AIIM Certified Claims Manager CCM Exam
**Question 1.** Which Medicare part primarily covers inpatient hospital services?
A) Part A
B) Part B
C) Part C
D) Part D
Answer: A
Explanation: Medicare Part A provides coverage for inpatient hospital stays, skilled nursing
facility care, and some home health services.
**Question 2.** In a bundled payment model, the provider is reimbursed:
A) Per individual service rendered
B) A single fixed amount for an entire episode of care
C) Based on the number of procedures performed
D) Only after patient satisfaction surveys are completed
Answer: B
Explanation: Bundled payments combine multiple services into one comprehensive payment for
a defined episode of care, encouraging efficiency.
**Question 3.** A deductible is best described as:
A) The amount the insurer pays before the patient contributes
B) The fixed monthly premium paid by the policyholder
C) The amount the patient must pay before insurance begins to cover expenses
D) The percentage of costs the insurer reimburses after the deductible is met
Answer: C
Explanation: The deductible is the out‑of‑pocket amount the claimant must pay before the
insurer starts paying for covered services.
, AIIM Certified Claims Manager CCM Exam
**Question 4.** Which of the following is NOT a typical component of Utilization Management?
A) Prior authorization
B) Clinical review of medical necessity
C) Claimant financial counseling
D) Discharge planning
Answer: C
Explanation: Utilization Management focuses on ensuring appropriate use of services; financial
counseling is not a core component.
**Question 5.** The Social Determinant of Health most directly related to a claimant’s ability to
attend therapy appointments is:
A) Education level
B) Housing stability
C) Transportation access
D) Cultural beliefs
Answer: C
Explanation: Reliable transportation directly affects a claimant’s ability to reach scheduled
medical or therapy appointments.
**Question 6.** Which behavioral health condition is most commonly associated with
increased workers’ compensation claim duration?
A) Generalized anxiety disorder
B) Major depressive disorder
C) Bipolar disorder
D) Schizophrenia
Answer: B
, AIIM Certified Claims Manager CCM Exam
Explanation: Major depressive disorder can significantly delay recovery and return‑to‑work,
extending claim duration.
**Question 7.** A claimant’s primary support system is evaluated to determine:
A) The level of insurance premium discounts available
B) Eligibility for vocational rehabilitation services
C) The claimant’s capacity to adhere to treatment plans
D) The necessity for legal representation
Answer: C
Explanation: Assessing family and community support helps gauge the claimant’s ability to
follow treatment and recovery protocols.
**Question 8.** Crisis intervention in claims management most often involves:
A) Initiating a long‑term psychotherapy referral
B) Providing immediate emotional support and safety planning
C) Conducting a full functional capacity evaluation
D) Filing a legal grievance on behalf of the claimant
Answer: B
Explanation: Crisis intervention aims to stabilize the claimant quickly, offering emotional support
and safety measures.
**Question 9.** Client empowerment techniques that improve self‑care adherence include:
A) Mandatory daily check‑ins with the case manager
B) Providing educational resources and goal‑setting tools
C) Restricting claimant access to claim details
D) Offering financial incentives for early discharge
Answer: B
, AIIM Certified Claims Manager CCM Exam
Explanation: Empowering claimants through education and collaborative goal setting enhances
adherence to treatment plans.
**Question 10.** HEDIS is primarily used to measure:
A) Hospital equipment depreciation
B) Health plan performance on preventive and chronic care metrics
C) Employee satisfaction in corporate wellness programs
D) The profitability of insurance carriers
Answer: B
Explanation: HEDIS (Healthcare Effectiveness Data and Information Set) tracks quality indicators
for health plans, focusing on preventive and chronic disease management.
**Question 11.** In a cost‑benefit analysis of a case management intervention, the “benefit”
most often refers to:
A) The amount saved by reducing claim processing time
B) The total number of claims opened in a year
C) The premium revenue generated from new policies
D) The increase in employee morale
Answer: A
Explanation: Benefits in this context are quantified savings, such as reduced medical costs or
faster claim resolution.
