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WGU C425 Healthcare Delivery Systems, Regulation,
and Compliance-Exam Questions and Answers
A new movement known as the Mental Health Reform
... [Show More] became popular throughout
the country at the end of the 19th century. Which initiative did this reform
accomplish for health care?
A. It provided health insurance for mental health
B. It recognized that obesity was a mental disorder
C. It stated that mental health treatment was primary care
D. It addressed the need to improve mental health treatment. - ANSWER-D
The federal government amended the Social Security Act in 1965 to provide
Medicare and Medicaid programs. For which population were these programs
originally designed to provide benefits?
A. Elderly and poor
B. infants and elderly
C. infants and mothers
D. Military and dependants - ANSWER-A
In 2010, President Obama signed into law the Patient Protection and Affordable
Care Act. What was the initial intended impact of this Act?
A. To endure that elderly will have access to health care
B. To ensure that caregivers will have access to health care
C. To endure that uninsured individuals have access to health care
D. To endure that military personnel will have access to health care - ANSWER-C
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Which important change in the US healthcare system was made with the enactment
of the Social Security Act?
A. It ensured patients have health care and funding
B. It granted veterans access to healthcare services
C. It allowed states to decide if they want to pay for Medicare
D. It funded payments through the federal government and the states - ANSWER-
D
Why is the federally sponsored health insurance program known as Medicare
important in the development of delivery of care in the U.S.?
A. It provides low-income citizens with benefits for prescriptions.
B. It provides persons under age 65 with access to healthcare services.
C. It provides underprivileged populations with coverage for medical services.
D. It provides persons over age 65 with benefits for inpatient hospital services. -
ANSWER-D
Medicaid is a state-managed and dually funded program. States have some
flexibility on which Medicaid benefits to cover as long as the state meets basic
federal requirements. What does this state-run program ensure?
A. Children and the elderly receive health care
B. Services are not limited based on medical necessity
C. Basic healthcare coverage is available to U.S. citizens over the age of 65
D. People's constitutional right to privacy is not violated in running this program -
ANSWER-B
Medicaid provides healthcare services to a specified population. Which statement
accurately describes Medicaid regulations?
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A. It can be interrupted without notification.
B. It is limited to visits for primary physicians.
C. It is available to individuals who meet income guidelines.
D. It requires that states provide prescription drug coverage. - ANSWER-C
The implementation of the Affordable Care Act seeks to provide health insurance
to millions of uninsured Americans. How has this Act impacted healthcare
delivery?
A. Medicaid has been expanded in each state.
B. Universal health insurance is now available.
C. Lifetime limits on coverage have been removed.
D. Employers are required to offer insurance to employees. - ANSWER-C
The Patient Protection and Affordable Care Act will impact the healthcare delivery
system in many ways. One change was allowing states to amend their Medicaid
program. Which change did the Patient Protection and Affordable Care Act
program support?
A. Quality
B. Coverage
C. Provider options
D. Reimbursement - ANSWER-B
A doctor is setting up a new practice and wants to receive federal reimbursement.
The doctor contacts the Center for Medicare and Medicaid Services for assistance.
Which kind of information is provided by this agency?
A. Guidelines for private insurance
B. Handouts for patient-related diagnosis
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C. Recommendations for patient confidentiality
D. Parameters of the diagnostic-related groups - ANSWER-D
A 40-year-old individual without children and a limited income is concerned about
the new Affordable Healthcare Act. The individual wants to know about eligibility
for healthcare services at a reduced cost. Which agency should this individual
contact?
