CCM exam prep - all topics Questions with Correct
Answers
Case management Correct Answer-a collaborative process that assesses,
plans, implements, coordinates, monitors and evaluates the options and
services required to meet the client's health and human services needs.
Case Management Characteristics Correct Answer-characterized by
advocacy, communication, and resource management and promotes
quality and cost-effective interventions and outcomes.
Glagow Coma Scale Correct Answer-Client assessment tool that
measures level of coma in the acute phase of injury it is an objective
way of recording the conscious state of a person. Eye opening, Best
verbal, best motor. < 8 coma, 13-15 mild injury.
Strengths Based Model Correct Answer-assesses clients capacities and
potential resources as well as problems and current unmet needs.
Eliciting capacities and potential resources as well as problems and
current unmet needs.
Independent Living Model Correct Answer-sees a disability as a
construct of society
Medicare Prospective Payment System Correct Answer-hospitals paid a
pre-determined rate for each Medicare admission. Each patient is
classified into a DRG.
,PHQ-9 Correct Answer-Client assessment tool for depression
Braden Scale Correct Answer-Client assessment tool for pressure sore
risk
Clinical Pathway Correct Answer-Structured multidisciplinary CM plan
designed to support the implementation of specific clinical guidelines
and protocols. They are maps that guide the healthcare team on usual
treatment patterns related to common diagnoses, conditions and
procedures e.g., CHF
SF-36 Correct Answer-Client assessment tool to measure physical and
mental health.
Medicare Correct Answer-Established in 1965 under Title XVIII or
Social Security Act. Four Parts A-hospital insurance, B-medical
insurance (doctors visits), C-Medicare Advantage program in a private
plan such as HMO, D-prescription drug benefit
Medicare Benefits and Cost Sharing Correct Answer-Not covered are:
Acupuncture, chiropractor, cosmetic, custodial home care, dental care,
DME convenience, hearing aids, eyeglasses, foot care, meals on wheels,
personal convenience, prescription drugs, private nurses, routine
physical, vision
areas of accountability of case management Correct
Answer-clinical/outcome
,financial
functional/outcome
satisfaction
behavior
process
*episode or continuum
**individual or population
Measuring performance: Process Correct Answer-The measure of how
many pts receive a treatment or service i.e. vaccinations, screenings, ex.
diabetic foot exam ALSO practitioner's practice conforming to practice
standards.
Measuring performance: Functional outcome Correct Answer-The
measure reflects the health state of a patient as a result of health care ex.
increased independency in ADLs, mobility
Measuring performance: Clinical outcome Correct Answer-The measure
reflects the health state of a patient as a result of health care ex. blood
pressure goals ex. HgA1c level, wound healing
Measuring performance: behavioral 'process' Correct Answer-ex. self-
monitoring of blood sugar
Measuring performance: Financial Correct Answer-ex. fewer ED visits,
ALOS decreased
, Women's Health and Cancer Rights Act of 1998 Correct Answer-1. Part
of Omnibus Appropriations Bill. 2. required group health plans to
provide coverage for mastectomies and provide certain reconstructive
related services following mastectomies.
Women's health and cancer rights act coverage Correct Answer-1.
reconstruction of the breast. 2. surgery and reconstruction of the other
breast 3. breast prothesis
4. treatment for physical complications attendant to the mastectomy
Women's health and cancer rights act prohibitions Correct Answer-
Health plans are not allowed to deny anyone coverage for the sole
reason of avoiding the requirements of the act AND cannot induce a
physician to limit the care that is required under the act by penalizing or
limiting reimbursement to the physician.
Can states modify HIPAA's portability requirement Correct Answer-
Yes. HIPAA requirements do not supercede state requirements. Stricter
laws prevail. States can 1. shorten the 6 month look back period. 2.
shorten 12 month maximum pre-existing condition exclusion period.3.
increase the 63 day/significant break in coverage 4. increase 30 day
period for newborns, adopted children, children placed in adoption and
pregnant women. 5. Expand the prohibitions on conditions and people to
whom a pre-existing condition exclusion period may be applied beyond
exceptions. 6. reduce additional special enrollment periods. 7. reduce
maximum HMO affiliation period to less than 2 months.
