CCM EXAM PREP - ALL TOPICS WITH ALL CORRECT &
100% VERIFIED ANSWERS|ACTUAL COMPLETE EXAM |
ALREADY GRADED A+
Case management ✔Correct Answer-a collaborative process that assesses, plans, implements,
coordinates, monitors and evaluates the options and services required to meet the client's health
and human services needs.
Case Management Characteristics ✔Correct Answer-characterized by advocacy, communication,
and resource management and promotes quality and cost-effective interventions and outcomes.
Glagow Coma Scale ✔Correct Answer-Client assessment tool that measures level of coma in the
acute phase of injury it is an objective way of recording the conscious state of a person. Eye opening,
Best verbal, best motor. < 8 coma, 13-15 mild injury.
Strengths Based Model ✔Correct Answer-assesses clients capacities and potential resources as
well as problems and current unmet needs. Eliciting capacities and potential resources as well as
problems and current unmet needs.
Independent Living Model ✔Correct Answer-sees a disability as a construct of society
Medicare Prospective Payment System ✔Correct Answer-hospitals paid a pre-determined rate for
each Medicare admission. Each patient is classified into a DRG.
PHQ-9 ✔Correct Answer-Client assessment tool for depression
Braden Scale ✔Correct Answer-Client assessment tool for pressure sore risk
Clinical Pathway ✔Correct Answer-Structured multidisciplinary CM plan designed to support the
implementation of specific clinical guidelines and protocols. They are maps that guide the healthcare
team on usual treatment patterns related to common diagnoses, conditions and procedures e.g.,
CHF
SF-36 ✔Correct Answer-Client assessment tool to measure physical and mental health.
Medicare ✔Correct Answer-Established in 1965 under Title XVIII or Social Security Act. Four Parts
A-hospital insurance, B-medical insurance (doctors visits), C-Medicare Advantage program in a
private plan such as HMO, D-prescription drug benefit
Medicare Benefits and Cost Sharing ✔Correct Answer-Not covered are: Acupuncture, chiropractor,
cosmetic, custodial home care, dental care, DME convenience, hearing aids, eyeglasses, foot care,
meals on wheels, personal convenience, prescription drugs, private nurses, routine physical, vision
areas of accountability of case management ✔Correct Answer-clinical/outcome
financial
functional/outcome
satisfaction
behavior
,process
*episode or continuum
**individual or population
Measuring performance: Process ✔Correct Answer-The measure of how many pts receive a
treatment or service i.e. vaccinations, screenings, ex. diabetic foot exam ALSO practitioner's practice
conforming to practice standards.
Measuring performance: Functional outcome ✔Correct Answer-The measure reflects the health
state of a patient as a result of health care ex. increased independency in ADLs, mobility
Measuring performance: Clinical outcome ✔Correct Answer-The measure reflects the health state
of a patient as a result of health care ex. blood pressure goals ex. HgA1c level, wound healing
Measuring performance: behavioral 'process' ✔Correct Answer-ex. self-monitoring of blood sugar
Measuring performance: Financial ✔Correct Answer-ex. fewer ED visits, ALOS decreased
Women's Health and Cancer Rights Act of 1998 ✔Correct Answer-1. Part of Omnibus
Appropriations Bill. 2. required group health plans to provide coverage for mastectomies and provide
certain reconstructive related services following mastectomies.
Women's health and cancer rights act coverage ✔Correct Answer-1. reconstruction of the breast.
2. surgery and reconstruction of the other breast 3. breast prothesis
4. treatment for physical complications attendant to the mastectomy
Women's health and cancer rights act prohibitions ✔Correct Answer-Health plans are not allowed
to deny anyone coverage for the sole reason of avoiding the requirements of the act AND cannot
induce a physician to limit the care that is required under the act by penalizing or limiting
reimbursement to the physician.
Can states modify HIPAA's portability requirement ✔Correct Answer-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, adopted children, children
placed in adoption and 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.
Break in coverage ✔Correct Answer-63 days or longer that a subscriber has been without health
insurance coverage (not including waiting periods)
Waiting period ✔Correct Answer-period of time specified by health insurance contract that occurs
between signing up for insurance and the beginning of health insurance coverage. Cannot be
counted as creditible coverage time. Individuals can use COBRA from their previous employers for
health insurance
Establishing waiting period ✔Correct Answer-HIPAA does not prohibit plans from establishing a
waiting period. But the waiting period and the pre-existing conditions exclusions must start at the
same time and run concurrently.
