WGU D391 Questions Sections 1 - 3 | Questions and Answers - Latest 2025/2026.

D391 Pracice Questions Sections 1 - 3 Points: 56/64 Correct 2/2 Points The Beveridge model is entirely publicly funded through taxes, where the government owns and operates healthcare facilities. The Bismarck model uses private health insur‐ ance, but the government mandates coverage and regulates costs. National Health Insurance combines elements of both by funding healthcare through taxes while al‐ lowing private providers. The Out-of-Pocket model requires individuals to pay for all their healthcare costs without government involvement. The Beveridge model relies on individual premiums paid directly to private health insur‐ ers. The Bismarck model funds healthcare exclusively through employer-sponsored insur‐ ance plans. The National Health Insurance model is based on employer mandates for in‐ surance coverage, while the Out-of-Pocket model provides universal healthcare coverage through government taxes. The Beveridge model involves private insurance companies that function like public health insurance programs. The Bismarck model involves government-subsidized health insur‐ ance purchased by individuals. National Health Insurance is publicly funded with no pri‐ vate healthcare providers involved. The Out-of-Pocket model operates primarily through employer-sponsored insurance plans. The Beveridge model involves employer-sponsored insurance, while the Bismarck model is fully funded through government taxation. The National Health Insurance model combines individual savings accounts with state-run insurance programs. The Out-of-Pocket model involves the government fully funding healthcare services through tax revenue. Which of the following best describes how the Beveridge, Bismarck, National Health Insurance, and Out-of-Pocket models differ in terms of funding sources and the role of government in the healthcare system? 1. 1/19Correct 2/2 Points Under the FFS model, providers are paid based on the quality of care delivered, while un‐ der the VBC model, providers are paid based on the number of services they provide. The FFS model encourages providers to limit their services to reduce costs, whereas the VBC model promotes higher service utilization without penalty. The FFS model reimburses providers based on the quantity of services provided, which can lead to overutilization, while the VBC model reimburses providers based on the quality of care, with penalties for poor performance. The FFS model was abolished under the ACA, replaced by the VBC model, which focuses on paying providers based on the number of patients they see, not the quality of care provided. Which of the following is a key difference between the Fee-for-Service (FFS) model and the Value-Based Care (VBC) model, as outlined in the context of the Affordable Care Act (ACA)? 2. Incorrect 0/2 Points The Anti-Kickback Statute primarily targets individuals who provide financial incentives to patients for seeking medical treatments, regardless of the quality of care. The Anti-Kickback Statute only applies to pharmaceutical companies and medical device manufacturers, prohibiting them from giving incentives to doctors for prescribing specific drugs or devices. The Anti-Kickback Statute prohibits healthcare providers from offering or receiving kickbacks, bribes, or rebates in exchange for referrals of Medicare or Medicaid pa‐ tients or business, aiming to reduce fraud and conflicts of interest in the healthcare system. Which of the following best describes the purpose and scope of the Anti-Kickback Statute (AKS) in healthcare? 3. 2/19The Anti-Kickback Statute allows healthcare providers to offer financial incentives to pa‐ tients in exchange for their loyalty and continued use of a particular healthcare facility or provider. Correct 2/2 Points The Health Insurance Exchange only offers health insurance plans for those above the age of 65 and provides no coverage for younger individuals. The Health Insurance Exchange serves as a marketplace where individuals and small businesses can compare and purchase health insurance plans that meet ACA stan‐ dards, with potential subsidies based on income. The Health Insurance Exchange only facilitates the purchase of Medicaid plans and is not involved in providing private insurance options. The Health Insurance Exchange allows individuals to purchase insurance directly from pri‐ vate insurers, bypassing all federal and state regulations. Under the Affordable Care Act, which of the following best describes the purpose and function of the Health Insurance Exchange (Marketplace)? 4. Correct 2/2 Points A small business owner is selecting a health insurance plan for their employees. The owner wants to provide a plan that offers comprehensive coverage while keeping costs manageable for the business.Using the DECIDE model, the owner follows the steps: D: Define the problem: The owner needs to choose the best health insurance plan for employees. E: Establish the criteria: The plan should offer comprehensive coverage, affordable premiums, and be accepted by most local doctors. C: Consider the options: PPO, HMO, or EPO insurance plans. I: Identify the best option: PPO offers the most flexibility for employees and coverage for out-of-network services. D: Decide on the plan: The owner selects the PPO plan. E: Evaluate the decision: The owner surveys employees to assess satisfaction and monitors claims to ensure the plan is working effectively. 5. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 Consider other types of insurance plans like dental or vision coverage Establish the criteria for employee health needs Redefine the problem based on the company’s financial situation Which of the following would be the next logical step after the owner has decided on the PPO plan? Correct 2/2 Points An HMO requires members to get referrals from a primary care physician (PCP) to see specialists, while a PPO allows direct access to specialists without a referral. A PPO requires members to get referrals from a PCP to see specialists, while an HMO al‐ lows direct access to specialists without a referral. Both HMO and PPO plans require referrals from a PCP for specialist visits, but PPO plans have no in-network restrictions. Both HMO and PPO plans allow unlimited out-of-network provider access with no addi‐ tional costs to the member. Which of the following is the primary distinction between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO) plan in terms of provider access? 6. Correct 2/2 Points Doctors are solely responsible for diagnosing and treating medical conditions, while nurses focus only on administrative tasks, with no direct involvement in patient care. Which of the following best describes the roles of healthcare providers in the ecosystem, highlighting the collaborative nature of care delivery? 7. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 agnosing and treating conditions, and nurses ensuring continuous patient care, coor‐ dination, and support throughout treatment. Therapists and mental health providers work independently of doctors and nurses, focus‐ ing only on specialized treatments such as speech therapy or psychiatric care, without in‐ teracting with other healthcare professionals. Advanced practice providers, including nurse practitioners and physician assistants, per‐ form only administrative tasks like coordinating patient appointments and managing med‐ ical records, without being involved in direct care or medical treatment. Correct 2/2 Points Physician’s Assistants (PAs) are trained with a medical model focus and work under the supervision of a physician, while Nurse Practitioners (NPs) are trained with a nurs‐ ing model focus and typically operate independently in primary care settings. Nurse Practitioners (NPs) are trained to perform surgical procedures, while Physician’s Assistants (PAs) focus solely on diagnosing and treating patients in outpatient settings. Physician’s Assistants (PAs) are only licensed to work in hospital settings, while Nurse Practitioners (NPs) can only practice in clinics and outpatient settings. Nurse Practitioners (NPs) require a medical degree to diagnose and treat patients, while Physician’s Assistants (PAs) must complete a nursing program before practicing in their role. Which of the following statements best highlights the key difference between a Physician’s Assistant (PA) and a Nurse Practitioner (NP)? 8. Correct 2/2 Points Organization refers to the legal structure that controls healthcare funding, while delivery is only concerned with medical treatments provided at the point of care. Which of the following best describes the interrelationship between the three fundamental components of a healthcare system: organization, funding, and delivery? 9. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 ery of services, and delivery focuses solely on clinical care without consideration of organi‐ zational structure. The organization of the healthcare system establishes the framework within which re‐ sources are allocated and services are delivered, while funding ensures that the nec‐ essary financial resources are available for effective care delivery. Delivery is independent of both organization and funding, focusing only on the clinical in‐ teractions between patients and healthcare professionals. Correct 2/2 Points The False Claims Act primarily applies to private individuals who are directly involved in healthcare fraud but does not hold organizations or government contractors accountable for fraudulent billing. The False Claims Act allows whistleblowers, known as "relators," to file lawsuits on behalf of the government, and if successful, they may receive a portion of the recovered dam‐ ages, which can be up to 30% of the total amount. The False Claims Act only applies to cases involving deliberate intent to defraud, and does not cover cases where errors or mistakes in billing were made unintentionally. The False Claims Act has no provision for government intervention and requires whistle‐ blowers to pursue legal action independently, without any involvement from the Department of Justice. Which of the following statements about the False Claims Act (FCA) is most accurate? 10. Correct 2/2 Points Which of the following best describes the relationship between the five P's (patients, physicians, professional healthcare administrators, policymakers, and payers) in creating an effective healthcare ecosystem? 11. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 6/19Physicians and payers collaborate directly to set healthcare policies, while patients and policymakers work together to ensure that healthcare administrators comply with legal standards. Professional healthcare administrators primarily focus on managing healthcare re‐ sources, while physicians and patients have a collaborative role in decision-making, with policymakers and payers shaping the rules and financial structures around care delivery. Payers are responsible for delivering patient care directly, while policymakers oversee the day-to-day operations of healthcare administrators, leaving patients and physicians with no direct involvement in system-level decisions. Policymakers set healthcare regulations in isolation from physicians and patients, while professional healthcare administrators handle the business aspects of healthcare, and payers are solely concerned with billing and reimbursement processes. Correct 2/2 Points A payer is an individual who directly negotiates the cost of medical services with health‐ care providers on behalf of the patient, often in exchange for discounted rates for services rendered. A payer is an organization or entity, such as an insurance company or government program, that funds or reimburses the cost of medical care for the patient, often through premiums or government funding, as seen with Medicare. A payer is only a third-party insurance company that covers medical expenses in exchange for a lump-sum payment upfront by the patient, regardless of the care received. A payer is a private entity that invests in healthcare companies to generate profit, without directly engaging in the reimbursement of medical expenses or care coverage. Which of the following best describes the role of a payer in the U.S. healthcare system, as exemplified by the Chin family grandparent's transition to Medicare for coverage? 12. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 Health insurance guarantees the lowest possible premium costs, regardless of health his‐ tory or personal risk. Health insurance offers protection by covering the full cost of all medical treatments and services, eliminating the need for out-of-pocket expenses. Health insurance helps protect individuals from bearing the full expense of unexpect‐ ed medical treatments, offers wellness and prevention programs, and provides finan‐ cial assistance for chronic illness management. Health insurance eliminates the risk of mental health problems or chronic illness by offer‐ ing comprehensive wellness programs that fully prevent disease. Which of the following best explains why health insurance is crucial for individuals facing unexpected illness or injury? 13. Correct 2/2 Points HIPAA mandates the secure transmission and storage of patients' personal health in‐ formation and imposes penalties for violations, but it also allows for certain disclo‐ sures without patient consent for healthcare operations and law enforcement purposes. HIPAA mandates that all healthcare organizations must provide patients with immediate access to their medical records without any form of authorization. HIPAA establishes strict standards for the protection of patients' electronic health informa‐ tion and allows healthcare providers to share that information freely among all healthcare facilities. HIPAA eliminates the need for informed consent when sharing patients' medical data with insurers, as long as the sharing is for purposes of improving healthcare delivery. Which of the following is a key component of the Health Insurance Portability and Accountability Act (HIPAA) related to patient privacy? 14. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 ACOs and bundled payments are unrelated, as ACOs focus on increasing the volume of services provided, while bundled payments aim to reduce the total cost of care by reward‐ ing efficient care delivery. ACOs are designed to increase provider payments for high-cost procedures, while bundled payments are a method to incentivize providers to reduce services and care costs. ACOs emphasize coordination of care and managing populations' health outcomes across various providers, while bundled payments involve providing a single, fixed payment for a group of services related to a specific medical condition or episode of care. Both ACOs and bundled payments aim to increase hospital admissions by rewarding providers for performing more tests and procedures on patients. Which of the following statements correctly describes the relationship between Accountable Care Organizations (ACOs) and bundled payments in the context of healthcare reform? 15. Incorrect 0/2 Points HIPAA (Health Insurance Portability and Accountability Act) ERISA (Employee Retirement Income Security Act) The Affordable Care Act (ACA) The Consolidated Omnibus Budget Reconciliation Act (COBRA) Which of the following federal laws primarily regulates how employers handle health insurance benefits for their employees? 