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CCM exam prep questions
and answers with verified
answers | solved
Terms in this set (594)
a collaborative process that assesses, plans,
implements, coordinates, monitors and evaluates the
Case management
options and services required to meet the client's
health and human services needs.
characterized by advocacy, communication, and
Case Management
resource management and promotes quality and
Characteristics
cost-effective interventions and outcomes.
Client assessment tool that measures level of coma
in the acute phase of injury it is an objective way of
Glagow Coma Scale recording the conscious state of a person. Eye
opening, Best verbal, best motor. < 8 coma, 13-15 mild
injury.
assesses clients capacities and potential resources as
well as problems and current unmet needs. Eliciting
Strengths Based Model
capacities and potential resources as well as
problems and current unmet needs.
Independent Living Model sees a disability as a construct of society
hospitals paid a pre-determined rate for each
Medicare
Medicare admission. Each patient is classified into a
Prospective
DRG.
Payment System
PHQ-9 Client assessment tool for depression
Braden Scale Client assessment tool for pressure sore risk
1/22
, Structured multidisciplinary CM plan designed to
support the implementation of specific clinical
guidelines and protocols. They are maps that guide
Clinical Pathway
the healthcare team on usual treatment patterns
related to common diagnoses, conditions and
procedures e.g., CHF
Client assessment tool to measure physical and
SF-36
mental health.
Established in 1965 under Title XVIII or Social Security
Act. Four Parts A-hospital insurance, B-medical
Medicare insurance (doctors visits), C-Medicare Advantage
program in a private plan such as HMO, D-
prescription drug benefit
Not covered are: Acupuncture, chiropractor,
cosmetic, custodial home care, dental care, DME
Medicare Benefits and
convenience, hearing aids, eyeglasses, foot care,
Cost Sharing
meals on wheels, personal convenience, prescription
drugs, private nurses, routine physical, vision
clinical/outcome
financial
functional/outcome
areas of accountability of satisfaction
case management behavior
process
*episode or continuum
**individual or population
The measure of how many pts receive a treatment
Measuring performance: or service i.e. vaccinations, screenings, ex. diabetic
Process foot exam ALSO practitioner's practice
conforming to
practice standards.
The measure reflects the health state of a patient as
Measuring performance:
a result of health care ex. increased
Functional outcome
independency in ADLs, mobility
2/22
, The measure reflects the health state of a patient as
Measuring performance:
a result of health care ex. blood pressure goals
Clinical outcome
ex.
HgA1c level, wound healing
Measuring performance: ex. self-monitoring of blood sugar
behavioral 'process'
Measuring performance: ex. fewer ED visits, ALOS decreased
Financial
1. Part of Omnibus Appropriations Bill. 2. required
Women's Health and group health plans to provide coverage for
Cancer Rights Act of 1998 mastectomies and provide certain reconstructive
related services following mastectomies.
1. reconstruction of the breast. 2. surgery and
Women's health and reconstruction of the other breast 3. breast prothesis
cancer rights act coverage 4. treatment for physical complications attendant to
the mastectomy
Health plans are not allowed to deny anyone
coverage for the sole reason of avoiding the
Women's health and
requirements of the act AND cannot induce a
cancer rights act
physician to limit the care that is required under the
prohibitions
act by penalizing or limiting reimbursement to the
physician.
Yes. HIPAA requirements do not supercede state
requirements. Stricter laws prevail. States can 1.
shorten the 6 month look back period. 2. shorten 12
month maximum pre-existing condition exclusion
period.3. increase the 63 day/significant break in
coverage 4. increase 30 day period for newborns,
Can states modify HIPAA's
adopted children, children placed in adoption and
portability requirement
pregnant women. 5. Expand the prohibitions on
conditions and people to whom a pre-existing
condition exclusion period may be applied
beyond exceptions. 6. reduce additional special
enrollment periods. 7. reduce maximum HMO
affiliation period to less than 2 months.