,Creditable Coverage ✔Correct Answer-For the purpose of the Health Insurance Portability and
Accountability Act, coverage under virtually any type indivual or group health care plan without a
break in coverage of 63 days or more. Cannot be taken into account when determining a significant
break in coverage. Only coverage after the 63 day break will be counted. Any coverage before the 63
day break will not be considered.
COBRA ✔Correct Answer-Consolidated Omnibus Budget Reconciliation Act; law to provide
terminated employees or those who lose insurance coverage because of reduced work to be able to
buy group insurance for themselves and their families for a limited amount of time.
Certification of creditable coverage ✔Correct Answer-Documentation that is provided
automatically by the plan or issuer when the individual loses coverage or becomes entitled to elect
COBRA continuation coverage and when an individual's COBRA continuation covearage ceases ; Be
provided if requested before loss of coverage or within 24 months of loss of coverage. May be
provided through use of model certificate
Nondiscrimination requirements ✔Correct Answer-Inividuals cannot be excluded from coverage
under the terms of the plan based on specified factors related to health status. Health plans cannot
establish rules of eligibility based on healht status related factors" such as health status, medical
condition, claims experience, receipt of health care, medical history, genetic information, evidence of
insurability or disablity. Insurer cannot drop a patient from coverage because it knows that the
patient will require a liver transplant next year. Cannot charge more for premiums based on health
status.
Security of health information and electronic signature standards ✔Correct Answer-provides a
uniform level of protection of all health information that is housed or transmitted electronically.
pertains to the individual.
Tax Equity and Fiscal Responsibility ACT of 1982 ✔Correct Answer-the purpose of this act is to
control the rising cost of providing health care services to medicare beneficiaries and has incentives
for cost containment. The act:1. established a case based reimbursement system (DRG) payment
system determined the cost of care for selected diagnoses while also placing limits on rate increases
in hospital venues. 2. Exempted medical rehabilitation from DRGs. Rehabiliation would continue as a
cost based reimbursement system with limits. 3. Amended social security act so that group health
plans pay before medicare for active employees 65-69 years old and for their spouses in the same
age group. 4. revised Age discrimination act by requiring employers to offer health benefits to active
employees 65-69 and their spouses in the same age bracket. 5. establish peer review organizations to
reduce costs associated with the hospital stays of medicare and medicaid patients. Also established
hospice benefit.
The Mental Health Parity Act of 1996 ✔Correct Answer-A statute that forbids health plans from
placing lifetime or annual limits on mental health coverage that are less generous than those placed
on medical or surgical benefits. Excluded substance abuse. If a plan does cover mental health, it
cannot set a separate dollar limit from medical care. Other limits allowed: limited number of annual
outpatient visits; Limited number of annual inpatient days; a per visit fee; Higher deductibles and
copayments without parity in medical and surgical benefits. If a parity would require an increase of
1% or more in its health care costs, the plan would be exempt.
, The Pregnancy discrimination act ✔Correct Answer-is an amendment to Title VII stating that
employment discrimination based on pregnancy, childbirth, or related medical conditions is
prohibited as a form of sex discrimination
Newborns and Mother's Health Protection Act of 1996 ✔Correct Answer-Health plans may not
restrict benefits for any hospital length of stay in connection with child birth for new born or her
bother to less than 48 hours following a normal vaginal delivery or less than 96 hours following a
delivery by cesarean section. They may not require providers to request for authorization for up to
48/96 hours . May not increase an individuals coinsurance for any later portion of a 48 hour /96 hour
hospital stay. 3. they cannot provide monetary payments to encourage a mother to accept less than
minimum protections available under NMHPA. They cannot penalizeor other wise reduce or limit the
reimbursement of an attending provider because the provider furnished care to a mother or
newborn in accordance to NMHPA. They cannot provide monetary or other incentives to an
attending provier to induce the provider to furnish care to a mother or new born in a manner
inconsistent with the NMHPA.
