid is a state-managed and dually funded program. States have some flexibility on which Medicaid benefits to cover as long as the state meets basic federal requirements. What does this state-run program ensure? - CORRECT ANSWER-Services are not limited based on medical necessity Medicaid provides healthcare services to a specified population. Which statement accurately describes Medicaid regulations? - CORRECT ANSWER-It is available to individuals who meet income guidelines. The implementation of the Affordable Care Act seeks to provide health insurance to millions of uninsured Americans. How has this Act impacted healthcare delivery? - CORRECT ANSWER-Lifetime limits on coverage have been removed. The Patient Protection and Affordable Care Act will impact the healthcare delivery system in many ways. One change was allowing states to amend their Medicaid program. Which change did the Patient Protection and Affordable Care Act program support? - CORRECT ANSWER-Coverage A doctor is setting up a new practice and wants to receive federal reimbursement. The doctor contacts the Center for Medicare and Medicaid Services for assistance. Which kind of information is provided by this agency? - CORRECT ANSWERParameters of the diagnostic-related groups A 40-year-old individual without children and a limited income is concerned about the new Affordable Healthcare Act. The individual wants to know about eligibility for healthcare services at a reduced cost. Which agency should this individual contact? - CORRECT ANSWER-Department of Health and Human Services A doctor wants to help patients understand which products are safe. The doctor decides to use information provided by the FDA. Which two products are regulated by this organization? Choose 2 answers - CORRECT ANSWER-Vaccines ordered by doctors to be used in a study Medications that are in the developmental process A new movement known as the Mental Health Reform became popular throughout the country at the end of the 19th century. Which initiative did this reform accomplish for health care? - CORRECT ANSWER-It addressed the need to improve mental health treatment. The federal government amended the Social Security Act in 1965 to provide Medicare and Medicaid programs. For which population were these programs originally designed to provide benefits? - CORRECT ANSWER-Elderly and poor In 2010, President Obama signed into law the Patient Protection and Affordable Care Act. What was the initial intended impact of this Act? - CORRECT ANSWER-To ensure that uninsured individuals have access to health care Patients presenting to the emergency department (ED) broadly fall into one of three categories:• emergency conditions- requires immediate attention as is potentially harmful and/or life threatening• urgent conditions- requires attention within a few hours with longer delays potentially leading to greater harm to the patient• non-urgent conditions- do not require resources of the emergency department. Which graph accurately depicts the proportion of care delivered in an urban emergency department? - CORRECT ANSWER-38% EMERGENCY 48% URGENT 14% NONURGENT Match the service provided with the type of hospital that provides the service. Answer options may be used more than once or not at all. Select your answers from the pull-down list. - CORRECT ANSWER-Specifically provides cardiac services - SPECIALTY Specifically provides same day surgery services - AMBULATORY SURGERY CENTER Offers primarily same day and extended stay surgery- ACUTE SURGERY CENTER Treats inpatients with a specific type of disease or condition - SPECIALTY A primary care physician prescribes an antibiotic for a patient with a sinus infection. Which two elements categorize this situation as primary care?Choose 2 answers - CORRECT ANSWER-The care is provided by a generalist. The treatment is at the initial point of patient contact. An institution provides healthcare services to patients who are working to restore functional abilities along with assuming activities of daily living. Which type of care entity provides these services? - CORRECT ANSWERRehabilitation care A patient was in an accident and suffered multiple burns, broken bones, and extensive organ damage. Which type of care will this patient need? - CORRECT ANSWER-Tertiary A patient saw a general practitioner for eye pain. The doctor examined the patient's eyes but was unable to find the cause and referred the patient to an ophthalmologist. Which level of care will be pursued? - CORRECT ANSWER-Secondary Match each medical situation with the appropriate treatment facility. Answer options may be used more than once or not at all. Select your answers from the pull-down list. - CORRECT ANSWER-Comprehensive health care often for the uninsured - HEALTH CLINIC Healthcare treatment for acute and chronic illness in an office - OUTPATIENT Healthcare treatment by a nurse for acute and chronic illness at home - HOME HEALTH Walk-in clinic focused on the delivery of immediate non-life-threatening care services in lieu of a traditional ER - URGENT CARE A woman has had heavy menses for the past year. She visits the doctor who suggests a dilatation and curettage (D and C). What is a cost effective healthcare delivery option for this procedure? - CORRECT ANSWER-Specialty care clinic An employer changed insurance carriers. An employee's long-standing primary care physician is not a part of the new plan. Since this physician has been treating the employee for a chronic medical condition for the last 10 years, the employee is concerned about their healthcare costs. Which decision will provide cost-effective care for the patient? - CORRECT ANSWERContinuing to follow the previous physician's recommendations while seeking a new innetwork physician A patient has acquired a sexually transmitted disease. The patient makes minimum wage at a part-time job and does not have health insurance. How can this patient overcome these barriers? - CORRECT ANSWER-Visit a state health department A patient's physician suspects a mental disorder but is unsure how to properly treat the diagnosis. The mental health population still lacks research to properly care for this disorder. Which barrier is causing this to happen? - CORRECT ANSWER-Funding After being treated for breast cancer, a woman was denied a follow-up MRI scan by a Health Maintenance Organization (HMO). The patient contacted the insurance company and was again denied on internal appeal despite the current physician's letter in support of the claim. What should be this patient's next step? - CORRECT ANSWER-Seek legal advice A patient goes to the hospital emergency room to be seen for an increased heart rate. The patient was diagnosed with severe anxiety and was discharged. This visit is followed by an invoice to the patient's insurance company. The patient complained to the state health board. Who in the hospital should the patient have reached out to first? - CORRECT ANSWER-The patient advocate An employer organization is facing increasing demands to offer a new health insurance product. The CEO of the organization decides to introduce a PPO.