A. American Medical Association
B. American Hospital Association
C. Department of the Inspector General
D. Department of Health and Human Services - ANSWER-D
A doctor wants to help patients understand which products are safe. The doctor
decides to use information provided by the FDA. Which two products are regulated
by this organization? (Choose 2)
A. Produce labeled as organic
B. Meat processed for human consumption
C. Vaccines ordered by doctors to be used in a study
D. Medications that are in the developmental process - ANSWER-C & D
Patients presenting to the emergency department (ED) broadly fall into one of
three categories:
A. emergency conditions- requires immediate attention as is potentially harmful
and/or life threatening
B. urgent conditions- requires attention within a few hours with longer delays
potentially leading to greater harm to the patient
C. non-urgent conditions- do not require resources of the emergency department
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D. all of the above - ANSWER-D
A primary care physician prescribes an antibiotic for a patient with a sinus
infection. Which two elements categorize this situation as primary care? (Choose 2
answers)
A. The care is provided by a generalist.
B. The care is provided by a holistic doctor.
C. The treatment is provided by a specialist.
D. The treatment is at the initial point of patient contact. - ANSWER-C & D
An institution provides healthcare services to patients who are working to restore
functional abilities along with assuming activities of daily living. Which type of
care entity provides these services?
A. Acute care
B. Critical care
C. Home health care
D. Rehabilitation care - ANSWER-D
An employer changed insurance carriers. An employee's long-standing primary
care physician is not a part of the new plan. Since this physician has been treating
the employee for a chronic medical condition for the last 10 years, the employee is
concerned about their healthcare costs. Which decision will provide cost-effective
care for the patient?
A. Going to an urgent care for any needed treatment of the chronic disease
B. Using the out-of-network benefit while staying with the established physician
C. Continuing to follow the previous
physician's recommendations while seeking a new in-network physician
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D. Managing the condition independently with occasional consultation from a prior
primary care physician - ANSWER-C
A patient has acquired a sexually transmitted disease. The patient makes minimum
wage at a part-time job and does not have health insurance. How can this patient
overcome these barriers?
A. Research online for a doctor
B. Use telemedicine to diagnose
C. Visit a state health department
D. Obtain medication from a pharmacy - ANSWER-C
A patient's physician suspects a mental disorder but is unsure how to properly treat
the diagnosis. The mental health population still lacks research to properly care for
this disorder. Which barrier is causing this to happen?
A. Funding
B. Licensing
C. Insurance
D. Ignorance - ANSWER-A
A patient was in an accident and suffered multiple burns, broken bones, and
extensive organ damage. Which type of care will this patient need?
A. Primary
B. Secondary
C. Tertiary
D. Quaternary - ANSWER-D
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A patient saw a general practitioner for eye pain. The doctor examined the patient's
eyes but was unable to find the cause and referred the patient to an
ophthalmologist. Which level of care will be pursued?
A. Primary
B. Secondary
C. Tertiary
D. Quaternary - ANSWER-B
A woman has had heavy menses for the past year. She visits the doctor who
suggests a dilatation and curettage (D and C). What is a cost-effective healthcare
delivery option for this procedure?
A. Urgent care clinic
B. Specialty care clinic
C. Tertiary care hospital
D. Transitional care hospital - ANSWER-B
An elderly patient in poor financial straits was referred to a professional that will
provide assistance with purchasing medication. Which professional received this
referral?
A. Pharmacist
B. Social worker
C. Psychologists
D. Nursing assistant - ANSWER-B
A patient is experiencing lower back pain. The patient is vomiting and can barely
speak. The emergency department determines that the patient is probably
experiencing kidney stones. Which professional will confirm this diagnosis?
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A. Radiologist
B. X-ray technician
C. Ultrasound technician
D. Pain management specialist - ANSWER-A
A 66-year-old individual gets short of breath while walking his dog. The individual
calls the doctor. The doctor knows the individual is a smoker and has asthma. How
should the doctor respond to this situation?
A. Schedule an immediate visit to the office
B. Schedule an immediate visit to a cardiologist
C. Set up a meeting to discuss smoking cessation
D. Set up an appointment with exercise physiologist - ANSWER-A
After being treated for breast cancer, a woman was denied a follow-up MRI scan
by a Health Maintenance Organization (HMO). The patient contacted the insurance
company and was again denied on internal appeal despite the current physician's
letter in support of the claim. What should be this patient's next step?
A. Seek legal advice
B. File a second appeal
C. Lobby a special interest group for assistance
D. Contact the American Cancer Society for help - ANSWER-A
A patient goes to the hospital emergency room to be seen for an increased heart
rate. The patient was diagnosed with severe anxiety and was discharged. This visit
is followed by an invoice to the patient's insurance company. The patient
complained to the state health board. Who in the hospital should the patient have
reached out to first?
