C425 OA Review 2025 UPDATE Verified Questions And Answers |
C425 OA Review
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1. Which of the following is true in regards to health care There are more special-
today in the United States? ty physicians than primary
There are more primary care physicians than specialty 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 payment sys-
pital industry during the 1980s? tem
Hill-Burton Act
Managed care
Prospective payment system
Medicare and Medicaid
3. Designated Related Groups (DRG) -based reimburse- Reduce the length of stay
ment necessitated hospitals to do what? for hospitalized patients
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
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
, C425 OA Review
Study online at https://quizlet.com/_hhjcy1
Gatekeeping
Precertification
5. What is one aspect in which managed care differs from Responsibility for delivery
conventional insurance? of services
Collection of premiums
Assumption of risk
Responsibility for delivery of services
Payments to providers
6. What is the purpose of Skilled Nursing Facilities (SNF) It enables a facility to serve
certification? Medicare clients.
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 Medic-
aid clients.
7. What is the main goal of long-term care as it relates to Promote independence
a patient's function?
Restore function
Provide assistance
Promote independence
Adapt to change
8. The U.S. government plays a limited role in the health being the responsible par-
delivery system. The government's role in the arena of ty for health care deliv-
health care delivery consists of: ery through Medicare and
developing private hospital organizations. Medicaid programs.
regulating public and private programs at the local
levels.
being the responsible party for health care delivery
C425 OA Review
Guaranteed Success!!
Study online at https://quizlet.com/_hhjcy1
1. Which of the following is true in regards to health care There are more special-
today in the United States? ty physicians than primary
There are more primary care physicians than specialty 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 payment sys-
pital industry during the 1980s? tem
Hill-Burton Act
Managed care
Prospective payment system
Medicare and Medicaid
3. Designated Related Groups (DRG) -based reimburse- Reduce the length of stay
ment necessitated hospitals to do what? for hospitalized patients
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
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
, C425 OA Review
Study online at https://quizlet.com/_hhjcy1
Gatekeeping
Precertification
5. What is one aspect in which managed care differs from Responsibility for delivery
conventional insurance? of services
Collection of premiums
Assumption of risk
Responsibility for delivery of services
Payments to providers
6. What is the purpose of Skilled Nursing Facilities (SNF) It enables a facility to serve
certification? Medicare clients.
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 Medic-
aid clients.
7. What is the main goal of long-term care as it relates to Promote independence
a patient's function?
Restore function
Provide assistance
Promote independence
Adapt to change
8. The U.S. government plays a limited role in the health being the responsible par-
delivery system. The government's role in the arena of ty for health care deliv-
health care delivery consists of: ery through Medicare and
developing private hospital organizations. Medicaid programs.
regulating public and private programs at the local
levels.
being the responsible party for health care delivery
