CCM EXAM PREPARATION NEWEST 2026/2027 | ACTUAL
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS |
ALREADY GRADED A+
Which evaluation would you perform to determine if a client has the capability to return to work?
A. Pain tolerance evaluation.
B. Functional capacity evaluation.
C. Disability evaluation.
D. Evaluation by client interview. - ANSWER B. The functional capacity exam is a process of assessing
a persons, physical and functional abilities to perform task. The patients performance level should
match the demands of the occupation and question. The purpose of the exam is to determine if a
patient is ready to go back to work after an injury.
Risk management is a sub domain of which of the following court case management domains?
A. Psychosocial aspects.
Be. Healthcare management, and delivery.
C. Principles of practice.
D. Case management concepts. - ANSWER C. There are six domains for case management practice.
These include case management concepts, case management principles, and practice
strategy/practice, psychosocial and support systems, health management, and delivery, healthcare,
reimbursement, and vocational concepts/strategies. Risk management is a sub domain of case
management principles, and practice/strategies.
The case management process of documenting goals, objectives, and actions to meet a clients needs
is:
A. Assessment
B. Coordination.
C. Planning.
D. Monitoring. - ANSWER C. Planning is the process by which case manager, documents, goals,
objectives, and actions that will meet a clients needs. Assessment entails gathering data about a
client special needs and situation prior to forming a case management plan. Coordination involves
organization, modification, and documentation of resources necessary to achieve goals. Set forth in
the plan, and monitoring involves securing information needed to gauge the effectiveness of the
plan.
,Which of the following is a major component of essential knowledge for case manager?
A. Healthcare reimbursement.
B. Moral character.
C. Independent practice principles.
D. Statistical analysis. - ANSWER A. Healthcare reimbursement is one of the major categories of
knowledge necessary for a case manager, because there are many different reimbursement
mechanisms available, depending upon the patients particular situation.
The primary role of the case manager is to act as a:
A. Patient advocate.
B. Disease manager.
C. Utilization reviewer
D. Care plan creator - ANSWER A. Patient advocate is the best ANSWER. Advocacy is essential to a
case managers daily practice. A case manager acts on behalf of clients who may not be able to speak
for themselves or who are not knowledgeable about healthcare. Above all, the case manager should
always have the clients best interest in mind.
Which model of healthcare decision-making best demonstrates the principle of beneficence?
A. Patient sovereignty.
B. Paternalism
C. Shared decision-making.
D. Maternalism - ANSWER B. A relationship between healthcare practitioners and patients is
paternalistic and beneficial. This means that people trust the practitioner to do what is in the best
medical interest of the patient. Paternalism is justified in that patient usually don't comprehend
medical concepts well enough to make the correct decision about their care. In the patient
sovereignty model, the patient is open. "boss." In this case, one could argue that the patient knows
better than anyone else what is in his best interest. Shared decision making means the healthcare
team and the patient work together.
According to the standards of practice for case managers, there are four key functions of a case
manager. Which of the following is not one of the key functions?
A. Planner
B. Assessor.
See. Litigator.
D. Advocate. - ANSWER C. The four key functions of the case manager are planner, assessor,
facilitator, and advocate. A case manager must assess a situation to identify problems that need case
,management. The case manager must also planned long and short term goals, and collaboration
with the client, the clients family, and with other healthcare professionals. Facilitation includes
coordinating and implementing the care plan, maintaining communication, and expediting care. As
an advocate, the case manager, ensure that the clients needs are identified and addressed.
Nursing case management that is "within the walls" refers to which setting?
A. Outpatient setting.
B. Community clinic setting.
See. Health maintenance organization (HMO).
D. Acute hospital setting - ANSWER D. The term "within the walls" (WTW) refers to activities within
the acute hospital environment. This is distinct from "beyond the walls" (BTW), which refers to case
management in outpatient and community settings.
A terminally ill. Client is exhausting, all financial resources to pay medical cost. The case manager has
suggested obtaining cash value on his life insurance policy prior to death. This process is known as a:
a. Nontraditional policy.
B. Supplementary policy
C. Viatical settlement.
D. Gatekeeping. - ANSWER C. This scenario describes the process known as viatical settlement,
whereby a patient can obtain a cash value from a life insurance policy prior to death. ANSWERs a, B,
and D are irrelevant to the situation.