A. The patient advocate
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B. The head of cardiology
C. The hospital supervisor
D. The head of the HR department - ANSWER-A
An employer organization is facing increasing demands to offer a new health
insurance product. The CEO of the organization decides to introduce a PPO.
Which professional organization will the CEO consult?
A. National Institute of Health
B. American Medical Association
C. National Committee for Quality Assurance
D. American College of Healthcare Executives - ANSWER-C
A dental department ordered new hand pieces. The Occupational Safety and Health
Administration and the Centers for Disease Control mandate processing by the
Sterile Processing Department to reduce exposure to patients. Which area of
concern is identified by this type of mandate?
A. Infection control
B. Ergonomic equipment
C. Medical waste disposal
D. Exposure incident response - ANSWER-A
Congress passed a bill establishing the Veterans Choice Act, which allows veterans
living 40 miles from a Veterans Administration (VA) facility, who cannot be seen
within 30 days of the clinically appropriate date, to be sent to non-VA facilities.
How does this interaction influence the Veterans Administration?
A. It enables the VA patients to be seen faster.
B. It increases the quality of care at the VA.
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C. It increases the number of patients seen by VA.
D. It enables the VA facility to decrease clinical staff. - ANSWER-A
An unemployed single pregnant woman visits a doctor's office. Until that time, she
has not sought medical care, and her gestation time is 30 weeks. Which next step
will help remove a barrier to this patient's care and ensure a positive prognosis?
A. Refer to a midwife
B. Set up prenatal visits
C. Update immunizations
D. Screen for genetic defects - ANSWER-B
A patient presents to a medical practice with limited English proficiency. Which
strategy will overcome this patient's barrier to care?
A. Use specific medical jargon
B. Use exaggerated gesture when speaking
C. Invite a bilingual staff member to translate
D. Give the patient extensive medical literature - ANSWER-C
A Hispanic teenager from a low-income family presents to a medical office. The
patient resides in a small city and is 15 weeks pregnant. What is the primary barrier
to prenatal care for this patient?
A. Age
B. Cost of care
C. Ethnic background
D. Geographical location - ANSWER-B
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A patient is diagnosed with a medical condition that has not been treated by
doctors in that rural area. Which solution will provide care for this patient?
A. Involve family members in the care
B. Coordinate telemedicine with a specialist
C. Organize transportation to a local hospital
D. Provide extensive literature on the disease - ANSWER-B
An elderly individual lives alone and has missed several doctor appointments. The
individual has attempted to solve the problem by buying a new calendar, but the
solution has not worked. What is a practical option to ensure timely visits and
proper care?
A. Call the patient the day before the appointment
B. Provide medication refills for a longer period
C. Ensure that insurance information is updated
D. Have a community van transport the individual - ANSWER-A
An 80-year-old patient lives alone and does not drive due to a fractured ankle. The
patient has been advised that the healing process for a fractured ankle will take
approximately six weeks. Family members have come together to discuss medical
options. Which option should the family consider for this patient?
A. Hospice care
B. Nursing home
C. Home health care
D. Skilled nursing facility - ANSWER-C
Rural residents may experience higher morbidity and mortality rates compared to
residents of urban centers. Which factor contributes to healthcare barriers in this
population?
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A. Inability to pay for insurance coverage
B. Limited number of primary care physicians
C. Preference for traditional and home-based cures
D. Desire to only visit primary care physicians and nurses - ANSWER-B
A medical facility is facing some serious financial pressures. Upon closer review
of medical billing records, some discrepancies have come to light such as
upcoding. Which barrier is reducing the ability to control healthcare costs at this
facility?
A. Fraud
B. Price fixing
C. Conflict of interest
D. Compliance mapping - ANSWER-A
A medical group CEO is concerned because the agency is experiencing losses. The
CEO hired a financial consultant to review the agency and identified areas for
potential cost savings. The main issue was that patients were required to travel to a
different healthcare facility in order to have certain medical tests done. Which
system inefficiency did the consultant find?
