WGU C428 Financial Resource
Management Exam Questions and
Answers Graded A+
Accountable Care Organization (ACO) - Correct answer-Groups of Medicare
providers and suppliers that work together to coordinate care for traditional
Medicare patients.
Accountable Care Organization Goal - Correct answer-To deliver seamless, high-
quality care instead of the fragmented care that often results from a fee-for-service
payment system.
Beneficiary - Correct answer-Insurers usually refer to the patient for which
services are paid
Benefit Payment - Correct answer-Once the insurer has determined the claim is
appropriate, a payment is made to the provider.
Bundled payments - Correct answer-A single prospective payment by a health plan
to all providers involved in a patients episode of care where the providers divide
the payment among themselves.
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, Centers for Medicare and Medicaid Services (CMS) - Correct answer-The federal
government oversees all parts of the Medicare and Medicaid programs through
this.
Children's Health Insurance Program (CHIP) - Correct answer-A joint federal-state
program that provides health-care insurance for uninsured children up to 19 whos
families do not qualify for Medicaid.
Claim - Correct answer-A bill for healthcare services provided.
Coinsurance - Correct answer-A percentage of the insurance payment amount that
is paid by the patient, along with the amount paid by the insurer.
Copay - Correct answer-A flat amount that a patient pays at each time of service.
Covered benefit - Correct answer-The services for which the insurer will pay are
usually referred to as a covered benefit.
Deductible - Correct answer-A pre-determined amount that the patient pays before
the insurer begins to pay for service.
Denial - Correct answer-The insurer may determine that the claim from the
provider is not a covered benefit and will not pay the claim.
Employer Mandate - Correct answer-Requires employers with 50 or more full time
employees to offer health insurance coverage.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
Management Exam Questions and
Answers Graded A+
Accountable Care Organization (ACO) - Correct answer-Groups of Medicare
providers and suppliers that work together to coordinate care for traditional
Medicare patients.
Accountable Care Organization Goal - Correct answer-To deliver seamless, high-
quality care instead of the fragmented care that often results from a fee-for-service
payment system.
Beneficiary - Correct answer-Insurers usually refer to the patient for which
services are paid
Benefit Payment - Correct answer-Once the insurer has determined the claim is
appropriate, a payment is made to the provider.
Bundled payments - Correct answer-A single prospective payment by a health plan
to all providers involved in a patients episode of care where the providers divide
the payment among themselves.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
, Centers for Medicare and Medicaid Services (CMS) - Correct answer-The federal
government oversees all parts of the Medicare and Medicaid programs through
this.
Children's Health Insurance Program (CHIP) - Correct answer-A joint federal-state
program that provides health-care insurance for uninsured children up to 19 whos
families do not qualify for Medicaid.
Claim - Correct answer-A bill for healthcare services provided.
Coinsurance - Correct answer-A percentage of the insurance payment amount that
is paid by the patient, along with the amount paid by the insurer.
Copay - Correct answer-A flat amount that a patient pays at each time of service.
Covered benefit - Correct answer-The services for which the insurer will pay are
usually referred to as a covered benefit.
Deductible - Correct answer-A pre-determined amount that the patient pays before
the insurer begins to pay for service.
Denial - Correct answer-The insurer may determine that the claim from the
provider is not a covered benefit and will not pay the claim.
Employer Mandate - Correct answer-Requires employers with 50 or more full time
employees to offer health insurance coverage.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