The Mental Health Parity and Addiction Equity Act of 2008 ✔Correct Answer-MHPAEA preserves
the MHPA protections and adds significant new protections, such as extending the parity
requirements to substance use disorders. Although the law requires a general equivalence in the way
MH/SUD and medical/surgical benefits are treated with respect to annual and lifetime dollar limits,
financial requirements and treatment limitations, MHPAEA does NOT require large group health
plans or health insurance issuers to cover MH/SUD benefits. The law's requirements apply only to
large group health plans and health insurance issuers that choose to include MH/SUD benefits in
their benefit packages. However, the Affordable Care Act builds on MHPAEA and requires coverage of
mental health and substance use disorder services as one of ten EHB categories
Exceptions to MHPAEA 2008 ✔Correct Answer-Except as noted below, MHPAEA requirements do
not apply to:
Non-Federal governmental plans that have 100 or fewer employees; Small private employers that
have 50 or fewer employees; Group health plans and health insurance issuers that are exempt from
MHPAEA based on their increased cost (except as noted below). Plans and issuers that make changes
to comply with MHPAEA and incur an increased cost of at least 2% in the first year that MHPAEA
applies to the plan or coverage or at least one percent in any subsequent plan year may claim an
exemption from MHPAEA based on their increased cost. If such a cost is incurred, the plan or
coverage is exempt from MHPAEA requirements for the plan or policy year following the year the
cost was incurred. These exemptions last one year. After that, the plan or coverage is required to
comply again; however, if the plan or coverage incurs an increased cost of at least 1% in that plan or
policy year, the plan or coverage could claim the exemption for the following plan or policy year;
Large, self-funded non-Federal governmental employers that opt-out of the requirements of
MHPAEA.
hard savings ✔Correct Answer-Examples of "hard" savings are directly linked to Case Management.
Examples would be reduction in payer denials or decrease in avoidable days.
soft savings ✔Correct Answer-Examples of "soft" savings are indirectly linked to Case Management
such as lower readmission rates or lower post-op complication rates. These can be converted into
dollars.
1987 Nursing Home Reform Act ✔Correct Answer-The basic objective of the Nursing Home Reform
Act is to ensure that residents of nursing homes receive quality care that will result in their achieving
100% VERIFIED ANSWERS|ACTUAL COMPLETE EXAM |
ALREADY GRADED A+
Case management ✔Correct Answer-a collaborative process that assesses, plans, implements,
coordinates, monitors and evaluates the options and services required to meet the client's health
and human services needs.
Case Management Characteristics ✔Correct Answer-characterized by advocacy, communication,
and resource management and promotes quality and cost-effective interventions and outcomes.
Glagow Coma Scale ✔Correct Answer-Client assessment tool that measures level of coma in the
acute phase of injury it is an objective way of recording the conscious state of a person. Eye opening,
Best verbal, best motor. < 8 coma, 13-15 mild injury.
Strengths Based Model ✔Correct Answer-assesses clients capacities and potential resources as
well as problems and current unmet needs. Eliciting capacities and potential resources as well as
problems and current unmet needs.
Independent Living Model ✔Correct Answer-sees a disability as a construct of society
Medicare Prospective Payment System ✔Correct Answer-hospitals paid a pre-determined rate for
each Medicare admission. Each patient is classified into a DRG.
PHQ-9 ✔Correct Answer-Client assessment tool for depression
Braden Scale ✔Correct Answer-Client assessment tool for pressure sore risk
Clinical Pathway ✔Correct Answer-Structured multidisciplinary CM plan designed to support the
implementation of specific clinical guidelines and protocols. They are maps that guide the healthcare
team on usual treatment patterns related to common diagnoses, conditions and procedures e.g.,
CHF
SF-36 ✔Correct Answer-Client assessment tool to measure physical and mental health.
Medicare ✔Correct Answer-Established in 1965 under Title XVIII or Social Security Act. Four Parts
A-hospital insurance, B-medical insurance (doctors visits), C-Medicare Advantage program in a
private plan such as HMO, D-prescription drug benefit
Medicare Benefits and Cost Sharing ✔Correct Answer-Not covered are: Acupuncture, chiropractor,
cosmetic, custodial home care, dental care, DME convenience, hearing aids, eyeglasses, foot care,
meals on wheels, personal convenience, prescription drugs, private nurses, routine physical, vision
areas of accountability of case management ✔Correct Answer-clinical/outcome
financial
functional/outcome
satisfaction
behavior
,process
*episode or continuum
**individual or population
Measuring performance: Process ✔Correct Answer-The measure of how many pts receive a
treatment or service i.e. vaccinations, screenings, ex. diabetic foot exam ALSO practitioner's practice
conforming to practice standards.