16. Incorrect 0/2 Points 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 eliminating the Medicare Part D "donut hole," and providing additional preventive ser‐ vices without cost-sharing. The ACA eliminated Medicare Advantage plans and replaced them with traditional fee-forservice Medicare, aiming to reduce administrative complexity. The ACA increased Medicare eligibility age to 67 and required all beneficiaries to purchase private insurance to supplement their coverage. The ACA primarily focused on expanding Medicaid, and did not include any significant pro‐ visions related to Medicare. Which of the following statements accurately describes the changes to Medicare introduced by the Affordable Care Act (ACA)? 17. Correct 2/2 Points Healthcare stakeholders encompass a diverse range of groups, including patients, providers, payers, policymakers, and administrators, all of whom play interconnected roles in determining the delivery, financing, and regulation of healthcare services. Healthcare stakeholders are limited to patients and healthcare providers, with their prima‐ ry focus being the clinical treatment of individuals, while other groups like payers and poli‐ cymakers only play a secondary role in the healthcare system. Healthcare stakeholders are solely responsible for influencing the economic structure of the healthcare system, with patient care being largely determined by the government and non-profit organizations. The role of healthcare stakeholders is restricted to managing financial resources, with the quality of care being primarily governed by clinical standards and medical research inde‐ pendently of these groups. Which of the following statements best characterizes the roles and influence of healthcare stakeholders in shaping the quality and accessibility of care? 18. Correct 2/2 Points 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 Review all available medications for the patient’s condition Establish the criteria for selecting a treatment plan Identify the best treatment plan based on patient preferences A patient diagnosed with type 2 diabetes is considering treatment options. The doctor presents multiple plans: lifestyle changes with medication, insulin therapy, or a combination of both. The patient is unsure which treatment would be the most effective for managing their condition.Using the DECIDE model, the healthcare team helps the patient make a decision. D: Define the problem: The patient needs to choose a treatment plan that will best control their diabetes. E: Establish the criteria: The treatment plan should help manage blood sugar levels, minimize side effects, and fit the patient's lifestyle. C: Consider the options: Lifestyle changes with medication, insulin therapy, and a combination. I: Identify the best option: A combination of lifestyle changes and medication. D: Decide on the plan: The patient chooses the combination approach. E: Evaluate the decision: Monitor blood sugar levels and assess the patient's response to the treatment plan. Which of the following would be the most important step in the DECIDE model after the patient selects a treatment option? 19. Correct 2/2 Points Subsidies are available to all individuals regardless of income or household size. Subsidies are only available for those purchasing employer-sponsored insurance through their employer. Subsidies are available for individuals whose household income is between 100% and 400% of the federal poverty level. Under the Affordable Care Act (ACA), which of the following best describes eligibility for a subsidy in the Health Insurance Marketplace? 20. 11/19Subsidies are available only to individuals under the age of 30, with no income requirements. Correct 2/2 Points The delivery system consists of three main components: the consumer, the staff pro‐ viding services, and a payment system. Acute care facilities, like hospitals, offer brief but severe care, while ambulatory care provides outpatient services for non-urgent treatments, and long-term care addresses chronic conditions that require continuous support. The healthcare delivery system focuses solely on acute care, where consumers are treated for minor health issues, and the staff is limited to administrative personnel managing pa‐ tient data and billing. Payment for services is typically deferred until after treatment is completed. In the healthcare delivery system, the consumer is primarily responsible for all aspects of care, including treatment decisions, while staff administer services only on an as-needed basis. Payment for services is optional, with the patient determining whether to pay for care based on their health condition. The healthcare delivery system is made up of consumers and staff who work together in a rigid structure, with little distinction between acute care, ambulatory care, and long-term care services. Payment for services is handled exclusively by government programs, leav‐ ing private insurance providers and consumers out of the process. Which of the following statements accurately describes the components of a healthcare delivery system and the different types of healthcare facilities? 21. Correct 2/2 Points HSAs are available only to individuals with low-income and provide tax-free premiums. HSAs require employees to use their savings for retirement only and do not cover medical expenses. Which of the following is a primary benefit of Health Savings Accounts (HSAs) in employer-sponsored insurance plans? 