This is Part 1 of the Certified Case
Manager (CCM) Exam Prep
Comprehensive Test Bank based on the
2025 CCMC Exam Blueprint by the
Commission for Case Manager
Certification.
TABLE OF CONTENTS - PART 1 of 5
Domain 1: Care Management - Questions 1-45
Domain 2: Reimbursement Methods - Questions 46-63
Domain 3: Psychosocial Concepts and Support Systems - Questions 64-78
Domain 4: Quality and Outcomes Evaluation and Measurements - Questions 79-88
Domain 5: Rehabilitation Concepts and Strategies - Questions 89-94
Domain 6: Ethical, Legal, and Practice Standards - Questions 95-100
DOMAIN 1: CARE MANAGEMENT
Q1. A case manager is assigned a new client with multiple chronic conditions and a recent hospital
discharge. What is the MOST appropriate FIRST step in the case management process?
Develop a client-centered plan of care based on a comprehensive assessment of needs.
Coordinate referrals to community-based support service agencies.
Perform a comprehensive assessment of needs including social, behavioral, and physical function.
Review the client's medication list for reconciliation and access issues.
Correct Answer: Perform a comprehensive assessment of needs including social, behavioral, and
physical function.
Rationale: Case management begins with assessment, which is the foundation for all planning
and coordination. Without a thorough understanding of needs, any plan would be incomplete.
,Coordinating referrals before assessment would be premature. Medication review is a component of
assessment, not the comprehensive first step.
Q2. A case manager is working with a client who has been readmitted three times in six months for
the same condition. What is the PRIORITY intervention?
Understand key aspects of transitions of care and care coordination through the continuum.
Apply cost containment principles to reduce unnecessary readmissions.
Perform a comprehensive assessment of needs including social determinants.
Collaborate with the interdisciplinary team to develop a discharge plan.
Correct Answer: Understand key aspects of transitions of care and care coordination through the
continuum.
Rationale: Repeated readmissions suggest a breakdown in transitions and coordination. The
case manager must first understand where transitions fail before intervening. Cost containment
follows coordination. Assessment is necessary but does not target the transition failure. Discharge
planning requires the transition knowledge first.
Q3. A case manager is developing a plan for a client with limited health literacy. What consideration
is MOST important?
Apply evidence-based case management models, processes, and tools.
Develop a client-centered plan that accounts for the client's learning needs and preferences.
Understand differences in and application of age-specific care.
Address medication management including access and education.
Correct Answer: Develop a client-centered plan that accounts for the client's learning needs and
preferences.
Rationale: Client-centered planning requires adapting to the client's literacy level. A plan that
ignores literacy will fail regardless of evidence base. Age-specific care is important but not the
priority here. Medication management is a component, not the overarching principle.
Q4. A client is medically stable but requires ongoing skilled nursing for wound care. What level of
care is MOST appropriate?
Inpatient acute care.
Observation status.
Outpatient wound care clinic.
Skilled nursing facility.
,Correct Answer: Skilled nursing facility.
Rationale: Ongoing skilled nursing exceeds outpatient capability. Inpatient acute care is not
required for a stable client. Observation is for short-term monitoring. An outpatient clinic cannot
provide continuous skilled nursing.
Q5. A client at end of life wishes to remain at home. What is the MOST appropriate action?
Understand palliative, hospice, and end-of-life care including chronic pain management.
Apply cost containment principles to the end-of-life plan.
Collaborate with community agencies to arrange home hospice.
Address medication management including access and reconciliation.
Correct Answer: Understand palliative, hospice, and end-of-life care including chronic pain
management.
Rationale: Understanding end-of-life care principles enables appropriate coordination. Cost
containment is not the priority at end of life. Collaboration follows understanding. Medication
management is a component, not the first step.
Q6. Which factor is MOST likely to affect a client's ability to manage a chronic condition?
The client's employment status and health insurance coverage.
The client's preferred hospital for emergency care.