A relationship, whereby a case manager act in a client best interest based on trust is known as:
A. Fiduciary.
B. Ex parte.
C tort
D. Due diligence. - ANSWER A. A case manager establishes a relationship with a client to advocate for
his best interest. This makes the case manager a fiduciary. The term ex parte refers to illegal,
proceeding or a legal order. A tort, on the other hand, refers to a wrongful act performed will it fully.
When a person investigates a business or personal relationship prior to signing a contract, he is
performing due diligence.
When a case manager refers a client to a specific provider, what type of relationship exist between
the case manager, and the provider?
A. Vicarious agency.
B. Advocate.
, C. Ostensible agency.
D. Favoritism. - ANSWER C. The relationship that exists between the case manager, and a referral
provider is an ostensible agency. If that provider works to perform negligent actions. The referring
case manager may also become subject to litigation. A fiduciary is a relationship, whereby the case
manager act in the clients best interest. The case manager is an advocate for the client, not the
provider.
A case manager knowingly refers a patient to a provider who is unqualified to render services to the
patient. This is known as:
A. Temporary referral
B. Dual relationship.
C. Referral by client consent.
D. Negligent referral - ANSWER D. The case manager has to have knowledge of the referral providers,
credentials, and clinical experience. If a case manager sends a patient to an unqualified referral
provider, this constitutes a negligent referral. It is important for the case managers to check in with
patients afterward, to assure that they had a positive experience with the provider. It is also the case
managers responsibility to report any misconduct on the part of that provider.
You have decided to become a case manager for a friend. Which of the following best describes the
situation?
A. Unbiased relationship.
B. Favoritism.
C. Dual relationship.
D. Professional courtesy - ANSWER C. This type of relationship is a dual relationship, because you are
both friend and case manager. This often leads to a conflict of interest. Having a friendship with a
client outside of the clinical arena, introduces biases that interfere with your performance as a
professional.
A manage care contract may have provisions that prohibit Doctors from discussing treatment choices
with patients if the choices are not covered by their manage care plan. This provision is an example
of:
A. Confidentiality provision.
B. Gag clause.
C. Ethical dilemma.
D. Clinical pathway. - ANSWER B. In a managed healthcare plan, a gag clause prevents healthcare
providers from discussing with the patient treatment options that are not covered by that particular
manage care plan.
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS |
ALREADY GRADED A+
Which evaluation would you perform to determine if a client has the capability to return to work?
A. Pain tolerance evaluation.
B. Functional capacity evaluation.
C. Disability evaluation.
D. Evaluation by client interview. - ANSWER B. The functional capacity exam is a process of assessing
a persons, physical and functional abilities to perform task. The patients performance level should
match the demands of the occupation and question. The purpose of the exam is to determine if a
patient is ready to go back to work after an injury.
Risk management is a sub domain of which of the following court case management domains?
A. Psychosocial aspects.
Be. Healthcare management, and delivery.
C. Principles of practice.
D. Case management concepts. - ANSWER C. There are six domains for case management practice.
These include case management concepts, case management principles, and practice
strategy/practice, psychosocial and support systems, health management, and delivery, healthcare,
reimbursement, and vocational concepts/strategies. Risk management is a sub domain of case
management principles, and practice/strategies.
The case management process of documenting goals, objectives, and actions to meet a clients needs
is:
A. Assessment
B. Coordination.
C. Planning.
D. Monitoring. - ANSWER C. Planning is the process by which case manager, documents, goals,
objectives, and actions that will meet a clients needs. Assessment entails gathering data about a
client special needs and situation prior to forming a case management plan. Coordination involves
organization, modification, and documentation of resources necessary to achieve goals. Set forth in
the plan, and monitoring involves securing information needed to gauge the effectiveness of the
plan.
,Which of the following is a major component of essential knowledge for case manager?
A. Healthcare reimbursement.
B. Moral character.
C. Independent practice principles.
D. Statistical analysis. - ANSWER A. Healthcare reimbursement is one of the major categories of
knowledge necessary for a case manager, because there are many different reimbursement
mechanisms available, depending upon the patients particular situation.
The primary role of the case manager is to act as a:
A. Patient advocate.
B. Disease manager.
C. Utilization reviewer
D. Care plan creator - ANSWER A. Patient advocate is the best ANSWER. Advocacy is essential to a
case managers daily practice. A case manager acts on behalf of clients who may not be able to speak
for themselves or who are not knowledgeable about healthcare. Above all, the case manager should
always have the clients best interest in mind.