A. Agency's lack of space
B. Agency's staffing issues
C. Access to comprehensive care
D. Access to transportation services - ANSWER-C
An individual left his job, resulting in the loss of medical insurance. As a result, a
dependent went nine months without a physician-recommended medical test. In
which two ways does this act as a barrier to health care? (Choose 2 answers)
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A. It limits access.
B. It increases costs.
C. It decreases patient safety.
D. It increases chances of infection. - ANSWER-A & B
A medical facility is dealing with low staff-to-patient ratios. In response, the
manager consistently requests that nurses stop the care being given to one patient
to take care of another patient. How can the facility make sure all patients receive
quality care?
A. Stop caring for the first patient
B. Tell the administrator that it will take some time
C. Bring both patients in the same area to offer care
D. Develop a team-based approach to care delivery - ANSWER-D
A physician gives a nurse an order over the telephone regarding how to treat a
patient with cardiovascular disease. As the nurse is taking down the detailed order,
a physician interrupts and requests a diet order for another patient. What action
should the nurse take to maintain quality of care?
A. Address the needs of the first physician
B. Have the medical receptionist take the diet order
C. Develop a protocol for placing physicians on hold
D. Use the electronic health record system to prioritize patients - ANSWER-A
Over the last decade, there has been discussion regarding the U.S. healthcare
system needing payment reform. The healthcare system currently experiences a
lack of resources and complex payment systems. Which two inefficiencies act as
barriers to this type of reform? (Choose 2 answers)
A. Reduction of entry errors
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B. Over payment to providers
C. Lack of alignment among payors
D. Continued use of fee-for-service payment - ANSWER-C & D
One of the tenets of the Affordable Care Act is to provide increased preventive
care to patients. This increased focus on prevention will impact the supply of
needed healthcare providers. Which health professionals will be directly impacted
by this focus?
A. Critical care nurses
B. Specialist physicians
C. Primary care physicians
D. Hospital physician assistants - ANSWER-C
There is a predicted shortage of primary care providers in the U.S. healthcare
system over the next few decades. What are two ways this reduction will impact
healthcare? (Choose 2 answers)
A. Decrease cost of care
B. Increase patient wait time
C. Decrease patient access to care
D. Increase patient demand for care - ANSWER-B & C
A hospital is in a very competitive market and must adjust in order to increase
market share. The hospital decides to emphasize evidence-based care. How will
this change the future of healthcare delivery at this location?
A. Readmission rates will decline for critical care patients who are discharged to
home.
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B. Enrollment in medical research facilities will increase survival rates for critical
care patients.
C. Physicians will rely on continuing education training to provide the best quality
care for patients.
D. Data from patient satisfaction surveys can be analyzed using technology in
order to improve quality of care. - ANSWER-D
A newly hired nurse has been asked to fully read the policies of the hospital and
the unit before the first day of work. What is the impact of this information on this
new employee's healthcare delivery?
A. Licensing renewal
B. Regulatory renewal
C. Licensure compliance
D. Regulatory compliance - ANSWER-B
As individuals age, the ability to remain independent in a home may change. As a
result, alternate levels of care may need to be sought. Which economic factor will
influence future healthcare delivery for aging individuals?
A. The supply of medicines for chronic illnesses will decrease.
B. Bed availability may decrease and have a major effect on patient admittance.
C. The needs of a growing population will soon outpace the production of
medicines.
D. Costs of generic medicines will continue to decrease, and those with
prescription coverage will often receive their medicine with a minimum copay. -
ANSWER-B
A local hospital recently implemented a telemedicine program in its facility to
address deficiencies in global health care. How will this program influence
healthcare delivery?
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A. It will increase staffing for the hospital that is seeing more patients.
B. It will increase reimbursement for providers who are seeing more cases.
C. It will increase healthcare costs for the hospital that is seeing more patients.
D. It will increase the exchange of knowledge which is occurring between
providers. - ANSWER-D
A local top teaching hospital sets up a committee to address escalating hospital
costs. The committee needs to find cost containment options that will strengthen its
ability to compete with other facilities in the area. Which recommendation will
achieve this goal without reducing the quality of care?
