CCM EXAM PREP - ALL TOPICS ACTUAL EXAM ALL QUESTIONS AND WELL ELABORATED ANSWERS TOP RATED VERSION FOR ALREADY A+ GRADED HIGHLY RECOMMENDED |NEW AND REVISED

CCM EXAM PREP - ALL TOPICS
ACTUAL EXAM ALL QUESTIONS AND
WELL ELABORATED ANSWERS TOP
RATED VERSION FOR ALREADY A+
GRADED HIGHLY RECOMMENDED
|NEW AND REVISED
Casemmanagementm-
mCORRECTmANSWERmamcollaborativemprocessmthatmassesses,mplans,mimplements,mcoordinates,mm


onitorsmandmevaluatesmthemoptionsmandmservicesmrequiredmtommeetmthemclient'smhealthmandmhum
anmservicesmneeds.



CasemManagementmCharacteristicsm-
mCORRECTmANSWERmcharacterizedmbymadvocacy,mcommunication,mandmresourcemmanagementma


ndmpromotesmqualitymandmcost-effectiveminterventionsmandmoutcomes.



GlagowmComamScalem-
mCORRECTmANSWERmClientmassessmentmtoolmthatmmeasuresmlevelmofmcomaminmthemacutemphasem


ofminjurymitmismanmobjectivemwaymofmrecordingmthemconsciousmstatemofmamperson.mEyemopening,mBe
stmverbal,mbestmmotor.m<m8mcoma,m13-15mmildminjury.



StrengthsmBasedmModelm-
mCORRECTmANSWERmassessesmclientsmcapacitiesmandmpotentialmresourcesmasmwellmasmproblemsma


ndmcurrentmunmetmneeds.mElicitingmcapacitiesmandmpotentialmresourcesmasmwellmasmproblemsmand
mcurrentmunmetmneeds.




IndependentmLivingmModelm-mCORRECTmANSWERmseesmamdisabilitymasmamconstructmofmsociety



MedicaremProspectivemPaymentmSystemm-mCORRECTmANSWERmhospitalsmpaidmampre-
determinedmratemformeachmMedicaremadmission.mEachmpatientmismclassifiedmintomamDRG.

,PHQ-9m-mCORRECTmANSWERmClientmassessmentmtoolmformdepression



BradenmScalem-mCORRECTmANSWERmClientmassessmentmtoolmformpressuremsoremrisk



ClinicalmPathwaym-
mCORRECTmANSWERmStructuredmmultidisciplinarymCMmplanmdesignedmtomsupportmthemimplement


ationmofmspecificmclinicalmguidelinesmandmprotocols.mTheymaremmapsmthatmguidemthemhealthcaremt
eammonmusualmtreatmentmpatternsmrelatedmtomcommonmdiagnoses,mconditionsmandmproceduresme
.g.,mCHF



SF-36m-mCORRECTmANSWERmClientmassessmentmtoolmtommeasuremphysicalmandmmentalmhealth.



Medicarem-
mCORRECTmANSWERmEstablishedminm1965mundermTitlemXVIIImormSocialmSecuritymAct.mFourmPartsmA-


hospitalminsurance,mB-medicalminsurancem(doctorsmvisits),mC-
MedicaremAdvantagemprogramminmamprivatemplanmsuchmasmHMO,mD-prescriptionmdrugmbenefit



MedicaremBenefitsmandmCostmSharingm-
mCORRECTmANSWERmNotmcoveredmare:mAcupuncture,mchiropractor,mcosmetic,mcustodialmhomemca


re,mdentalmcare,mDMEmconvenience,mhearingmaids,meyeglasses,mfootmcare,mmealsmonmwheels,mpers
onalmconvenience,mprescriptionmdrugs,mprivatemnurses,mroutinemphysical,mvision



areasmofmaccountabilitymofmcasemmanagementm-mCORRECTmANSWERmclinical/outcome

financial

functional/outcome

satisfaction

behavior

process

,*episodemormcontinuum

**individualmormpopulation



Measuringmperformance:mProcessm-
mCORRECTmANSWERmThemmeasuremofmhowmmanymptsmreceivemamtreatmentmormservicemi.e.mvaccin


ations,mscreenings,mex.mdiabeticmfootmexammALSOmpractitioner'smpracticemconformingmtompractice
mstandards.




