CCM exam prep - all topics 2024 Correct Questions and Answers!

CCM exam prep - all topics 2024 Correct Questions and Answers! Case management - 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 - ANSWER characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. Glagow Coma Scale - 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 - 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 - ANSWER sees a disability as a construct of society Medicare Prospective Payment System - ANSWER hospitals paid a pre-determined rate for each Medicare admission. Each patient is classified into a DRG. PHQ-9 - ANSWER Client assessment tool for depression Braden Scale - ANSWER Client assessment tool for pressure sore risk Clinical Pathway - 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 - ANSWER Client assessment tool to measure physical and mental health. Medicare - 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 - 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 - ANSWER clinical/outcome financial functional/outcome satisfaction behavior process *episode or continuum **individual or population Measuring performance: Process - 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 - 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 - 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' - ANSWER ex. self-monitoring of blood sugar Measuring performance: Financial - ANSWER ex. fewer ED visits, ALOS decreased Women's Health and Cancer Rights Act of 1998 - 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 - 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 - 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 - 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