A. Replacing physician assistants with nurse practitioners
B. Replacing hospital dialysis technicians with contract employees
C. Outsourcing the reading of lab results to an organization offshore
D. Outsourcing the radiology department to another teaching hospital in town -
ANSWER-C
The governor of the predominantly rural farming state of South Dakota is
concerned about the physician shortage. Which impact will a physician shortage
have on delivery of healthcare to this population?
A. Population health management will increase.
B. Coordination of care for patients will decrease.
C. Timely diagnosis of health problems will decrease.
D. Healthcare expenses reimbursement will increase. - ANSWER-C
Gene therapy is a new therapy protocol used in cancer treatment. How will this
therapy influence the future of healthcare delivery?
A. There will be a decrease in cancer preventive techniques.
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B. There will be an increase in alternative choices for patients.
C. There will be a decrease in the effectiveness of overall cancer treatment.
D. There will be an increase in the effectiveness of chemotherapy and radiation
treatments. - ANSWER-B
Medical tourism is on the rise and could have a significant economic impact.
Which strategy should U.S. health providers employ to compete with this industry?
A. Limit the number of foreign medical graduates from practicing in the U.S.
B. Reduce the price of healthcare services in the U.S. while improving quality
C. Create legislation to prevent U.S. citizens from seeking care in other countries
D. Increase advertising initiatives locally so U.S. citizens know services are
available - ANSWER-B
A small, rural hospital has fallen on hard times with continued payment cutbacks
and increased financial pressures. Which strategy will keep the hospital open long-
term?
A. Expanding to a full-service hospital with an operating room
B. Submitting grants to the National Institute of Health to offset costs
C. Seeking an affiliation with a larger teaching hospital for cross referrals
D. Requesting financial assistance from the American Hospital Association -
ANSWER-C
Valid diagnostic tests will change how healthcare systems manage mental health
patients. How will these tests impact future healthcare delivery for this population?
A. The number of mental health cases diagnosed will decrease.
B. Stigma associated with mental health problems will increase.
C. The National Institute of Health will develop new diagnostic codes.
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D. Insurance coverage for mental illness will be similar to physical illness. -
ANSWER-D
Evidence-based care promotes cost-effective interventions. What is an unintended
consequence of this methodology?
A. Insurance plan members will see an increase in their premiums.
B. The number of providers taking complicated cases will decrease.
C. Providers will have fewer resources from which to make decisions.
D. Practitioners will lose the ability to apply treatment alternatives. - ANSWER-D
Which two benefits can be expected given the new trend of health care moving to a
more preventative model? (Choose 2 answers)
A. Longer life spans
B. Shorter wait times
C. Increased medical costs
D. Decreased medical costs - ANSWER-A & D
The Role of Gate Keeper is typically assigned to:
A. Primary Care Physicians
B. Regulatory Agencies
C. Specialists
D. Surgeons - ANSWER-A
Countries with health systems oriented toward primary care:
A. Achieve better health levels
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B. Higher satisfaction with health services
C. Lower expenditures in the delivery of health
D. All the Above - ANSWER-D
Gene therapy is on the rise, in the future we can expect:
A. Greater treatment options
B. Less treatment options
C. Higher deductibles
D. None of the above - ANSWER-A
Rural healthcare is far less accessible than that of urban centers and it dramatically
limits the life expectancy in those areas. The lack of physicians per capita leads to:
A. Shorter wait times
B. Lower deductibles
C. Better coordination of Care
D. Worse Coordination of care - ANSWER-D
The first insurance in the U.S. was:
A. Blue Cross
B. Medicare
C. Workman's Comp
D. Medicaid - ANSWER-C
Telemedicine allows for greater sharing of needed information by:
A. Allowing experts to give opinions from far away
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B. Cutting costs in on duty personnel
C. Decreasing on call times
D. All the above - ANSWER-D
Which organization was instrumental in beginning the Blue Cross Network:
A. Centers of Disease Control (CDC)
B. The Joint Commission/JCAHO (TJC)
C. American Hospital Association (AHA)
D. None of the Above - ANSWER-C
Medicare part A covers?
