ADVANCED CCM MULTIPLE CHOICE
EXAM WITH VERIFIED QUESTIONS
AND ANSWERS 2025/2026
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
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 - CORRECT ANSWER-Answer: C) ER, hospital-based clinic,
observation and ambulatory surgery
EXAM WITH VERIFIED QUESTIONS
AND ANSWERS 2025/2026
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
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 - CORRECT ANSWER-Answer: C) ER, hospital-based clinic,
observation and ambulatory surgery