Which model of healthcare decision-making best demonstrates the principle of beneficence?
A. Patient sovereignty.
B. Paternalism
C. Shared decision-making.
D. Maternalism - ANSWER B. A relationship between healthcare practitioners and patients is
paternalistic and beneficial. This means that people trust the practitioner to do what is in the best
medical interest of the patient. Paternalism is justified in that patient usually don't comprehend
medical concepts well enough to make the correct decision about their care. In the patient
sovereignty model, the patient is open. "boss." In this case, one could argue that the patient knows
better than anyone else what is in his best interest. Shared decision making means the healthcare
team and the patient work together.
According to the standards of practice for case managers, there are four key functions of a case
manager. Which of the following is not one of the key functions?
A. Planner
B. Assessor.
See. Litigator.
D. Advocate. - ANSWER C. The four key functions of the case manager are planner, assessor,
facilitator, and advocate. A case manager must assess a situation to identify problems that need case
,management. The case manager must also planned long and short term goals, and collaboration
with the client, the clients family, and with other healthcare professionals. Facilitation includes
coordinating and implementing the care plan, maintaining communication, and expediting care. As
an advocate, the case manager, ensure that the clients needs are identified and addressed.
Nursing case management that is "within the walls" refers to which setting?
A. Outpatient setting.
B. Community clinic setting.
See. Health maintenance organization (HMO).
D. Acute hospital setting - ANSWER D. The term "within the walls" (WTW) refers to activities within
the acute hospital environment. This is distinct from "beyond the walls" (BTW), which refers to case
management in outpatient and community settings.
A terminally ill. Client is exhausting, all financial resources to pay medical cost. The case manager has
suggested obtaining cash value on his life insurance policy prior to death. This process is known as a:
a. Nontraditional policy.
B. Supplementary policy
C. Viatical settlement.
D. Gatekeeping. - ANSWER C. This scenario describes the process known as viatical settlement,
whereby a patient can obtain a cash value from a life insurance policy prior to death. ANSWERs a, B,
and D are irrelevant to the situation.
A relationship, whereby a case manager act in a client best interest based on trust is known as:
A. Fiduciary.
B. Ex parte.
C tort
D. Due diligence. - ANSWER A. A case manager establishes a relationship with a client to advocate for
his best interest. This makes the case manager a fiduciary. The term ex parte refers to illegal,
proceeding or a legal order. A tort, on the other hand, refers to a wrongful act performed will it fully.
When a person investigates a business or personal relationship prior to signing a contract, he is
performing due diligence.
When a case manager refers a client to a specific provider, what type of relationship exist between
the case manager, and the provider?
A. Vicarious agency.
B. Advocate.
, C. Ostensible agency.
D. Favoritism. - ANSWER C. The relationship that exists between the case manager, and a referral
provider is an ostensible agency. If that provider works to perform negligent actions. The referring
case manager may also become subject to litigation. A fiduciary is a relationship, whereby the case
manager act in the clients best interest. The case manager is an advocate for the client, not the
provider.
A case manager knowingly refers a patient to a provider who is unqualified to render services to the
patient. This is known as:
A. Temporary referral
B. Dual relationship.
C. Referral by client consent.
D. Negligent referral - ANSWER D. The case manager has to have knowledge of the referral providers,
credentials, and clinical experience. If a case manager sends a patient to an unqualified referral
provider, this constitutes a negligent referral. It is important for the case managers to check in with
patients afterward, to assure that they had a positive experience with the provider. It is also the case
managers responsibility to report any misconduct on the part of that provider.
You have decided to become a case manager for a friend. Which of the following best describes the
situation?
A. Unbiased relationship.
B. Favoritism.
C. Dual relationship.
D. Professional courtesy - ANSWER C. This type of relationship is a dual relationship, because you are
both friend and case manager. This often leads to a conflict of interest. Having a friendship with a
client outside of the clinical arena, introduces biases that interfere with your performance as a
professional.
A manage care contract may have provisions that prohibit Doctors from discussing treatment choices
with patients if the choices are not covered by their manage care plan. This provision is an example
of:
A. Confidentiality provision.
B. Gag clause.
C. Ethical dilemma.
D. Clinical pathway. - ANSWER B. In a managed healthcare plan, a gag clause prevents healthcare
providers from discussing with the patient treatment options that are not covered by that particular
manage care plan.
