CCM exam prep - all topics Questions and Answers Updated 2026

CCM exam prep - all topics
Questions and Answers Updated
2026
CaseMmanagementM-
MAnswerMaMcollaborativeMprocessMthatMassesses,Mplans,Mimplements,Mcoordinates,Mmonit
orsMandMevaluatesMtheMoptionsMandMservicesMrequiredMtoMmeetMtheMclient'sMhealthMa
ndMhumanMservicesMneeds.



CaseMManagementMCharacteristicsM-
MAnswerMcharacterizedMbyMadvocacy,Mcommunication,MandMresourceMmanagementMandM
promotesMqualityMandMcost-effectiveMinterventionsMandMoutcomes.



GlagowMComaMScaleM-
MAnswerMClientMassessmentMtoolMthatMmeasuresMlevelMofMcomaMinMtheMacuteMphase
MofMinjuryMitMisManMobjectiveMwayMofMrecordingMtheMconsciousMstateMofMaMperson.M
EyeMopening,MBestMverbal,MbestMmotor.M<M8Mcoma,M13-15MmildMinjury.



StrengthsMBasedMModelM-
MAnswerMassessesMclientsMcapacitiesMandMpotentialMresourcesMasMwellMasMproblemsMan
dMcurrentMunmetMneeds.MElicitingMcapacitiesMandMpotentialMresourcesMasMwellMasMprob
lemsMandMcurrentMunmetMneeds.



IndependentMLivingMModelM-MAnswerMseesMaMdisabilityMasMaMconstructMofMsociety



MedicareMProspectiveMPaymentMSystemM-MAnswerMhospitalsMpaidMaMpre-
determinedMrateMforMeachMMedicareMadmission.MEachMpatientMisMclassifiedMintoMaMDR
G.



PHQ-9M-MAnswerMClientMassessmentMtoolMforMdepression



BradenMScaleM-MAnswerMClientMassessmentMtoolMforMpressureMsoreMrisk



ClinicalMPathwayM-
MAnswerMStructuredMmultidisciplinaryMCMMplanMdesignedMtoMsupportMtheMimplementatio
nMofMspecificMclinicalMguidelinesMandMprotocols.MTheyMareMmapsMthatMguideMtheMhealt

,hcareMteamMonMusualMtreatmentMpatternsMrelatedMtoMcommonMdiagnoses,MconditionsMa
ndMproceduresMe.g.,MCHF



SF-36M-MAnswerMClientMassessmentMtoolMtoMmeasureMphysicalMandMmentalMhealth.



MedicareM-
MAnswerMEstablishedMinM1965MunderMTitleMXVIIIMorMSocialMSecurityMAct.MFourMPartsM
A-hospitalMinsurance,MB-medicalMinsuranceM(doctorsMvisits),MC-
MedicareMAdvantageMprogramMinMaMprivateMplanMsuchMasMHMO,MD-
prescriptionMdrugMbenefit



MedicareMBenefitsMandMCostMSharingM-
MAnswerMNotMcoveredMare:MAcupuncture,Mchiropractor,Mcosmetic,McustodialMhomeMcare,
MdentalMcare,MDMEMconvenience,MhearingMaids,Meyeglasses,MfootMcare,MmealsMonMwhe
els,MpersonalMconvenience,MprescriptionMdrugs,MprivateMnurses,MroutineMphysical,Mvision



areasMofMaccountabilityMofMcaseMmanagementM-MAnswerMclinical/outcome

financial

functional/outcome

satisfaction

behavior

process

*episodeMorMcontinuum

**individualMorMpopulation



MeasuringMperformance:MProcessM-
MAnswerMTheMmeasureMofMhowMmanyMptsMreceiveMaMtreatmentMorMserviceMi.e.Mvacci
nations,Mscreenings,Mex.MdiabeticMfootMexamMALSOMpractitioner'sMpracticeMconformingMt
oMpracticeMstandards.



MeasuringMperformance:MFunctionalMoutcomeM-
MAnswerMTheMmeasureMreflectsMtheMhealthMstateMofMaMpatientMasMaMresultMofMhealt
hMcareMex.MincreasedMindependencyMinMADLs,Mmobility

,MeasuringMperformance:MClinicalMoutcomeM-
MAnswerMTheMmeasureMreflectsMtheMhealthMstateMofMaMpatientMasMaMresultMofMhealt
hMcareMex.MbloodMpressureMgoalsMex.MHgA1cMlevel,MwoundMhealing



MeasuringMperformance:MbehavioralM'process'M-MAnswerMex.Mself-
monitoringMofMbloodMsugar



MeasuringMperformance:MFinancialM-MAnswerMex.MfewerMEDMvisits,MALOSMdecreased



Women'sMHealthMandMCancerMRightsMActMofM1998M-
MAnswerM1.MPartMofMOmnibusMAppropriationsMBill.M2.MrequiredMgroupMhealthMplansMto
MprovideMcoverageMforMmastectomiesMandMprovideMcertainMreconstructiveMrelatedMservic
esMfollowingMmastectomies.