**Question 12.** The PDSA cycle’s “Study” phase primarily involves:
A) Implementing a new policy without monitoring
B) Collecting data to evaluate the effect of the change
C) Developing a detailed project charter
D) Training staff on the new workflow
**Question 1.** Which Medicare part primarily covers inpatient hospital services?
A) Part A
B) Part B
C) Part C
D) Part D
Answer: A
Explanation: Medicare Part A provides coverage for inpatient hospital stays, skilled nursing
facility care, and some home health services.
**Question 2.** In a bundled payment model, the provider is reimbursed:
A) Per individual service rendered
B) A single fixed amount for an entire episode of care
C) Based on the number of procedures performed
D) Only after patient satisfaction surveys are completed
Answer: B
Explanation: Bundled payments combine multiple services into one comprehensive payment for
a defined episode of care, encouraging efficiency.
**Question 3.** A deductible is best described as:
A) The amount the insurer pays before the patient contributes
B) The fixed monthly premium paid by the policyholder
C) The amount the patient must pay before insurance begins to cover expenses
D) The percentage of costs the insurer reimburses after the deductible is met
Answer: C
Explanation: The deductible is the out‑of‑pocket amount the claimant must pay before the
insurer starts paying for covered services.
, AIIM Certified Claims Manager CCM Exam
**Question 4.** Which of the following is NOT a typical component of Utilization Management?
A) Prior authorization
B) Clinical review of medical necessity
C) Claimant financial counseling
D) Discharge planning
Answer: C
Explanation: Utilization Management focuses on ensuring appropriate use of services; financial
counseling is not a core component.
**Question 5.** The Social Determinant of Health most directly related to a claimant’s ability to
attend therapy appointments is:
A) Education level
B) Housing stability
C) Transportation access
D) Cultural beliefs
Answer: C
Explanation: Reliable transportation directly affects a claimant’s ability to reach scheduled
medical or therapy appointments.
**Question 6.** Which behavioral health condition is most commonly associated with
increased workers’ compensation claim duration?
A) Generalized anxiety disorder
B) Major depressive disorder
C) Bipolar disorder
D) Schizophrenia
Answer: B
, AIIM Certified Claims Manager CCM Exam
Explanation: Major depressive disorder can significantly delay recovery and return‑to‑work,
extending claim duration.
**Question 7.** A claimant’s primary support system is evaluated to determine:
A) The level of insurance premium discounts available
B) Eligibility for vocational rehabilitation services
C) The claimant’s capacity to adhere to treatment plans
D) The necessity for legal representation
Answer: C
Explanation: Assessing family and community support helps gauge the claimant’s ability to
follow treatment and recovery protocols.
**Question 8.** Crisis intervention in claims management most often involves:
A) Initiating a long‑term psychotherapy referral
B) Providing immediate emotional support and safety planning
C) Conducting a full functional capacity evaluation
D) Filing a legal grievance on behalf of the claimant
Answer: B
Explanation: Crisis intervention aims to stabilize the claimant quickly, offering emotional support
and safety measures.
**Question 9.** Client empowerment techniques that improve self‑care adherence include:
A) Mandatory daily check‑ins with the case manager
B) Providing educational resources and goal‑setting tools
C) Restricting claimant access to claim details
D) Offering financial incentives for early discharge
Answer: B
, AIIM Certified Claims Manager CCM Exam
Explanation: Empowering claimants through education and collaborative goal setting enhances
adherence to treatment plans.
**Question 10.** HEDIS is primarily used to measure:
A) Hospital equipment depreciation
B) Health plan performance on preventive and chronic care metrics
C) Employee satisfaction in corporate wellness programs
D) The profitability of insurance carriers
Answer: B
Explanation: HEDIS (Healthcare Effectiveness Data and Information Set) tracks quality indicators
for health plans, focusing on preventive and chronic disease management.
**Question 11.** In a cost‑benefit analysis of a case management intervention, the “benefit”
most often refers to:
A) The amount saved by reducing claim processing time
B) The total number of claims opened in a year
C) The premium revenue generated from new policies
D) The increase in employee morale
Answer: A
Explanation: Benefits in this context are quantified savings, such as reduced medical costs or
faster claim resolution.
**Question 12.** The PDSA cycle’s “Study” phase primarily involves:
A) Implementing a new policy without monitoring
B) Collecting data to evaluate the effect of the change
C) Developing a detailed project charter
D) Training staff on the new workflow