The client's family history of the condition.
The client's level of formal education.
Correct Answer: The client's employment status and health insurance coverage.
Rationale: Employment and insurance directly affect access, affordability, and continuity.
Preferred hospital is a preference. Family history is a clinical risk factor. Education is relevant but less
determinative of access.
Q7. What is the MOST important factor for a successful hospital-to-home transition?
Understanding key aspects of transitions of care.
Developing a discharge plan that addresses the client's specific needs.
Coordinating with the interdisciplinary team.
Addressing medication reconciliation.
Correct Answer: Understanding key aspects of transitions of care.
, Rationale: Understanding transitions is the foundation for effective planning. Discharge
planning, team coordination, and medication reconciliation follow this understanding. None can be
effective without it.
Q8. Which reimbursement program is MOST relevant for a veteran client?
TRICARE.
Veterans Administration benefits.
Medicare.
Medicaid.
Correct Answer: Veterans Administration benefits.
Rationale: VA benefits are specifically for veterans. TRICARE is for active-duty military. Medicare
is age or disability based. Medicaid is income based. VA is the most directly relevant program.
Q9. What is the PRIMARY purpose of utilization review?
Apply utilization review principles, guidelines, and tools.
Determine if the hospital stay is medically necessary and appropriate.
Understand reimbursement and payment methodologies.
Apply cost containment principles.
Correct Answer: Determine if the hospital stay is medically necessary and appropriate.
Rationale: Utilization review evaluates medical necessity and appropriateness. Payment
methodology is context. Cost containment is secondary. Applying principles is the method, not the
goal.
Q10. Which resource is MOST appropriate for a client needing a wheelchair and home modifications?
Waiver programs.
Special needs trusts.
Private benefit programs.
Accountable care organizations.
Correct Answer: Waiver programs.
Rationale: Home and community-based waivers fund equipment and home modifications.
Special needs trusts manage assets. Private benefits may cover some equipment. ACOs are payment
models, not direct resources.
Manager (CCM) Exam Prep
Comprehensive Test Bank based on the
2025 CCMC Exam Blueprint by the
Commission for Case Manager
Certification.
TABLE OF CONTENTS - PART 1 of 5
Domain 1: Care Management - Questions 1-45
Domain 2: Reimbursement Methods - Questions 46-63
Domain 3: Psychosocial Concepts and Support Systems - Questions 64-78
Domain 4: Quality and Outcomes Evaluation and Measurements - Questions 79-88
Domain 5: Rehabilitation Concepts and Strategies - Questions 89-94
Domain 6: Ethical, Legal, and Practice Standards - Questions 95-100
DOMAIN 1: CARE MANAGEMENT
Q1. A case manager is assigned a new client with multiple chronic conditions and a recent hospital
discharge. What is the MOST appropriate FIRST step in the case management process?
Develop a client-centered plan of care based on a comprehensive assessment of needs.
Coordinate referrals to community-based support service agencies.
Perform a comprehensive assessment of needs including social, behavioral, and physical function.
Review the client's medication list for reconciliation and access issues.
Correct Answer: Perform a comprehensive assessment of needs including social, behavioral, and
physical function.
Rationale: Case management begins with assessment, which is the foundation for all planning
and coordination. Without a thorough understanding of needs, any plan would be incomplete.
,Coordinating referrals before assessment would be premature. Medication review is a component of
assessment, not the comprehensive first step.
Q2. A case manager is working with a client who has been readmitted three times in six months for
the same condition. What is the PRIORITY intervention?
Understand key aspects of transitions of care and care coordination through the continuum.
Apply cost containment principles to reduce unnecessary readmissions.
Perform a comprehensive assessment of needs including social determinants.
Collaborate with the interdisciplinary team to develop a discharge plan.
Correct Answer: Understand key aspects of transitions of care and care coordination through the
continuum.