22. 12/19HSAs can only be used for dental and vision expenses, with no coverage for medical treatments. HSAs allow employees to contribute pre-tax dollars to save for future healthcare ex‐ penses and provide tax benefits on both contributions and withdrawals. Correct 2/2 Points FQHCs are privately owned health centers that only provide specialty care and are not eli‐ gible for government funding. FQHCs primarily focus on inpatient services and are required to charge patients for all services provided. FQHCs are limited to rural areas and are not allowed to operate in urban settings where health disparities are high. FQHCs provide comprehensive primary care services, including dental, mental health, and preventive services, and receive federal funding to serve underserved popula‐ tions, regardless of their ability to pay. Which of the following is a characteristic of Federally Qualified Health Centers (FQHCs)? 23. Incorrect 0/2 Points The HRRP aims to increase hospital readmission rates by providing financial incentives to hospitals for readmitting patients with chronic conditions. The HRRP reduces Medicare payments to hospitals with high readmission rates for specific conditions, encouraging hospitals to improve care coordination and reduce avoidable readmissions. The HRRP provides subsidies to hospitals to offset the costs of treating patients who are readmitted multiple times within 30 days of discharge. Which of the following is a goal of the Hospital Readmission Reduction Program (HRRP) under the Affordable Care Act? 24. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 of readmissions, with no penalty for extended stays. Correct 2/2 Points Health and human services workers, such as social workers and care coordinators, are mainly involved in diagnosing and treating medical conditions, with limited roles in organi‐ zational management or community health reform. The roles of health and human services workers are primarily confined to clinical settings, where they focus on providing direct care to patients, while administrators and public health educators focus solely on policy changes and legal reforms. Health and human services workers play diverse roles that include direct patient care, managing large healthcare organizations, reforming laws to improve community health, and educating the public on preventative health measures to enhance overall well-being. Health and human services workers are solely responsible for administering healthcare in‐ surance programs and managing patient data, with little involvement in direct patient care or public health advocacy. Which of the following best reflects the broad responsibilities of health and human services workers in the U.S. healthcare ecosystem, as described in the context of managing individual care, community health, and organizational change? 25. Correct 2/2 Points CMS administers the Medicare and Medicaid programs, including eligibility and bene‐ fits, while SSA handles the processing of Social Security benefits but does not manage Medicare or Medicaid programs. CMS is responsible for both administering Social Security benefits and the Medicare/Medicaid programs, while SSA solely focuses on healthcare services. What is the primary difference between the role of the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA)? 26. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 agement of Medicaid. CMS handles all aspects of Social Security disability claims, while SSA oversees the deliv‐ ery of healthcare services through Medicare and Medicaid. Correct 2/2 Points Nurse Practitioners (NPs) provide direct patient care only under the supervision of a physi‐ cian, while Registered Nurses (RNs) are independent in making clinical decisions. Nurse Practitioners (NPs) have advanced education and training that allows them to diagnose, treat, and prescribe medications, while Registered Nurses (RNs) provide pa‐ tient care and assist with medical procedures but do not diagnose or prescribe. Nurse Practitioners (NPs) focus solely on patient education and support, whereas Registered Nurses (RNs) perform advanced medical procedures and surgeries under the supervision of doctors. Nurse Practitioners (NPs) primarily manage administrative tasks in healthcare settings, while Registered Nurses (RNs) are responsible for direct clinical care and patient assessments. Which of the following statements best differentiates the role of a Nurse Practitioner (NP) from that of a Registered Nurse (RN)? 27. Correct 2/2 Points Primary care focuses primarily on specialized treatments for acute illnesses, whereas postacute care is limited to short-term rehabilitation and does not address chronic conditions. Post-acute care facilities focus solely on long-term care for elderly individuals, and prima‐ ry care is primarily concerned with hospital inpatient services and emergency medical care. Which of the following statements best describes the role of primary care and post-acute care in the healthcare ecosystem? 28. 