WGU C425 Topic 1 Exam Questions and Answers with Verified
Solutions | Latest 2026 Update
Q: Define Health?
Answer:
a complete state of physical, mental, and social well-being, and not merely the
absence of disease or infirmity
Q: How have historical, cultural, and socioeconomic factors influenced the
current healthcare delivery system?
Answer:
increased the need for afforable univarsal cost efficient integrated healthcare
Q: Why should American healthcare professionals develop literacy in more
holistic modes of healthcare delivery?
Answer:
Because spiritual beliefs and practices positively influence physical, mental, and
social well-being and may affect the incidences, experiences, and outcomes of
many medical problems
Q: Identify types of insurance.
Answer:
Medicare, Medicaid, Workers compensation, Private
Q: Explain each type of insurance: Medicare, Medicaid/CHIP, Private
Answer:
"Medicare - provided publicly financed health insurance to all elderly individuals,
regardless of their incomes. Part A and Part B of Medicare Medicaid / CHIP -
covered the eligible poor and was based on the earlier Kerr-Mills Act program. It
would be financed through federal matching funds to the states in accordance with
each state's per capita income. Workers comp- covered the eligible poor and was
based on the earlier Kerr-Mills Act program. It would be financed through federal
matching funds to the states in accordance with each state's per capita income.
Private - not available to all
Q: Explain theory of risk pooling.
, Answer:
Sharing all risk amoung a group of insurance companies. companies reduce their
own risk because the high cost of the unhealthy is offset by the realitely low cost of
the healthier.
Q: Explain reimbursement methods.
Answer:
Fee for service - Each service is reimburse Bundled payments - a group of services
(dentist, xrays, frams) Capitation - monthly payment to physician cover visits
Prospective reimbursement (PPS) - uses certain pre established criteria to
determine in advance the amount of reimbursement.
Q: What are the 4 types of PPS? Explain what they are
Answer:
Diagnosis Related Groups - DRGs prospectively sets a bundled price according to
the principal diagnosis at the time of admission. The hospital receives the
Q: predetermined fixed rate for that particular DRG classification. Ambulatory
Payment Classifications (APCS)
Answer:
divides all outpatient services into more than 300 procedural groups, with specific
reimbursement rates being associated with each APC group. The rates are also
adjusted for geographic variations in wages. APC reimbursement includes services
such as anesthesia, certain drugs, supplies, and recovery room charges in a package
price established by Medicare. Resource Utilization Groups (RUGS) - categories
are used for determining an SNF's overall severity of health conditions requiring
medical and nursing intervention. The aggregate of clinical severity in a facility is
referred to as its case mix. It is determined by first evaluating each patient's
medical and nursing care needs. Based on this evaluation, each patient is classified
into one of 66 RUGs (according to RUG-IV classifications). Home Health
Resource Groups - home health care pays a fixed, predetermined rate for each
60-day episode of care, regardless of the specific services delivered. Thus all
services provided by a home health agency are bundled under one payment made
on a per-patient basis.
Solutions | Latest 2026 Update
Q: Define Health?
Answer:
a complete state of physical, mental, and social well-being, and not merely the
absence of disease or infirmity
Q: How have historical, cultural, and socioeconomic factors influenced the
current healthcare delivery system?
Answer:
increased the need for afforable univarsal cost efficient integrated healthcare
Q: Why should American healthcare professionals develop literacy in more
holistic modes of healthcare delivery?
Answer:
Because spiritual beliefs and practices positively influence physical, mental, and
social well-being and may affect the incidences, experiences, and outcomes of
many medical problems
Q: Identify types of insurance.
Answer:
Medicare, Medicaid, Workers compensation, Private
Q: Explain each type of insurance: Medicare, Medicaid/CHIP, Private
Answer:
"Medicare - provided publicly financed health insurance to all elderly individuals,
regardless of their incomes. Part A and Part B of Medicare Medicaid / CHIP -
covered the eligible poor and was based on the earlier Kerr-Mills Act program. It
would be financed through federal matching funds to the states in accordance with
each state's per capita income. Workers comp- covered the eligible poor and was
based on the earlier Kerr-Mills Act program. It would be financed through federal
matching funds to the states in accordance with each state's per capita income.
Private - not available to all
Q: Explain theory of risk pooling.
, Answer:
Sharing all risk amoung a group of insurance companies. companies reduce their
own risk because the high cost of the unhealthy is offset by the realitely low cost of
the healthier.
Q: Explain reimbursement methods.
Answer:
Fee for service - Each service is reimburse Bundled payments - a group of services
(dentist, xrays, frams) Capitation - monthly payment to physician cover visits
Prospective reimbursement (PPS) - uses certain pre established criteria to
determine in advance the amount of reimbursement.
Q: What are the 4 types of PPS? Explain what they are
Answer:
Diagnosis Related Groups - DRGs prospectively sets a bundled price according to
the principal diagnosis at the time of admission. The hospital receives the
Q: predetermined fixed rate for that particular DRG classification. Ambulatory
Payment Classifications (APCS)
Answer:
divides all outpatient services into more than 300 procedural groups, with specific
reimbursement rates being associated with each APC group. The rates are also
adjusted for geographic variations in wages. APC reimbursement includes services
such as anesthesia, certain drugs, supplies, and recovery room charges in a package
price established by Medicare. Resource Utilization Groups (RUGS) - categories
are used for determining an SNF's overall severity of health conditions requiring
medical and nursing intervention. The aggregate of clinical severity in a facility is
referred to as its case mix. It is determined by first evaluating each patient's
medical and nursing care needs. Based on this evaluation, each patient is classified
into one of 66 RUGs (according to RUG-IV classifications). Home Health
Resource Groups - home health care pays a fixed, predetermined rate for each
60-day episode of care, regardless of the specific services delivered. Thus all
services provided by a home health agency are bundled under one payment made
on a per-patient basis.
