WGU C425 HEALTHCARE DELIVERY REGULATION
AND CPMPLIANCE OA EXAM PREP COMPLETE
ACTUAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS (MOST TEST QUESTIONS) A
NEW UPDATED VERSION 2024|GUARANTEED PASS
A+
What do Regulatory Organizations do? - ANSWERPromote public health by
-monitoring healthcare-related organizations
-imposing sanctions for non-compliance
Ultimate Goal of Healthcare Regulations - ANSWERPatient Safety
Regulation - ANSWERRules, laws, directives, mandates, etc that encourage compliance.
Non-compliance can result in large range of consequences based on severity of violation
-penalties, fines
-civil or criminal penalties
Compliance Monitoring - ANSWERUltimately the healthcare manager's responsibility
-create culture of compliance
-guarantee all employees' understanding of regulations and the consequences of non-
compliance
Role(s) of Consumer Protection - ANSWER-build consumer confidence
-when they feel safe, they are more inclined to seek healthcare
-help foster strong provider-patient relationships
-reminder to providers that all patients have a right to respectful and personalized care
-holds providers accountable for their patients
HIPPA - ANSWERHealth Insurance Portability and Accountability Act
-protect patient info
-knowledge of and compliance with HIPPA is essential for healthcare managers
,Patient Protection - ANSWERStarts with legal guidelines
-est by The Office for Civil Rights and ERISA
-law is only first step in ensuring patient-centered care
-there are multiple factors that contribute to health and well-being
Purpose of Competition in Healthcare - ANSWER-Encourage healthcare orgs to deliver
higher quality care
-Encourages minimizing costs for patients
-Gov has est key Anti-trust Regulations to prevent anti-competitive action
Healthcare pre-1965 - ANSWER-only payment source was private insurance
-excluded elderly, unemployed, and poor
2 Most Transformative Events in US Healthcare - ANSWER1965- Creation of Medicare
and Medicaid
2010 - Affordable Care Act
Demand-Side Rationing - ANSWERIndirect Rationing
- Occurs when NOT everyone has health insurance
- Patient's ability to pay is what rations the health care
- Consumers are the demand side
Supply-Side Rationing - ANSWERRestricting the availability of expensive medical
technology and specialty care
-from organization side, not consumer side
Continual Legislative Changes - ANSWER-legislation that offers more expansive
healthcare coverage to wider range of Americans
-indicates conceptual shift - Healthcare is starting to be seen as a National Responsibility
Purpose of Anti-Trust Regulations and Anti-Kickback laws - ANSWERprotect consumers
by
- promoting economic competition among healthcare services
-encourage highest quality care at lowest possible price
The False Claims Act - ANSWER-criminalizes submitting false claims to Medicare or
Medicaid for payment
-applies even if there was no intent to defraud
Stark Law - ANSWER-Prohibits physicians from referring Medicaid and Medicare patients
to designated health services
--IF the physician or a relative has a financial stake in the service
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:
a) developing private hospital organizations.
b) regulating public and private programs at the local levels.
c) being the responsible party for health care delivery through Medicare and Medicaid
programs.
, d) aiding in competition among managed care organizations. - ANSWERC) 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:
a) social justice system.
b) market justice system.
c) money market system.
d) universal health care system. - ANSWERa) social justice system
Which of the following are characteristics of the medical care determinants of health?
a) Health care factors include access to technology but do not include access to
alternative therapies.
b) Mental health services are excluded from the WHO's primary health care framework.
c) 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).
d) The medical system is highly coordinated so that throughout the phases of their lives
patients are rarely faced with poor continuity of care. - ANSWERc) 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?
a) Beliefs and values
b) Science and technology
c) Social factors
d) Economic forces - ANSWERa) Beliefs and values
What is the purpose of a stop-loss provision in a health insurance plan?
a) It limits total out-of-pocket costs.
b) It ensures that the provider will not suffer a loss.
c) It protects the insurance underwriter.
d) It excludes certain types of risks from coverage - ANSWERa) It limits total out-of-
pocket costs.
Which of the following describes access to care?
a) It is distinguished from acceptability of services.
b) It is rarely predicted by race or income.
c) It is often predicted by income and occupation.
d) Access for disadvantaged populations was absent from legislative history until the
ACA. - ANSWERc) It is often predicted by income and occupation.
Accountable care organizations are:
a) focused on reducing medical malpractice.
b) designed to help increase cooperation between providers across various health care
settings to improve Medicare patient outcomes.
c) known for increasing health expenditures and sometimes reducing quality.
d) designed to improve access to care for children and pregnant women. - ANSWERb)
designed to help increase cooperation between providers across various health care
settings to improve Medicare patient outcomes.
