Exam (elaborations)
WGU C425 OA REVIEW QUESTIONS AND ANSWERS 2024
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WGU C425 OA REVIEW QUESTIONS AND ANSWERS 2024
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WGU C425 OA REVIEWwhich 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 - ANSWERS-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 - ANSWERS-Responsibility for delivery of services
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. - ANSWERS-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 - ANSWERS-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 - ANSWERS-Reduce the
length of stay for hospitalized patients
In
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. - ANSWERS-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 - ANSWERS-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. - ANSWERS-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. - ANSWERS-social justice system.
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