WGU C425 OA Exam 2025 Questions and
Answers
Which of the following is true in regards to health care today in the United States?
There are more primary care physicians than specialty physicians.
Primary care receives a higher reimbursement in professional fees.
There are more specialty physicians than primary physicians.
Outpatient care is slowly decreasing. - ANS There are more specialty physicians than primary
physicians.
What triggered the downsizing phase in the U.S. hospital industry during the 1980s?
Hill-Burton Act
Managed care
Prospective payment system
Medicare and Medicaid - ANS Prospective payment system
Designated Related Groups (DRG) -based reimbursement necessitated hospitals to do what?
Admit new patients at a faster rate than before
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 - ANS Reduce the length of stay
for hospitalized patients
Pg. 1 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
, In which type of utilization management is a primary care physician's opinion necessary in
referring or not referring a patient to a specialist?
Concurrent
Retrospective
Gatekeeping
Precertification - ANS Gatekeeping
What is one aspect in which managed care differs from conventional insurance?
Collection of premiums
Assumption of risk
Responsibility for delivery of services
Payments to providers - ANS Responsibility for delivery of services
What is the purpose of Skilled Nursing Facilities (SNF) certification?
It enables a facility to be operated as a skilled nursing 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 Medicaid clients. - ANS It enables a facility to
serve Medicare clients.
What is the main goal of long-term care as it relates to a patient's function?
Restore function
Provide assistance
Promote independence
Adapt to change - ANS Promote independence
The U.S. government plays a limited role in the health delivery system. The government's role
in the arena of health care delivery consists of:
Pg. 2 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
Answers
Which of the following is true in regards to health care today in the United States?
There are more primary care physicians than specialty physicians.
Primary care receives a higher reimbursement in professional fees.
There are more specialty physicians than primary physicians.
Outpatient care is slowly decreasing. - ANS There are more specialty physicians than primary
physicians.
What triggered the downsizing phase in the U.S. hospital industry during the 1980s?
Hill-Burton Act
Managed care
Prospective payment system
Medicare and Medicaid - ANS Prospective payment system
Designated Related Groups (DRG) -based reimbursement necessitated hospitals to do what?
Admit new patients at a faster rate than before
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 - ANS Reduce the length of stay
for hospitalized patients
Pg. 1 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
, In which type of utilization management is a primary care physician's opinion necessary in
referring or not referring a patient to a specialist?
Concurrent
Retrospective
Gatekeeping
Precertification - ANS Gatekeeping
What is one aspect in which managed care differs from conventional insurance?
Collection of premiums
Assumption of risk
Responsibility for delivery of services
Payments to providers - ANS Responsibility for delivery of services
What is the purpose of Skilled Nursing Facilities (SNF) certification?
It enables a facility to be operated as a skilled nursing 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 Medicaid clients. - ANS It enables a facility to
serve Medicare clients.
What is the main goal of long-term care as it relates to a patient's function?
Restore function
Provide assistance
Promote independence
Adapt to change - ANS Promote independence
The U.S. government plays a limited role in the health delivery system. The government's role
in the arena of health care delivery consists of:
Pg. 2 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