Women'sMhealthMandMcancerMrightsMactMcoverageM-
MAnswerM1.MreconstructionMofMtheMbreast.M2.MsurgeryMandMreconstructionMofMtheMoth
erMbreastM3.MbreastMprothesis

4.MtreatmentMforMphysicalMcomplicationsMattendantMtoMtheMmastectomy



Women'sMhealthMandMcancerMrightsMactMprohibitionsM-
MAnswerMHealthMplansMareMnotMallowedMtoMdenyManyoneMcoverageMforMtheMsoleMrea
sonMofMavoidingMtheMrequirementsMofMtheMactMANDMcannotMinduceMaMphysicianMtoMli
mitMtheMcareMthatMisMrequiredMunderMtheMactMbyMpenalizingMorMlimitingMreimburseme
ntMtoMtheMphysician.



CanMstatesMmodifyMHIPAA'sMportabilityMrequirementM-
MAnswerMYes.MHIPAAMrequirementsMdoMnotMsupercedeMstateMrequirements.MStricterMla
wsMprevail.MStatesMcanM1.MshortenMtheM6MmonthMlookMbackMperiod.M2.MshortenM12M
monthMmaximumMpre-
existingMconditionMexclusionMperiod.3.MincreaseMtheM63Mday/significantMbreakMinMcoverag
eM4.MincreaseM30MdayMperiodMforMnewborns,MadoptedMchildren,MchildrenMplacedMinMa
doptionMandMpregnantMwomen.M5.MExpandMtheMprohibitionsMonMconditionsMandMpeople
MtoMwhomMaMpre-
existingMconditionMexclusionMperiodMmayMbeMappliedMbeyondMexceptions.M6.MreduceMad
ditionalMspecialMenrollmentMperiods.M7.MreduceMmaximumMHMOMaffiliationMperiodMtoMle
ssMthanM2Mmonths.

, BreakMinMcoverageM-
MAnswerM63MdaysMorMlongerMthatMaMsubscriberMhasMbeenMwithoutMhealthMinsuranceM
coverageM(notMincludingMwaitingMperiods)



WaitingMperiodM-
MAnswerMperiodMofMtimeMspecifiedMbyMhealthMinsuranceMcontractMthatMoccursMbetwee
nMsigningMupMforMinsuranceMandMtheMbeginningMofMhealthMinsuranceMcoverage.MCannot
MbeMcountedMasMcreditibleMcoverageMtime.MIndividualsMcanMuseMCOBRAMfromMtheirMpr
eviousMemployersMforMhealthMinsurance



EstablishingMwaitingMperiodM-
MAnswerMHIPAAMdoesMnotMprohibitMplansMfromMestablishingMaMwaitingMperiod.MButMth
eMwaitingMperiodMandMtheMpre-
existingMconditionsMexclusionsMmustMstartMatMtheMsameMtimeMandMrunMconcurrently.



CreditableMCoverageM-
MAnswerMForMtheMpurposeMofMtheMHealthMInsuranceMPortabilityMandMAccountabilityMAc
t,McoverageMunderMvirtuallyManyMtypeMindivualMorMgroupMhealthMcareMplanMwithoutMa
MbreakMinMcoverageMofM63MdaysMorMmore.MCannotMbeMtakenMintoMaccountMwhenMde
terminingMaMsignificantMbreakMinMcoverage.MOnlyMcoverageMafterMtheM63MdayMbreakM
willMbeMcounted.MAnyMcoverageMbeforeMtheM63MdayMbreakMwillMnotMbeMconsidered.



COBRAM-
MAnswerMConsolidatedMOmnibusMBudgetMReconciliationMAct;MlawMtoMprovideMterminated
MemployeesMorMthoseMwhoMloseMinsuranceMcoverageMbecauseMofMreducedMworkMtoMb
eMableMtoMbuyMgroupMinsuranceMforMthemselvesMandMtheirMfamiliesMforMaMlimitedMa
mountMofMtime.



CertificationMofMcreditableMcoverageM-
MAnswerMDocumentationMthatMisMprovidedMautomaticallyMbyMtheMplanMorMissuerMwhen
MtheMindividualMlosesMcoverageMorMbecomesMentitledMtoMelectMCOBRAMcontinuationMco
verageMandMwhenManMindividual'sMCOBRAMcontinuationMcovearageMceasesM;MBeMprovide
dMifMrequestedMbeforeMlossMofMcoverageMorMwithinM24MmonthsMofMlossMofMcoverage.
MMayMbeMprovidedMthroughMuseMofMmodelMcertificate



NondiscriminationMrequirementsM-
MAnswerMInividualsMcannotMbeMexcludedMfromMcoverageMunderMtheMtermsMofMtheMpla
nMbasedMonMspecifiedMfactorsMrelatedMtoMhealthMstatus.MHealthMplansMcannotMestablish
MrulesMofMeligibilityMbasedMonMhealhtMstatusMrelatedMfactors"MsuchMasMhealthMstatus,
MmedicalMcondition,MclaimsMexperience,MreceiptMofMhealthMcare,MmedicalMhistory,Mgenet
icMinformation,MevidenceMofMinsurabilityMorMdisablity.MInsurerMcannotMdropMaMpatientMf