AND CPMPLIANCE OA EXAM PREP COMPLETE
ACTUAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS (MOST TEST QUESTIONS) A
NEW UPDATED VERSION 2024|GUARANTEED PASS
A+
What do Regulatory Organizations do? - ANSWERPromote public health by
-monitoring healthcare-related organizations
-imposing sanctions for non-compliance
Ultimate Goal of Healthcare Regulations - ANSWERPatient Safety
Regulation - ANSWERRules, laws, directives, mandates, etc that encourage compliance.
Non-compliance can result in large range of consequences based on severity of violation
-penalties, fines
-civil or criminal penalties
Compliance Monitoring - ANSWERUltimately the healthcare manager's responsibility
-create culture of compliance
-guarantee all employees' understanding of regulations and the consequences of non-
compliance
Role(s) of Consumer Protection - ANSWER-build consumer confidence
-when they feel safe, they are more inclined to seek healthcare
-help foster strong provider-patient relationships
-reminder to providers that all patients have a right to respectful and personalized care
-holds providers accountable for their patients
HIPPA - ANSWERHealth Insurance Portability and Accountability Act
-protect patient info
-knowledge of and compliance with HIPPA is essential for healthcare managers
,Patient Protection - ANSWERStarts with legal guidelines
-est by The Office for Civil Rights and ERISA
-law is only first step in ensuring patient-centered care
-there are multiple factors that contribute to health and well-being
Purpose of Competition in Healthcare - ANSWER-Encourage healthcare orgs to deliver
higher quality care
-Encourages minimizing costs for patients
-Gov has est key Anti-trust Regulations to prevent anti-competitive action
Healthcare pre-1965 - ANSWER-only payment source was private insurance
-excluded elderly, unemployed, and poor
2 Most Transformative Events in US Healthcare - ANSWER1965- Creation of Medicare
and Medicaid
2010 - Affordable Care Act
Demand-Side Rationing - ANSWERIndirect Rationing
- Occurs when NOT everyone has health insurance
- Patient's ability to pay is what rations the health care
- Consumers are the demand side
Supply-Side Rationing - ANSWERRestricting the availability of expensive medical
technology and specialty care
-from organization side, not consumer side
Continual Legislative Changes - ANSWER-legislation that offers more expansive
healthcare coverage to wider range of Americans
-indicates conceptual shift - Healthcare is starting to be seen as a National Responsibility
Purpose of Anti-Trust Regulations and Anti-Kickback laws - ANSWERprotect consumers
by
- promoting economic competition among healthcare services
-encourage highest quality care at lowest possible price
The False Claims Act - ANSWER-criminalizes submitting false claims to Medicare or
Medicaid for payment
-applies even if there was no intent to defraud
Stark Law - ANSWER-Prohibits physicians from referring Medicaid and Medicare patients
to designated health services
--IF the physician or a relative has a financial stake in the service
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:
a) developing private hospital organizations.
b) regulating public and private programs at the local levels.
c) being the responsible party for health care delivery through Medicare and Medicaid
programs.
, d) aiding in competition among managed care organizations. - ANSWERC) 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:
a) social justice system.
b) market justice system.
c) money market system.
d) universal health care system. - ANSWERa) social justice system
Which of the following are characteristics of the medical care determinants of health?
a) Health care factors include access to technology but do not include access to
alternative therapies.
b) Mental health services are excluded from the WHO's primary health care framework.
c) 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).
d) The medical system is highly coordinated so that throughout the phases of their lives
patients are rarely faced with poor continuity of care. - ANSWERc) 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?
a) Beliefs and values
b) Science and technology
c) Social factors
d) Economic forces - ANSWERa) Beliefs and values
What is the purpose of a stop-loss provision in a health insurance plan?
a) It limits total out-of-pocket costs.
b) It ensures that the provider will not suffer a loss.
c) It protects the insurance underwriter.
d) It excludes certain types of risks from coverage - ANSWERa) It limits total out-of-
pocket costs.
Which of the following describes access to care?
a) It is distinguished from acceptability of services.
b) It is rarely predicted by race or income.
c) It is often predicted by income and occupation.
d) Access for disadvantaged populations was absent from legislative history until the
ACA. - ANSWERc) It is often predicted by income and occupation.
Accountable care organizations are:
a) focused on reducing medical malpractice.
b) designed to help increase cooperation between providers across various health care
settings to improve Medicare patient outcomes.
c) known for increasing health expenditures and sometimes reducing quality.
d) designed to improve access to care for children and pregnant women. - ANSWERb)
designed to help increase cooperation between providers across various health care
settings to improve Medicare patient outcomes.