Measuring performance: Functional outcome ✔Correct Answer-The measure reflects the health
state of a patient as a result of health care ex. increased independency in ADLs, mobility
Measuring performance: Clinical outcome ✔Correct Answer-The measure reflects the health state
of a patient as a result of health care ex. blood pressure goals ex. HgA1c level, wound healing
Measuring performance: behavioral 'process' ✔Correct Answer-ex. self-monitoring of blood sugar
Measuring performance: Financial ✔Correct Answer-ex. fewer ED visits, ALOS decreased
Women's Health and Cancer Rights Act of 1998 ✔Correct Answer-1. Part of Omnibus
Appropriations Bill. 2. required group health plans to provide coverage for mastectomies and provide
certain reconstructive related services following mastectomies.
Women's health and cancer rights act coverage ✔Correct Answer-1. reconstruction of the breast.
2. surgery and reconstruction of the other breast 3. breast prothesis
4. treatment for physical complications attendant to the mastectomy
Women's health and cancer rights act prohibitions ✔Correct Answer-Health plans are not allowed
to deny anyone coverage for the sole reason of avoiding the requirements of the act AND cannot
induce a physician to limit the care that is required under the act by penalizing or limiting
reimbursement to the physician.
Can states modify HIPAA's portability requirement ✔Correct Answer-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, adopted children, children
placed in adoption and 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.
Break in coverage ✔Correct Answer-63 days or longer that a subscriber has been without health
insurance coverage (not including waiting periods)
Waiting period ✔Correct Answer-period of time specified by health insurance contract that occurs
between signing up for insurance and the beginning of health insurance coverage. Cannot be
counted as creditible coverage time. Individuals can use COBRA from their previous employers for
health insurance
Establishing waiting period ✔Correct Answer-HIPAA does not prohibit plans from establishing a
waiting period. But the waiting period and the pre-existing conditions exclusions must start at the
same time and run concurrently.
,Creditable Coverage ✔Correct Answer-For the purpose of the Health Insurance Portability and
Accountability Act, coverage under virtually any type indivual or group health care plan without a
break in coverage of 63 days or more. Cannot be taken into account when determining a significant
break in coverage. Only coverage after the 63 day break will be counted. Any coverage before the 63
day break will not be considered.
COBRA ✔Correct Answer-Consolidated Omnibus Budget Reconciliation Act; law to provide
terminated employees or those who lose insurance coverage because of reduced work to be able to
buy group insurance for themselves and their families for a limited amount of time.
Certification of creditable coverage ✔Correct Answer-Documentation that is provided
automatically by the plan or issuer when the individual loses coverage or becomes entitled to elect
COBRA continuation coverage and when an individual's COBRA continuation covearage ceases ; Be
provided if requested before loss of coverage or within 24 months of loss of coverage. May be
provided through use of model certificate
Nondiscrimination requirements ✔Correct Answer-Inividuals cannot be excluded from coverage
under the terms of the plan based on specified factors related to health status. Health plans cannot
establish rules of eligibility based on healht status related factors" such as health status, medical
condition, claims experience, receipt of health care, medical history, genetic information, evidence of
insurability or disablity. Insurer cannot drop a patient from coverage because it knows that the
patient will require a liver transplant next year. Cannot charge more for premiums based on health
status.
Security of health information and electronic signature standards ✔Correct Answer-provides a
uniform level of protection of all health information that is housed or transmitted electronically.
pertains to the individual.
