CCMA PRACTICE EXAM NEWEST 2026/2027 ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) WITH DETAILED RATIONALES |ALREADY
GRADED A+||BRAND NEW VERSION!!
Care Mgmt - ANSWER A healthcare delivery process that helps achieve better health outcomes by
anticipating and linking clients with the services they need more quickly. It also helps avoid
unnecessary services by preventing medical problems from escalating.
Case Mgmt - ANSWER A collaborative process that assesses, plans, implements, coordinates,
monitors, and evaluates the options and services required to meet an individual's health needs,
using communication and available resources to promote quality, cost-effective outcomes.
Case-Based Review - ANSWER The process of evaluating the quality and appropriateness of care
based on the review of individual medical records to determine whether the care delivered is
acceptable. It is performed by healthcare professional assigned by the hospital or an outside agency
(e.g., Peer Review Organization [PRO]).
Continuous Quality Improvement CQI - ANSWER a Key component of total quality mgmt that uses
rigorous, systematic, organization-wide processes to achieve ongoing improvement in the quality of
healthcare services and operation. It focuses on both outcomes and processes of care.
Effectiveness of Care - ANSWER The extent to which care is provided correctly (i.e., to meet the
patient's needs, improve quality of care, and resolve the pts problems), given the current state of
knowledge, and the desired outcome is achieved.
Efficacy of Care - ANSWER The potential, capacity or capability to produce the desired effect or
outcome, as already shown, e.g. through scientific research (evidence-based) findings.
Efficiency of Care - ANSWER The extent to which care is provided to meet the desired
effects/outcomes to improve quality of care and prevent the use of unnecessary resources.
Integrated Delivery System IDS - ANSWER A single organization or group of affiliated organizations
that provides a wide spectrum of ambulatory and tertiary care and services. Care may also be
provided across various settings of the healthcare continuum.
, Intensity of Service - ANSWER An acuity of illness criteria based on the evaluation/treatment plan,
interventions, and anticipated outcomes.
Intermediate Outcome - ANSWER A desired outcome that is met during a patient's hospital stay. It is
a milestone in the care of a patient or a trigger point for advancement in the plan of care.
Managed Competition - ANSWER A state of healthcare delivery in which a large number of
consumers choose among health plans that offer similar benefits. In theory, competition would be
based on cost and quality and ideally would limit high prices and improve quality of care.
Management Service Organization - ANSWER A management entity owned by a hospital, physician
organization, or third party. It contracts with payers and hospitals/physicians to provide certain
healthcare management services such as negotiating fee schedules and handling administrative
functions, including utilization management, billing, and collections.
Medical Loss Ratio MLR - ANSWER The ratio of healthcare costs to revenue received. Calculated as
total
medical expense divided by total revenue.
Medical Necessity on Admission - ANSWER A type of review used to determine that the hospital
admission is appropriate, clinically necessary, justified, and reimbursable.
Minimum Data Set MDS - ANSWER The assessment tool used in skilled nursing facility settings to
place patients into Resource Utilization Groups (RUGs), which determines the facilities
reimbursement rate.
Outcome and Assessment Information Set OASIS - ANSWER A prospective nursing assessment
instrument completed by home health agencies at the time the patient is entered for home health
services. Scoring determines the Home Health Resource Group (HHRG).
Outcome Indicators - ANSWER Measures of quality and cost of care. Metrics used to examine and
evaluate the results of the care delivered.
Outcomes Management - ANSWER The use of information and knowledge gained from outcomes
monitoring to achieve optimal patient outcomes through improved clinical decision making and
service delivery.
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) WITH DETAILED RATIONALES |ALREADY
GRADED A+||BRAND NEW VERSION!!
Care Mgmt - ANSWER A healthcare delivery process that helps achieve better health outcomes by
anticipating and linking clients with the services they need more quickly. It also helps avoid
unnecessary services by preventing medical problems from escalating.
Case Mgmt - ANSWER A collaborative process that assesses, plans, implements, coordinates,
monitors, and evaluates the options and services required to meet an individual's health needs,
using communication and available resources to promote quality, cost-effective outcomes.
Case-Based Review - ANSWER The process of evaluating the quality and appropriateness of care
based on the review of individual medical records to determine whether the care delivered is
acceptable. It is performed by healthcare professional assigned by the hospital or an outside agency
(e.g., Peer Review Organization [PRO]).
Continuous Quality Improvement CQI - ANSWER a Key component of total quality mgmt that uses
rigorous, systematic, organization-wide processes to achieve ongoing improvement in the quality of
healthcare services and operation. It focuses on both outcomes and processes of care.
Effectiveness of Care - ANSWER The extent to which care is provided correctly (i.e., to meet the
patient's needs, improve quality of care, and resolve the pts problems), given the current state of
knowledge, and the desired outcome is achieved.
Efficacy of Care - ANSWER The potential, capacity or capability to produce the desired effect or
outcome, as already shown, e.g. through scientific research (evidence-based) findings.
Efficiency of Care - ANSWER The extent to which care is provided to meet the desired
effects/outcomes to improve quality of care and prevent the use of unnecessary resources.
Integrated Delivery System IDS - ANSWER A single organization or group of affiliated organizations
that provides a wide spectrum of ambulatory and tertiary care and services. Care may also be
provided across various settings of the healthcare continuum.
, Intensity of Service - ANSWER An acuity of illness criteria based on the evaluation/treatment plan,
interventions, and anticipated outcomes.
Intermediate Outcome - ANSWER A desired outcome that is met during a patient's hospital stay. It is
a milestone in the care of a patient or a trigger point for advancement in the plan of care.
Managed Competition - ANSWER A state of healthcare delivery in which a large number of
consumers choose among health plans that offer similar benefits. In theory, competition would be
based on cost and quality and ideally would limit high prices and improve quality of care.
Management Service Organization - ANSWER A management entity owned by a hospital, physician
organization, or third party. It contracts with payers and hospitals/physicians to provide certain
healthcare management services such as negotiating fee schedules and handling administrative
functions, including utilization management, billing, and collections.
Medical Loss Ratio MLR - ANSWER The ratio of healthcare costs to revenue received. Calculated as
total
medical expense divided by total revenue.
Medical Necessity on Admission - ANSWER A type of review used to determine that the hospital
admission is appropriate, clinically necessary, justified, and reimbursable.
Minimum Data Set MDS - ANSWER The assessment tool used in skilled nursing facility settings to
place patients into Resource Utilization Groups (RUGs), which determines the facilities
reimbursement rate.
Outcome and Assessment Information Set OASIS - ANSWER A prospective nursing assessment
instrument completed by home health agencies at the time the patient is entered for home health
services. Scoring determines the Home Health Resource Group (HHRG).
Outcome Indicators - ANSWER Measures of quality and cost of care. Metrics used to examine and
evaluate the results of the care delivered.
Outcomes Management - ANSWER The use of information and knowledge gained from outcomes
monitoring to achieve optimal patient outcomes through improved clinical decision making and
service delivery.
