10/8/24, 8:27 PM WGU C428 OA EXAM 2024-2025 ACTUAL EXAM COMPLETE QUESTIONS WITH DETAILED VERIFIED ANSWERS (100% …
WGU C428 OA EXAM 2024-2025 ACTUAL EXAM
COMPLETE QUESTIONS WITH DETAILED
VERIFIED ANSWERS (100% CORRECT
ANSWERS) /ALREADY GRADED A+
Terms in this set (129)
*Costs------>monitor costs
*Cash------>keep enough cash
The 4 C's (Finance
*Capital------ >raise needed capital(money) to
Activities)
invest
*Control----->control resources
Accountable Care Organizations(ACOs) are groups
of Medicare providers and suppliers that work
together to coordinate care for traditional Medicare
patients.
Their goal is to deliver seamless, high-quality care
Accountable Care instead of the fragmented care that often results
Organization from a fee-for-service payment system.
The following group of providers can form an ACO:
physicians or certain non-physician practitioners in
group practices, hospitals employing physicians,
certain critical access hospitals, federally qualified
health centers, and rural health clinics
Insurers usually refer to the patient for which
Beneficiary
services are paid as the beneficiary
Once the insurer has determined the claim is
Benefit payment appropriate, a payment is made to the provider. This
payment is officially termed a benefit payment
, 10/8/24, 8:27 PM WGU C428 OA EXAM 2024-2025 ACTUAL EXAM COMPLETE QUESTIONS WITH DETAILED VERIFIED ANSWERS (100% …
A bundled payment is a single prospective payment
by a health plan to all providers involved in a
Bundled payments
patients episode of care where the providers divide
the payment among themselves
The federal government, through the Centers for
Medicare and Medicaid Services or CMS, oversees
Centers for Medicare and all parts of the Medicare and Medicaid programs.
Medicaid Services (CMS) CMS can waive a state's requirement to participate
in traditional Medicaid if the state offers
beneficiaries plans with better benefits.
The Children's Health Insurance Program, signed
Children's Health into law in 1997, serves uninsured children up to age
Insurance Program(CHIP) 19 in families with incomes too high to qualify them
for Medicaid.
Claim a bill for healthcare services provided
a percentage of the insurance payment amount that
Coinsurance is paid by the patient, along with the amount paid
by the insurer.
flat amount that a patient pays at each time of
Copay
service
The services for which the insurer will pay are
Covered benefit
usually referred to as a covered benefit.
A predetermined amount that the patient pays
Deductible
before the insurer begins to pay for the service
The insurer may determine that the claim from the
Denial provider is not a covered benefit and will not pay
the claim
requires employers with 50 or more full-time
Employer Mandate equivalent employees(FTEs) to offer health
insurance coverage.
an acute care hospital, long-term care hospital,
inpatient rehab hospital, psychiatric facility, skilled
Facility provider nursing facility, assisted living facility, home health
agency, hospice agency, clinic, or ambulatory
surgery center.
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