Answers
Case management Correct Answer-a collaborative process that assesses,
plans, implements, coordinates, monitors and evaluates the options and
services required to meet the client's health and human services needs.
Case Management Characteristics Correct Answer-characterized by
advocacy, communication, and resource management and promotes
quality and cost-effective interventions and outcomes.
Glagow Coma Scale Correct Answer-Client assessment tool that
measures level of coma in the acute phase of injury it is an objective
way of recording the conscious state of a person. Eye opening, Best
verbal, best motor. < 8 coma, 13-15 mild injury.
Strengths Based Model Correct Answer-assesses clients capacities and
potential resources as well as problems and current unmet needs.
Eliciting capacities and potential resources as well as problems and
current unmet needs.
Independent Living Model Correct Answer-sees a disability as a
construct of society
Medicare Prospective Payment System Correct Answer-hospitals paid a
pre-determined rate for each Medicare admission. Each patient is
classified into a DRG.
,PHQ-9 Correct Answer-Client assessment tool for depression
Braden Scale Correct Answer-Client assessment tool for pressure sore
risk
Clinical Pathway Correct Answer-Structured multidisciplinary CM plan
designed to support the implementation of specific clinical guidelines
and protocols. They are maps that guide the healthcare team on usual
treatment patterns related to common diagnoses, conditions and
procedures e.g., CHF
SF-36 Correct Answer-Client assessment tool to measure physical and
mental health.
Medicare Correct Answer-Established in 1965 under Title XVIII or
Social Security Act. Four Parts A-hospital insurance, B-medical
insurance (doctors visits), C-Medicare Advantage program in a private
plan such as HMO, D-prescription drug benefit
Medicare Benefits and Cost Sharing Correct Answer-Not covered are:
Acupuncture, chiropractor, cosmetic, custodial home care, dental care,
DME convenience, hearing aids, eyeglasses, foot care, meals on wheels,
personal convenience, prescription drugs, private nurses, routine
physical, vision
areas of accountability of case management Correct
Answer-clinical/outcome
,financial
functional/outcome
satisfaction
behavior
process
*episode or continuum
**individual or population
Measuring performance: Process Correct Answer-The measure of how
many pts receive a treatment or service i.e. vaccinations, screenings, ex.
diabetic foot exam ALSO practitioner's practice conforming to practice
standards.
Measuring performance: Functional outcome Correct Answer-The
measure reflects the health state of a patient as a result of health care ex.
increased independency in ADLs, mobility
Measuring performance: Clinical outcome Correct Answer-The measure
reflects the health state of a patient as a result of health care ex. blood
pressure goals ex. HgA1c level, wound healing
Measuring performance: behavioral 'process' Correct Answer-ex. self-
monitoring of blood sugar
Measuring performance: Financial Correct Answer-ex. fewer ED visits,
ALOS decreased
, Women's Health and Cancer Rights Act of 1998 Correct Answer-1. Part
of Omnibus Appropriations Bill. 2. required group health plans to
provide coverage for mastectomies and provide certain reconstructive
related services following mastectomies.
Women's health and cancer rights act coverage Correct Answer-1.
reconstruction of the breast. 2. surgery and reconstruction of the other
breast 3. breast prothesis
4. treatment for physical complications attendant to the mastectomy
Women's health and cancer rights act prohibitions Correct Answer-
Health plans are not allowed to deny anyone coverage for the sole
reason of avoiding the requirements of the act AND cannot induce a
physician to limit the care that is required under the act by penalizing or
limiting reimbursement to the physician.
Can states modify HIPAA's portability requirement Correct Answer-
Yes. HIPAA requirements do not supercede state requirements. Stricter
laws prevail. States can 1. shorten the 6 month look back period. 2.
shorten 12 month maximum pre-existing condition exclusion period.3.
increase the 63 day/significant break in coverage 4. increase 30 day
period for newborns, adopted children, children placed in adoption and
pregnant women. 5. Expand the prohibitions on conditions and people to
whom a pre-existing condition exclusion period may be applied beyond
exceptions. 6. reduce additional special enrollment periods. 7. reduce
maximum HMO affiliation period to less than 2 months.