Measuringmperformance:mFunctionalmoutcomem-
mCORRECTmANSWERmThemmeasuremreflectsmthemhealthmstatemofmampatientmasmamresultmofmhealthmc


aremex.mincreasedmindependencyminmADLs,mmobility



Measuringmperformance:mClinicalmoutcomem-
mCORRECTmANSWERmThemmeasuremreflectsmthemhealthmstatemofmampatientmasmamresultmofmhealthmc


aremex.mbloodmpressuremgoalsmex.mHgA1cmlevel,mwoundmhealing



Measuringmperformance:mbehavioralm'process'm-mCORRECTmANSWERmex.mself-
monitoringmofmbloodmsugar



Measuringmperformance:mFinancialm-mCORRECTmANSWERmex.mfewermEDmvisits,mALOSmdecreased



Women'smHealthmandmCancermRightsmActmofm1998m-
mCORRECTmANSWERm1.mPartmofmOmnibusmAppropriationsmBill.m2.mrequiredmgroupmhealthmplansmto


mprovidemcoveragemformmastectomiesmandmprovidemcertainmreconstructivemrelatedmservicesmfollo


wingmmastectomies.



Women'smhealthmandmcancermrightsmactmcoveragem-
mCORRECTmANSWERm1.mreconstruction mofmthembreast.m2.msurgerymandmreconstruction mofmthemoth


ermbreastm3.mbreastmprothesis

4.mtreatmentmformphysicalmcomplicationsmattendantmtomthemmastectomy

, Women'smhealthmandmcancermrightsmactmprohibitionsm-
mCORRECTmANSWERmHealthmplansmaremnotmallowedmtomdenymanyonemcoveragemformthemsolemreas


onmofmavoidingmthemrequirementsmofmthemactmANDmcannotminducemamphysicianmtomlimitmthemcarem
thatmismrequiredmundermthemactmbympenalizingmormlimitingmreimbursementmtomthemphysician.



CanmstatesmmodifymHIPAA'smportabilitymrequirementm-
mCORRECTmANSWERmYes.mHIPAAmrequirementsmdomnotmsupercedemstatemrequirements.mStricterml


awsmprevail.mStatesmcanm1.mshortenmthem6mmonthmlookmbackmperiod.m2.mshortenm12mmonthmmaxi
mummpre-
existingmconditionmexclusionmperiod.3.mincreasemthem63mday/significantmbreakminmcoveragem4.minc
reasem30mdaymperiodmformnewborns,madoptedmchildren,mchildrenmplacedminmadoptionmandmpregna
ntmwomen.m5.mExpandmthemprohibitionsmonmconditionsmandmpeoplemtomwhommampre-
existingmconditionmexclusionmperiodmmaymbemappliedmbeyondmexceptions.m6.mreducemadditionalms
pecialmenrollmentmperiods.m7.mreducemmaximummHMOmaffiliationmperiodmtomlessmthanm2mmonths.



Breakminmcoveragem-
mCORRECTmANSWERm63mdaysmormlongermthatmamsubscribermhasmbeenmwithoutmhealthminsurancemc


overagem(notmincludingmwaitingmperiods)



Waitingmperiodm-
mCORRECTmANSWERmperiodmofmtimemspecifiedmbymhealthminsurancemcontractmthatmoccursmbetwe


enmsigningmupmforminsurancemandmthembeginningmofmhealthminsurancemcoverage.mCannotmbemcoun
tedmasmcreditiblemcoveragemtime.mIndividualsmcanmusemCOBRAmfrommtheirmpreviousmemployersmfo
rmhealthminsurance



Establishingmwaitingmperiodm-
mCORRECTmANSWERmHIPAAmdoesmnotmprohibitmplansmfrommestablishingmamwaitingmperiod.mButmth


emwaitingmperiodmandmthempre-
existingmconditionsmexclusionsmmustmstartmatmthemsamemtimemandmrunmconcurrently.



CreditablemCoveragem-
mCORRECTmANSWERmFormthempurposemofmthemHealthmInsurancemPortabilitymandmAccountabilitymA