CCM EXAM QUESTIONS WITH COMPLETE
SOLUTIONS
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)
| | | | | | | | |
SOLUTIONS
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)
| | | | | | | | |
