WGU C425 OA Exam Questions and Answers Latest Updated 2023/2024 (Rated 100%)

WGU C425 OA Exam Questions and Answers Latest Updated 2023/2024 (Rated 100%). 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 - ANSWER-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 - ANSWER-Reduce the length of stay for hospitalized patients 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 - ANSWER-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 - ANSWER-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. - ANSWER-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 - ANSWER-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: developing private hospital organizations. regulating public and private programs at the local levels. being the responsible party for health care delivery through Medicare and Medicaid programs. aiding in competition among managed care organizations. - ANSWER-being the responsible party for health care delivery through Medicare and Medicaid programs. The ideology system that emphasizes the well-being of the community over an individual is called the: social justice system. market justice system. money market system. universal health care system. - ANSWER-social justice system. Which of the following are characteristics of the medical care determinants of health? Health care factors include access to technology but do not include access to alternative therapies. Mental health services are excluded from the WHO's primary health care framework. Whereas some services (preventive and primary care) contribute to general health status, others are more influential in end-of-life situations (hospice and long-term care). The medical system is highly coordinated so that throughout the phases of their lives patients are rarely faced with poor continuity of care. - ANSWER-Whereas some services (preventive and primary care) contribute to general health status, others are more influential in end-of-life situations (hospice and long-term care). Which of the following has been the primary factor that has shielded the U.S. health care system from a major overhaul? Beliefs and values Science and technology Social factors Economic forces - ANSWER-Beliefs and values What is the purpose of a stop-loss provision in a health insurance plan? It limits total out-of-pocket costs. It ensures that the provider will not suffer a loss. It protects the insurance underwriter. It excludes certain types of risks from coverage. - ANSWER-It limits total out-of-pocket costs. Which of the following describes access to care? It is distinguished from acceptability of services. It is rarely predicted by race or income. It is often predicted by income and occupation. Access for disadvantaged populations was absent from legislative history until the ACA. - ANSWER-It is often predicted by income and occupation. Accountable care organizations are: focused on reducing medical malpractice. designed to help increase cooperation between providers across various health care settings to improve Medicare patient outcomes. known for increasing health expenditures and sometimes reducing quality. designed to improve access to care for children and pregnant women. - ANSWERdesigned to help increase cooperation between providers across various health care settings to improve Medicare patient outcomes. How does health care policy-making operate in the United States? Incrementally Large changes at a time Exactly every 10 years Starts in the western states and moves east - ANSWER-Incrementally What two main concerns dominate the debate today over Medicare reform policy? Decrease spending; provide comprehensive coverage Provide comprehensive coverage; raise the age limit Decrease spending; cover children Increase spending; decrease nursing home coverage - ANSWER-Decrease spending; provide comprehensive coverage How was the Medicare PPS system designed to curb escalating health care costs? By providing a general fee schedule for services By providing children tax breaks By providing extensive coverage to the elderly By eliminating sales taxes on health care products - ANSWER-By providing a general fee schedule for services A job description for a physician would be to: determine the significance of a patient's health condition. only prescribe medications to patients. refer commonly occurring conditions to specialists. dispense medications. - ANSWER-determine the significance of a patient's health condition. A specialist must: work in a hospital. gain certification in an area of medical specialization. attend only medical school. serve as a gatekeeper to contain costs. - ANSWER-gain certification in an area of medical specialization. Studies have shown that NPP services can: improve access to primary care. be cost-prohibitive. provide mediocre services at a less expensive price. work independently of physicians. - ANSWER-improve access to primary care. Health service administrators:are responsible for the operational, clinical, and financial outcomes of the entire on the community as a whole rather than treating the ose and treat patient t physicians in patient care. - ANSWER-are responsible for the operational, clinical, and financial outcomes of the entire organization. Public health professionals: are responsible for the operational, clinical, and financial outcomes of the entire organization. focus on the community as a whole rather than treating the individual. diagnose and treat patient illnesses. assist physicians in patient care. - ANSWER-are responsible for the operational, clinical, and financial outcomes of the entire organization. Which of the following is one of the five core disciplines of public health? Biostatistics Dental hygiene Community health Drug development - ANSWER-Biostatistics Uninsured individuals typically tend to be: young adults (ages 25-40). urban dwellers. women. middle class. - ANSWER-young adults (ages 25-40). True or False? Manufacture of generic and other drugs by Asian countries for export helps the economies of both the manufacturing and importing countries. - ANSWERTrue True or False? In a single-payer national health care system, the government generally controls the location of physicians. - ANSWER-False True or False? Providers will likely receive larger and larger payments in future years. - ANSWER-True True or False? No international agency has the authority to enforce compliance with the International Health Regulations. Complete and Close Engage - ANSWER-True Which important change in the U.S. healthcare system was made with the enactment of the Social Security Act? It ensured patients have health care and funding. It granted veterans access to healthcare services. It allowed states to decide if they want to pay for Medicare. It funded payments through the federal government and the states. - ANSWER-It funded payments through the federal government and the states. 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? Children and the elderly receive health care Services are not limited based on medical necessity