3/22
CCM exam prep questions
and answers with verified
answers | solved
Terms in this set (594)
a collaborative process that assesses, plans,
implements, coordinates, monitors and evaluates the
Case management
options and services required to meet the client's
health and human services needs.
characterized by advocacy, communication, and
Case Management
resource management and promotes quality and
Characteristics
cost-effective interventions and outcomes.
Client assessment tool that measures level of coma
in the acute phase of injury it is an objective way of
Glagow Coma Scale recording the conscious state of a person. Eye
opening, Best verbal, best motor. < 8 coma, 13-15 mild
injury.
assesses clients capacities and potential resources as
well as problems and current unmet needs. Eliciting
Strengths Based Model
capacities and potential resources as well as
problems and current unmet needs.
Independent Living Model sees a disability as a construct of society
hospitals paid a pre-determined rate for each
Medicare
Medicare admission. Each patient is classified into a
Prospective
DRG.
Payment System
PHQ-9 Client assessment tool for depression
Braden Scale Client assessment tool for pressure sore risk
1/22
, Structured multidisciplinary CM plan designed to
support the implementation of specific clinical
guidelines and protocols. They are maps that guide
Clinical Pathway
the healthcare team on usual treatment patterns
related to common diagnoses, conditions and
procedures e.g., CHF
Client assessment tool to measure physical and
SF-36
mental health.
Established in 1965 under Title XVIII or Social Security
Act. Four Parts A-hospital insurance, B-medical
Medicare insurance (doctors visits), C-Medicare Advantage
program in a private plan such as HMO, D-
prescription drug benefit
Not covered are: Acupuncture, chiropractor,
cosmetic, custodial home care, dental care, DME
Medicare Benefits and
convenience, hearing aids, eyeglasses, foot care,
Cost Sharing
meals on wheels, personal convenience, prescription
drugs, private nurses, routine physical, vision
clinical/outcome
financial
functional/outcome
areas of accountability of satisfaction
case management behavior
process
*episode or continuum
**individual or population
The measure of how many pts receive a treatment
Measuring performance: or service i.e. vaccinations, screenings, ex. diabetic
Process foot exam ALSO practitioner's practice
conforming to
practice standards.
The measure reflects the health state of a patient as
Measuring performance:
a result of health care ex. increased
Functional outcome
independency in ADLs, mobility
2/22
, The measure reflects the health state of a patient as
Measuring performance:
a result of health care ex. blood pressure goals
Clinical outcome
ex.
HgA1c level, wound healing
Measuring performance: ex. self-monitoring of blood sugar
behavioral 'process'
Measuring performance: ex. fewer ED visits, ALOS decreased
Financial
1. Part of Omnibus Appropriations Bill. 2. required
Women's Health and group health plans to provide coverage for
Cancer Rights Act of 1998 mastectomies and provide certain reconstructive
related services following mastectomies.
1. reconstruction of the breast. 2. surgery and
Women's health and reconstruction of the other breast 3. breast prothesis
cancer rights act coverage 4. treatment for physical complications attendant to
the mastectomy
Health plans are not allowed to deny anyone
coverage for the sole reason of avoiding the
Women's health and
requirements of the act AND cannot induce a
cancer rights act
physician to limit the care that is required under the
prohibitions
act by penalizing or limiting reimbursement to the
physician.
Yes. HIPAA requirements do not supercede state
requirements. Stricter laws prevail. States can 1.
shorten the 6 month look back period. 2. shorten 12
month maximum pre-existing condition exclusion
period.3. increase the 63 day/significant break in
coverage 4. increase 30 day period for newborns,
Can states modify HIPAA's
adopted children, children placed in adoption and
portability requirement
pregnant women. 5. Expand the prohibitions on
conditions and people to whom a pre-existing
condition exclusion period may be applied
beyond exceptions. 6. reduce additional special
enrollment periods. 7. reduce maximum HMO
affiliation period to less than 2 months.
3/22
