CCM ELITE REVIEW FULLY SOLVED EDITION
2026 COMPREHENSIVE GUIDE WITH
SCENARIOS AND ANSWERS
◉ACO . Answer: Accountable Care Organization
◉Viatical Settlements . Answer: ability to sell own insurance policy
◉CHAMPVA . Answer: Civilian Health and Medical Program of the
Veterans Administrationtr
◉CHAMPVA for Life . Answer: provides healthcare benefits to families
of permanently disabled veterans, or killed in line of duty, not eligible
for tricare. Covers 65 or older, is a Medicare supplement.
◉TRICARE . Answer: is a U.S. government health insurance plan for
active military personnel, national guard, reserves, retirees, their families
and some former spouse's.
◉TRICARE for Life . Answer: primarily a supplemental insurance with
those with Medicare A & B coverage, &eligible for TRICARE in US. Is
the primary insurance overseas.
,◉advance directives . Answer: A signed document indicating that the
person's wishes regarding care during dying.
◉ASO . Answer: administrative services only, and insurance company
or TPA that provides administrative services for an employer group.
◉Adverse Events . Answer: any untoward occurrences not of natural
consequences.
◉Advocacy . Answer: support; active pleading on behalf of someone or
something
◉Alternate level of care . Answer: level of care used safely in place of
current level, determined by acuity.
◉Assessments . Answer: The process of collecting in-depth information
about a persons situation and function to identity needs.
◉assistive device . Answer: tool, software, or hardware to assist in
performing daily activities
◉Assistive technology . Answer: equipment or products used by
individuals with disabilities to improve functioning in activities
,◉Autonomy . Answer: person's right to self determination and
independence
◉Beneficence . Answer: Doing good or causing good to be done; kindly
action
◉Beneficiary . Answer: a person who derives advantage from
something, especially a trust, will, or life insurance policy.
◉Benefit package . Answer: the sum of services a health plan,
government agency, or employer contracts to provide.
◉Benefits . Answer: the amount payable by the insurance company to a
claimant or beneficiary under claimant s coverage.
◉Brain injury . Answer: Any brain damage that impairs normal
functioning of the brain, either temporarily or permanently
◉Burden of proof . Answer: the obligation facing a persuasive speaker
to prove that a change from current policy is necessary
◉Capitation . Answer: fixed amount of money per member-per-month
paid to care provider for covered services.
, ◉CARF . Answer: commission on accreditation of rehabilitation
facilities, private, non profit organization that establishs standards of
quality services for people with disabilities.
◉Carve outs . Answer: services that are excluded from a provider
contract, provider not responsible for services carved out of contract
◉Caseload . Answer: total number of patients followed by a case
manager at any point in time.
◉case management . Answer: collaborative process that assesses, plans,
implements, coordinates, monitors &evaluates options and services to
meet needs of individuals.
◉Case Management System . Answer: a computer program that helps a
counselor organize information used to serve a specific client
◉Case mix index (CMI) . Answer: sum of DRG-relative weights of all
patients seen in years time divided by patients hospitalized
◉Case rate . Answer: rate of reimbursement that packages pricing for a
certain category of services.
2026 COMPREHENSIVE GUIDE WITH
SCENARIOS AND ANSWERS
◉ACO . Answer: Accountable Care Organization
◉Viatical Settlements . Answer: ability to sell own insurance policy
◉CHAMPVA . Answer: Civilian Health and Medical Program of the
Veterans Administrationtr
◉CHAMPVA for Life . Answer: provides healthcare benefits to families
of permanently disabled veterans, or killed in line of duty, not eligible
for tricare. Covers 65 or older, is a Medicare supplement.
◉TRICARE . Answer: is a U.S. government health insurance plan for
active military personnel, national guard, reserves, retirees, their families
and some former spouse's.
◉TRICARE for Life . Answer: primarily a supplemental insurance with
those with Medicare A & B coverage, &eligible for TRICARE in US. Is
the primary insurance overseas.
,◉advance directives . Answer: A signed document indicating that the
person's wishes regarding care during dying.
◉ASO . Answer: administrative services only, and insurance company
or TPA that provides administrative services for an employer group.
◉Adverse Events . Answer: any untoward occurrences not of natural
consequences.
◉Advocacy . Answer: support; active pleading on behalf of someone or
something
◉Alternate level of care . Answer: level of care used safely in place of
current level, determined by acuity.
◉Assessments . Answer: The process of collecting in-depth information
about a persons situation and function to identity needs.
◉assistive device . Answer: tool, software, or hardware to assist in
performing daily activities
◉Assistive technology . Answer: equipment or products used by
individuals with disabilities to improve functioning in activities
,◉Autonomy . Answer: person's right to self determination and
independence
◉Beneficence . Answer: Doing good or causing good to be done; kindly
action
◉Beneficiary . Answer: a person who derives advantage from
something, especially a trust, will, or life insurance policy.
◉Benefit package . Answer: the sum of services a health plan,
government agency, or employer contracts to provide.
◉Benefits . Answer: the amount payable by the insurance company to a
claimant or beneficiary under claimant s coverage.
◉Brain injury . Answer: Any brain damage that impairs normal
functioning of the brain, either temporarily or permanently
◉Burden of proof . Answer: the obligation facing a persuasive speaker
to prove that a change from current policy is necessary
◉Capitation . Answer: fixed amount of money per member-per-month
paid to care provider for covered services.
, ◉CARF . Answer: commission on accreditation of rehabilitation
facilities, private, non profit organization that establishs standards of
quality services for people with disabilities.
◉Carve outs . Answer: services that are excluded from a provider
contract, provider not responsible for services carved out of contract
◉Caseload . Answer: total number of patients followed by a case
manager at any point in time.
◉case management . Answer: collaborative process that assesses, plans,
implements, coordinates, monitors &evaluates options and services to
meet needs of individuals.
◉Case Management System . Answer: a computer program that helps a
counselor organize information used to serve a specific client
◉Case mix index (CMI) . Answer: sum of DRG-relative weights of all
patients seen in years time divided by patients hospitalized
◉Case rate . Answer: rate of reimbursement that packages pricing for a
certain category of services.