Rationale: Repeated readmissions suggest a breakdown in transitions and coordination. The
case manager must first understand where transitions fail before intervening. Cost containment
follows coordination. Assessment is necessary but does not target the transition failure. Discharge
planning requires the transition knowledge first.
Q3. A case manager is developing a plan for a client with limited health literacy. What consideration
is MOST important?
Apply evidence-based case management models, processes, and tools.
Develop a client-centered plan that accounts for the client's learning needs and preferences.
Understand differences in and application of age-specific care.
Address medication management including access and education.
Correct Answer: Develop a client-centered plan that accounts for the client's learning needs and
preferences.
Rationale: Client-centered planning requires adapting to the client's literacy level. A plan that
ignores literacy will fail regardless of evidence base. Age-specific care is important but not the
priority here. Medication management is a component, not the overarching principle.
Q4. A client is medically stable but requires ongoing skilled nursing for wound care. What level of
care is MOST appropriate?
Inpatient acute care.
Observation status.
Outpatient wound care clinic.
Skilled nursing facility.
,Correct Answer: Skilled nursing facility.
Rationale: Ongoing skilled nursing exceeds outpatient capability. Inpatient acute care is not
required for a stable client. Observation is for short-term monitoring. An outpatient clinic cannot
provide continuous skilled nursing.
Q5. A client at end of life wishes to remain at home. What is the MOST appropriate action?
Understand palliative, hospice, and end-of-life care including chronic pain management.
Apply cost containment principles to the end-of-life plan.
Collaborate with community agencies to arrange home hospice.
Address medication management including access and reconciliation.
Correct Answer: Understand palliative, hospice, and end-of-life care including chronic pain
management.
Rationale: Understanding end-of-life care principles enables appropriate coordination. Cost
containment is not the priority at end of life. Collaboration follows understanding. Medication
management is a component, not the first step.
Q6. Which factor is MOST likely to affect a client's ability to manage a chronic condition?
The client's employment status and health insurance coverage.
The client's preferred hospital for emergency care.
The client's family history of the condition.
The client's level of formal education.
Correct Answer: The client's employment status and health insurance coverage.
Rationale: Employment and insurance directly affect access, affordability, and continuity.
Preferred hospital is a preference. Family history is a clinical risk factor. Education is relevant but less
determinative of access.
Q7. What is the MOST important factor for a successful hospital-to-home transition?
Understanding key aspects of transitions of care.
Developing a discharge plan that addresses the client's specific needs.
Coordinating with the interdisciplinary team.
Addressing medication reconciliation.
Correct Answer: Understanding key aspects of transitions of care.
, Rationale: Understanding transitions is the foundation for effective planning. Discharge
planning, team coordination, and medication reconciliation follow this understanding. None can be
effective without it.
Q8. Which reimbursement program is MOST relevant for a veteran client?
TRICARE.
Veterans Administration benefits.
Medicare.
Medicaid.
Correct Answer: Veterans Administration benefits.
Rationale: VA benefits are specifically for veterans. TRICARE is for active-duty military. Medicare
is age or disability based. Medicaid is income based. VA is the most directly relevant program.
Q9. What is the PRIMARY purpose of utilization review?
Apply utilization review principles, guidelines, and tools.
Determine if the hospital stay is medically necessary and appropriate.
Understand reimbursement and payment methodologies.
Apply cost containment principles.
Correct Answer: Determine if the hospital stay is medically necessary and appropriate.
Rationale: Utilization review evaluates medical necessity and appropriateness. Payment
methodology is context. Cost containment is secondary. Applying principles is the method, not the
goal.
Q10. Which resource is MOST appropriate for a client needing a wheelchair and home modifications?
Waiver programs.
Special needs trusts.
Private benefit programs.
Accountable care organizations.
Correct Answer: Waiver programs.
Rationale: Home and community-based waivers fund equipment and home modifications.
Special needs trusts manage assets. Private benefits may cover some equipment. ACOs are payment
models, not direct resources.
