CCM MULTIPLE CHOICE QUESTIONS WITH COMPLETE
SOLUTIONS 100% 2023/2024
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.
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.
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.
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
Answer: D) It is custodial
The Ambulatory Payment Classification System (APC) is used to determine payment rates for which
one of the following under Medicare?
A) Ambulatory surgery
B) Outpatient rehabilitation and ambulatory surgery
C) ER, hospital-based clinic, observation, and ambulatory surgery
D) Physician office visits
Answer: C) ER, hospital-based clinic, observation and ambulatory surgery
, Rationale: The Ambulatory Payment Classification System (APC) is Medicare's prospective payment
system for the hospital-based clinic, ER, observation, and ambulatory surgery encounter.
Which would be most appropriate for a 48-year-old nurse who has a broken leg as the result of a
work-related injury?
A) Work hardening
B) Work adjustment
C) Transitional Work Duty
D) Temporary Total Disability
Answer: C) Transitional Work Duty
Rationale: Transitional work duty (TWD) allow an injured employee to return to work. The employer
will create a temporary position which conforms to the restrictions put in place by the employee's
treating physician.
Which of the following is not used by case managers to foster wellness and autonomy?
A) Advocacy
B) Education
C) Coercion
D) Communication
Answer: C) Coercion
http://ccmcertification.org/.../definition-and-philosophy-cas...
CCMC's Philosophy of Case Management
Your client is considering a viatical settlement to help cover medical expenses. All of the following are
true about viatical settlements except:
A) The patient will be required by law to continue making the premium on the policy.
B) The money received from a viatical settlement is usually free from federal income tax.
C) The money received from a viatical settlement may impact eligibility for Medicaid.
D) There are no restrictions on how the money received from a viatical settlement can be used.
Answer: A) The patient will be required by law to continue making the premium on the policy
Rationale: The purchasing party becomes the beneficiary and takes responsibility for paying the
premium. The money received from a viatical settlement is usually free from federal income tax but
may impact eligibility for Medicaid. There are no restrictions on how the money received from a
viatical settlement can be used.
All of the following are true of an accelerated death benefit except:
A) It can be a rider on a life insurance policy
B) There are restrictions on how the money can be used
C) It is part of the Medicare Hospice Benefit
D) It allows the insured person to use some of the policy's benefit prior to dying
Answer: C) It is part of the Medicare Hospice Benefit
Rationale: Some life insurance policies have an accelerated death benefit (ADB) rider, allowing the
insured person to use some of the policy's benefit prior to dying. The ADB is deducted from the
amount the beneficiaries receive at death. There are restrictions on how the one can be used;
generally, it can be used for the long-term care and medical expenses.
Under Medicare, the Case Mix Group (CMG) is used to determine payment rates for which one of the
following?
A) Skilled Nursing Facility (SNF)
SOLUTIONS 100% 2023/2024
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.
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.
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.
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
Answer: D) It is custodial
The Ambulatory Payment Classification System (APC) is used to determine payment rates for which
one of the following under Medicare?
A) Ambulatory surgery
B) Outpatient rehabilitation and ambulatory surgery
C) ER, hospital-based clinic, observation, and ambulatory surgery
D) Physician office visits
Answer: C) ER, hospital-based clinic, observation and ambulatory surgery
, Rationale: The Ambulatory Payment Classification System (APC) is Medicare's prospective payment
system for the hospital-based clinic, ER, observation, and ambulatory surgery encounter.
Which would be most appropriate for a 48-year-old nurse who has a broken leg as the result of a
work-related injury?
A) Work hardening
B) Work adjustment
C) Transitional Work Duty
D) Temporary Total Disability
Answer: C) Transitional Work Duty
Rationale: Transitional work duty (TWD) allow an injured employee to return to work. The employer
will create a temporary position which conforms to the restrictions put in place by the employee's
treating physician.
Which of the following is not used by case managers to foster wellness and autonomy?
A) Advocacy
B) Education
C) Coercion
D) Communication
Answer: C) Coercion
http://ccmcertification.org/.../definition-and-philosophy-cas...
CCMC's Philosophy of Case Management
Your client is considering a viatical settlement to help cover medical expenses. All of the following are
true about viatical settlements except:
A) The patient will be required by law to continue making the premium on the policy.
B) The money received from a viatical settlement is usually free from federal income tax.
C) The money received from a viatical settlement may impact eligibility for Medicaid.
D) There are no restrictions on how the money received from a viatical settlement can be used.
Answer: A) The patient will be required by law to continue making the premium on the policy
Rationale: The purchasing party becomes the beneficiary and takes responsibility for paying the
premium. The money received from a viatical settlement is usually free from federal income tax but
may impact eligibility for Medicaid. There are no restrictions on how the money received from a
viatical settlement can be used.
All of the following are true of an accelerated death benefit except:
A) It can be a rider on a life insurance policy
B) There are restrictions on how the money can be used
C) It is part of the Medicare Hospice Benefit
D) It allows the insured person to use some of the policy's benefit prior to dying
Answer: C) It is part of the Medicare Hospice Benefit
Rationale: Some life insurance policies have an accelerated death benefit (ADB) rider, allowing the
insured person to use some of the policy's benefit prior to dying. The ADB is deducted from the
amount the beneficiaries receive at death. There are restrictions on how the one can be used;
generally, it can be used for the long-term care and medical expenses.
Under Medicare, the Case Mix Group (CMG) is used to determine payment rates for which one of the
following?
A) Skilled Nursing Facility (SNF)