15/19Primary care primarily deals with long-term care, such as nursing homes, while postacute care is exclusively concerned with emergency care and surgical interventions for im‐ mediate recovery. Primary care provides comprehensive, person-centered care, addressing both preven‐ tive and immediate health needs, and works in conjunction with post-acute care facili‐ ties to support recovery and independence after acute illness or surgery. Correct 2/2 Points Plan to implement the changes in all departments Do another round of testing before analyzing any data Act based on the findings to either refine the process or continue with the improvements Wait for feedback from patients before proceeding Question: A healthcare facility has been experiencing long wait times for patients in its emergency department (ED). The leadership team wants to address this issue using the Plan-Do-Study-Act (PDSA) cycle. Plan: The team identifies that patient flow could be improved by streamlining the triage process and reducing unnecessary testing in the first hour of a patient's arrival. Do: The team implements a new triage protocol where patients with minor conditions are quickly directed to an urgent care area for initial assessments. Study: After one month, the team collects data to compare the average wait times before and after the new protocol was implemented. Act: Based on the results, they decide whether to expand the changes to other departments or make additional adjustments. What is the next step in the PDSA cycle after completing the "Study" phase? 29. Correct 2/2 Points Which of the following best distinguishes "adverse selection" from "moral hazard" in the context of health insurance? 30. 2/17/26, 3:00 PM D391 Pracice Questions Sections 1 - 3 whereas moral hazard involves individuals being discouraged from seeking insurance due to high premiums. Adverse selection refers to insurance companies making excessive profits by denying cov‐ erage to high-risk individuals, while moral hazard is when insurance companies overesti‐ mate risk in their actuarial calculations. Adverse selection is only relevant to life insurance policies, while moral hazard only af‐ fects health insurance policies. Adverse selection occurs when individuals with higher health risks are more likely to purchase insurance, whereas moral hazard arises when insured individuals engage in riskier behavior because they do not bear the full cost of their actions. Correct 2/2 Points The healthcare ecosystem is primarily focused on reducing administrative costs and creat‐ ing legislation that benefits third-party payers, with minimal consideration for the quality of patient care. The healthcare ecosystem's main purpose is to increase the profit margins of healthcare organizations by streamlining healthcare delivery and limiting the role of government agencies in health-related legislation. The healthcare ecosystem is designed to focus primarily on the needs of healthcare providers, with the goal of optimizing their operational efficiencies, while patients and public health are secondary considerations. The goal of the healthcare ecosystem is to improve health outcomes by integrating diverse stakeholders—such as patients, healthcare providers, policymakers, and pay‐ ers—to enhance the quality of care, promote efficient resource use, and safeguard public health through legislative action and quality improvement efforts. Which of the following best explains the primary purpose and impact of the healthcare ecosystem, considering its various stakeholders and components? 31. 17/19Correct 2/2 Points The hospital focuses solely on improving efficiency and cost reduction. The hospital addresses multiple aspects of care, including safety, effectiveness, and patient-centeredness. The hospital only introduces technology for managing prescriptions. The hospital focuses on training only the medical staff and does not involve patients. Question: A hospital wants to improve its overall care delivery by focusing on the principles of safe, timely, effective, efficient, equitable, and patient-centered (STEEEP) care. The hospital has identified a concern with high medication errors in the intensive care unit (ICU), particularly related to the administration of highrisk medications. Safe: The hospital implements a double-check system to ensure medications are administered correctly. Timely: The team introduces a real-time alert system to notify healthcare providers about the need for medication administration. Effective: New protocols are developed to ensure that medications are aligned with best practice guidelines. Efficient: The hospital introduces a medication management software that streamlines prescription and administration records. Equitable: The hospital ensures that all patients, regardless of insurance or background, receive equal access to safe medication practices. Patient-Centered: The hospital involves patients in understanding their medications, encouraging them to ask questions and be part of the safety checks. Which of the following describes the hospital’s approach to improving quality using the STEEEP framework? 32. This content is created by the owner of the form. The data you submit will be sent to the form owner. Microsoft is not responsible for the privacy or security practices of its customers, including those of this form owner. Never give out your password.