Tax Equity and Fiscal Responsibility ACT of 1982 ✔Correct Answer-the purpose of this act is to
control the rising cost of providing health care services to medicare beneficiaries and has incentives
for cost containment. The act:1. established a case based reimbursement system (DRG) payment
system determined the cost of care for selected diagnoses while also placing limits on rate increases
in hospital venues. 2. Exempted medical rehabilitation from DRGs. Rehabiliation would continue as a
cost based reimbursement system with limits. 3. Amended social security act so that group health
plans pay before medicare for active employees 65-69 years old and for their spouses in the same
age group. 4. revised Age discrimination act by requiring employers to offer health benefits to active
employees 65-69 and their spouses in the same age bracket. 5. establish peer review organizations to
reduce costs associated with the hospital stays of medicare and medicaid patients. Also established
hospice benefit.
The Mental Health Parity Act of 1996 ✔Correct Answer-A statute that forbids health plans from
placing lifetime or annual limits on mental health coverage that are less generous than those placed
on medical or surgical benefits. Excluded substance abuse. If a plan does cover mental health, it
cannot set a separate dollar limit from medical care. Other limits allowed: limited number of annual
outpatient visits; Limited number of annual inpatient days; a per visit fee; Higher deductibles and
copayments without parity in medical and surgical benefits. If a parity would require an increase of
1% or more in its health care costs, the plan would be exempt.
, The Pregnancy discrimination act ✔Correct Answer-is an amendment to Title VII stating that
employment discrimination based on pregnancy, childbirth, or related medical conditions is
prohibited as a form of sex discrimination
Newborns and Mother's Health Protection Act of 1996 ✔Correct Answer-Health plans may not
restrict benefits for any hospital length of stay in connection with child birth for new born or her
bother to less than 48 hours following a normal vaginal delivery or less than 96 hours following a
delivery by cesarean section. They may not require providers to request for authorization for up to
48/96 hours . May not increase an individuals coinsurance for any later portion of a 48 hour /96 hour
hospital stay. 3. they cannot provide monetary payments to encourage a mother to accept less than
minimum protections available under NMHPA. They cannot penalizeor other wise reduce or limit the
reimbursement of an attending provider because the provider furnished care to a mother or
newborn in accordance to NMHPA. They cannot provide monetary or other incentives to an
attending provier to induce the provider to furnish care to a mother or new born in a manner
inconsistent with the NMHPA.
The Mental Health Parity and Addiction Equity Act of 2008 ✔Correct Answer-MHPAEA preserves
the MHPA protections and adds significant new protections, such as extending the parity
requirements to substance use disorders. Although the law requires a general equivalence in the way
MH/SUD and medical/surgical benefits are treated with respect to annual and lifetime dollar limits,
financial requirements and treatment limitations, MHPAEA does NOT require large group health
plans or health insurance issuers to cover MH/SUD benefits. The law's requirements apply only to
large group health plans and health insurance issuers that choose to include MH/SUD benefits in
their benefit packages. However, the Affordable Care Act builds on MHPAEA and requires coverage of
mental health and substance use disorder services as one of ten EHB categories
Exceptions to MHPAEA 2008 ✔Correct Answer-Except as noted below, MHPAEA requirements do
not apply to:
Non-Federal governmental plans that have 100 or fewer employees; Small private employers that
have 50 or fewer employees; Group health plans and health insurance issuers that are exempt from
MHPAEA based on their increased cost (except as noted below). Plans and issuers that make changes
to comply with MHPAEA and incur an increased cost of at least 2% in the first year that MHPAEA
applies to the plan or coverage or at least one percent in any subsequent plan year may claim an
exemption from MHPAEA based on their increased cost. If such a cost is incurred, the plan or
coverage is exempt from MHPAEA requirements for the plan or policy year following the year the
cost was incurred. These exemptions last one year. After that, the plan or coverage is required to
comply again; however, if the plan or coverage incurs an increased cost of at least 1% in that plan or
policy year, the plan or coverage could claim the exemption for the following plan or policy year;
Large, self-funded non-Federal governmental employers that opt-out of the requirements of
MHPAEA.
hard savings ✔Correct Answer-Examples of "hard" savings are directly linked to Case Management.
Examples would be reduction in payer denials or decrease in avoidable days.
soft savings ✔Correct Answer-Examples of "soft" savings are indirectly linked to Case Management
such as lower readmission rates or lower post-op complication rates. These can be converted into
dollars.
1987 Nursing Home Reform Act ✔Correct Answer-The basic objective of the Nursing Home Reform
Act is to ensure that residents of nursing homes receive quality care that will result in their achieving
