CCM EXAM QUESTIONS WITH COMPLETE
SOLUTIONS PLUS RATIONALES
All of the following are true regarding coordination of benefits (COB) except:
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|A) COB prevents double payment for services when a subscriber has health
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insurance coverage from two or more sources.
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| B) COB is voluntary.
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C) COB determines which insurer pays first when the insured is covered under
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more than one health insurance policy.
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D) COB coordinates workers' compensation with health insurance coverage. -
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CORRECT ANSWER✔✔-Answer: D) COB coordinates workers' compensation with
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health insurance coverage.
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Rationale: COB does not coordinate benefits with workers compensation. COB is a
| | | | | | | | | | |
voluntary program that prevents double payment for services when the
| | | | | | | | | | |
subscriber has health insurance from more than one source. COB has rules to
| | | | | | | | | | | | |
determine which insurer pays first. | | | |
Utilization management reviews services to ensure that:
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A) each line item on a submitted claim is an appropriate charge
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|B) they are medically necessary, provided in the most appropriate care setting,
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and at or above quality standards.
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C) appropriate discharge planning is performed.
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, D) they are ordered by a physician, provided in the most appropriate care setting,
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and exceed quality standards. - CORRECT ANSWER✔✔-Answer: B) they are
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medically necessary, provided in the most appropriate care setting, and at or
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above quality standards.
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Resource: CCMC Glossary of Terms| | | |
Rationale: Utilization Management: Review of services to ensure that they are
| | | | | | | | | | |
medically necessary, provided in the most appropriate care setting, and at or
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above quality standards.
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The case managers role when working with clients with substance abuse is to:
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A) Motivate the client to change.
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B) Support the treatment plan and assist in finding resources.
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C) Counsel the client.
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D) Monitor for substance use. - CORRECT ANSWER✔✔-Answer: B) Support the
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treatment plan and assist in finding resources.
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To meet the criteria of medical necessity all of the following should be present
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except:
A) It is reasonable
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B) It is based on evidence-based standards of care
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C) It is appropriate
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D) It is custodial - CORRECT ANSWER✔✔-Answer: D) It is custodial
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SOLUTIONS PLUS RATIONALES
All of the following are true regarding coordination of benefits (COB) except:
| | | | | | | | | | |
|A) COB prevents double payment for services when a subscriber has health
| | | | | | | | | | | |
insurance coverage from two or more sources.
| | | | | |
| B) COB is voluntary.
| | |
C) COB determines which insurer pays first when the insured is covered under
| | | | | | | | | | | | | |
more than one health insurance policy.
| | | | |
D) COB coordinates workers' compensation with health insurance coverage. -
| | | | | | | | | | |
CORRECT ANSWER✔✔-Answer: D) COB coordinates workers' compensation with
| | | | | | | |
health insurance coverage.
| |
Rationale: COB does not coordinate benefits with workers compensation. COB is a
| | | | | | | | | | |
voluntary program that prevents double payment for services when the
| | | | | | | | | | |
subscriber has health insurance from more than one source. COB has rules to
| | | | | | | | | | | | |
determine which insurer pays first. | | | |
Utilization management reviews services to ensure that:
| | | | | |
A) each line item on a submitted claim is an appropriate charge
| | | | | | | | | | |
|B) they are medically necessary, provided in the most appropriate care setting,
| | | | | | | | | | | |
and at or above quality standards.
| | | | |
C) appropriate discharge planning is performed.
| | | | |
, D) they are ordered by a physician, provided in the most appropriate care setting,
| | | | | | | | | | | | |
and exceed quality standards. - CORRECT ANSWER✔✔-Answer: B) they are
| | | | | | | | | | |
medically necessary, provided in the most appropriate care setting, and at or
| | | | | | | | | | | |
above quality standards.
| |
Resource: CCMC Glossary of Terms| | | |
Rationale: Utilization Management: Review of services to ensure that they are
| | | | | | | | | | |
medically necessary, provided in the most appropriate care setting, and at or
| | | | | | | | | | | |
above quality standards.
| |
The case managers role when working with clients with substance abuse is to:
| | | | | | | | | | | |
A) Motivate the client to change.
| | | | |
B) Support the treatment plan and assist in finding resources.
| | | | | | | | | |
C) Counsel the client.
| | |
D) Monitor for substance use. - CORRECT ANSWER✔✔-Answer: B) Support the
| | | | | | | | | | |
treatment plan and assist in finding resources.
| | | | | |
To meet the criteria of medical necessity all of the following should be present
| | | | | | | | | | | | | |
except:
A) It is reasonable
| | |
B) It is based on evidence-based standards of care
| | | | | | | |
C) It is appropriate
| | |
D) It is custodial - CORRECT ANSWER✔✔-Answer: D) It is custodial
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