A. Physician Fees
B. Hospital Fees
C. Both A&B
D. None of the above - ANSWER-B
Medicare Covers those who are ________, and those who are __________?
A. Impoverished/ Disabled
B. Disabled/ 65 and Over
C. 65 and over/ Impoverished
D. All the Above - ANSWER-B
What type of Billing Fraud is being used when the organization falsely reports the
illness or injury as being more serious than it is?
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A. Price Fixing
B. Conflict of interest
C. Up-coding
D. All the above - ANSWER-C
A patient that stays overnight is an_____________, a patient that receives care but
does not stay overnight is an ________________.
A. Impatient/ Dependent
B. Outpatient/ Dependent
C. Inpatient/ Outpatient
D. None of the Above - ANSWER-C
Adjusting the utilization of care while active treating the patient is what type of
review?
A. Prospective Utilization
B. Concurrent Utilization
C. Both A&B
D. None of the Above - ANSWER-B
This organization leads the effort to improve the quality of healthcare, reduce costs
and provide resourced for biomedical research and testing.
A. WHO
B. FDA
C. AHRQ
D. CDC - ANSWER-C
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Organizational integration gave rise to which of the following:
A. Medical Systems
B. Physician/Hospital Partnerships
C. Integrated Delivery System
D. All the Above - ANSWER-D
MCOs are accredited by the:
A. National Committee for Quality Assurance (NCQA).
B. Centers for Disease Control (CDC)
C. Department of Health and Human
Resources (DHHS)
D. None of the Above - ANSWER-A
Which is not a Utilization Review
A. Prospective Utilization Review
B. Concurrent Utilization Review
C. Retrospective Utilization Review
D. CMS Utilization Review - ANSWER-D
HMO use _________ and PPO offer ___________.
A. Discounts/ Capitation
B. Capitation/ Discounts
C. Vouchers/ Installments
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D. Installments/ Vouchers - ANSWER-B
Vulnerability is not determined by a convergence of:
A. Predisposing
B. Enabling
C. Need
D. Socio-Economics - ANSWER-D
Cost containment can be achieved by:
A. Price Controls
B. Competitive Approaches
C. Health Planning
D. All of the Above - ANSWER-D
Critical Pathways are used to plan:
A. Medical interventions in a set time-line
B. IV access points
C. Care Access
D. None of the Above - ANSWER-A
If Medicare expenditures totaled $523 billion in 2010; the program's income
amounted to $486 billion in the same year what does this mean?
A. Medicare is producing strong profits
B. Medicare is saving Billions in cost savings
C. Medicare has a financing shortfall
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D. Medicare is Bankrupt - ANSWER-C
Which is not a future concern for healthcare?
A. Inadequate wellness programs
B. Primary Care Services
C. Too few physician specialist
D. Healthcare tourism - ANSWER-C
In-house training is being conducted on OSHA standards for all staff. What is
being accomplished with this training?
A. Regulatory Renewal
B. Accreditation Renewal
C. Regulatory Compliance
D. None of the Above - ANSWER-C
Due to the rapid spread of diseases in our global economy the text supports the
idea of:
A. Isolationism
B. International Cooperation
C. Travel Health Screenings
D. None of the above - ANSWER-B
EBP is based on the premises of better outcomes and ____________.
A. Increased value
B. Maximum use of services
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C. Empowering physician autonomy
D. Tailoring patient care to the individual - ANSWER-A
Which historic healthcare facility type most closely resembles today's free clinics?
A. Alms houses
B. Dispensaries
C. Pest Houses
D. Asylums - ANSWER-B
Which historic healthcare facility type kept the poor, children and homeless we
kept as inmates?
A. Alms houses-
B. Dispensaries
C. Pest Houses
D. Asylums - ANSWER-A
Employer based health insurance is not
A. A job Perk
B. Tax Free
C. Open to union bargaining
D. Open to all employees - ANSWER-D
MCO's formed to take advantage of what stated reason:
A. Tax Incentives
B. Greater Buying Power
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C. Greater Political Power
D. None of the Above - ANSWER-B [Show Less]