CCM Exam 196 Questions with Verified Answers,100% CORRECT

CCM Exam 196 Questions with Verified Answers ACCOUNTABLE CARE ORGANIZATION (ACO) - CORRECT ANSWER A set of healthcare providers including primary care physicians, specialists, and hospitals that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients. ACTIVE LISTENING - CORRECT ANSWER A structured way of communication and interacting in which one is actively engaged with the speaker primarily through focused attention and suspension of one's own frame of reference, biases, distractions and judgment. A communication technique that improves personal relationships, fosters understanding, and facilitates cooperation and collaboration and eliminates conflict acuity - CORRECT ANSWER Complexity and severity of the client's health/medical condition What type of analysis would be demonstrated by saving 60 fewer infection days? - CORRECT ANSWER Cost-Effective Analaysis What type of case management model roles would communicate with the payor and make sure services are medically necessary and at/above quality standards? - CORRECT ANSWER Utilization Management What type of case management model role would move members through acute care in a timely manner? - CORRECT ANSWER Patient Flow What type of case management model role would move patients to the next level of care ensuring services are in place before discharge? - CORRECT ANSWER Discharge Planning T/F CM is the area of nursing and NOT Health and Human Services. - CORRECT ANSWER F T/F CM is in the area of Health and Human Services and NOT nursing. - CORRECT ANSWER T CM's often use "dashboards" to assist meeting CM goals, patient needs and need of CM clients. Dashboards are similar to a _______________. - CORRECT ANSWER Report Cards ___________provide executive-summary level reports of the CM program. - CORRECT ANSWER Cost-Benefit Analysis Name the 3 type of CM roles (ex. Single CM, RN and SW and RN, SW, and UM). - CORRECT ANSWER Integrative, Dyad, Triad/Collaborative Integrated CM is a ___________CM that assists with all barriers to health. - CORRECT ANSWER Primary T/F In Integrated CM, the single CM does all patient flow, UM and DCP. - CORRECT ANSWER T Dyad Model of CM is when _____ and ____ co-manage the patient. - CORRECT ANSWER SW and RN In the dyad model what does the RN do and what does the SW do? - CORRECT ANSWER RN - Clinical Information/Education; SW - Social, Financial, Discharge Needs In the triad model/collaborative model, the ____, _____, and ____ manage the patient. - CORRECT ANSWER SW, RN, UM The ________of care links ongoing needs of the individual with appropriate level of services. - CORRECT ANSWER Continuum of Care T/F The role of the RN varies across the continuum of care. - CORRECT ANSWER T What is the role of the RN across the continuum of care? - CORRECT ANSWER Ensure Continuity ___________involve transfer of information across different settings to minimize the risk of adverse events. - CORRECT ANSWER Transitions of Care ________is the care received by a patient over time and over multiple providers/settings. - CORRECT ANSWER Continuity of Care ________is assessing patient's needs after discharge to home/elsewhere. - CORRECT ANSWER Discharge Planning ____________is the assessment of patient's capacity to manage their own needs. - CORRECT ANSWER Functional Status Interdisciplinary or Interprofessional Care Team: Each discipline creates its own assignment/treatment plan. - CORRECT ANSWER Interdisciplinary Interdisciplinary or Interprofessional Care Team: May/may not report back to the team. - CORRECT ANSWER Interdisciplinary Interdisciplinary or Interprofessional Care Team: Team works INDEPENDENTLY to help the patient. - CORRECT ANSWER Interdisciplinary Interdisciplinary or Interprofessional Care Team: Each person is focused on their OWN discipline plan of care. - CORRECT ANSWER Interdisciplinary Interdisciplinary or Interprofessional Care Team: Makes a joint plan. - CORRECT ANSWER Interprofessional Interdisciplinary or Interprofessional Care Team: Assesses where they each overlap/gap and collaborates. - CORRECT ANSWER Interprofessional Interdisciplinary or Interprofessional Care Team: Team discussions on group process and working relationship of people with various expertise. - CORRECT ANSWER Interprofessional Disease Management or Case Management: Focus on groups of people with diagnosis that are of high cost. - CORRECT ANSWER Disease Managment Disease Management or Case Management: Goal is reaching them at the earliest time of diagnosis to decrease complications and prevent fragmentation. - CORRECT ANSWER Disease Managment Disease Management or Case Management: AKA Condition management to care for a certain population. - CORRECT ANSWER Disease Managment Disease Management or Case Management: Individual management - CORRECT ANSWER CM Disease Management or Case Management: Increased need and those with comorbidities. - CORRECT ANSWER CM Disease Management or Case Management: Management does not mean monitoring. - CORRECT ANSWER CM _________approach is healthcare management focuses on needs of specific patient or groups of patients with similar problems. - CORRECT ANSWER Targeted ___________care is uncoordinated care given via multiple clinicians/organizations. - CORRECT ANSWER Fragmented What is healthcare management that focuses on the needs of specific patients or groups of patients with similar problems? - CORRECT ANSWER Targeted approach When are the 3 times there is termination of CM? - CORRECT ANSWER Max allowable benefit; goals met; client wishes What type of CM role identifies existing/potential health problems by assessing physical, psychological, financial, and spiritual and develops a plan of care to identify key tasks and treatment required for patient's goals? - CORRECT ANSWER Client-Patient What type of CM role is to facilitate, coordinate and expedite care while ill, collaborate with interdisciplinary team to determine LOS and schedule/follow-up on tasks? - CORRECT ANSWER Managerial-Leadership What type of CM role is directed to cost containment/DRG/CPT? - CORRECT ANSWER Financial/Business What type of CM role is to communicate, teach, reinforce, and evaluate function of health care system? - CORRECT ANSWER Information Management What type of CM role is to network, politically voice and advocate for health? - CORRECT ANSWER Professional Development Where is the acute care management model done? - CORRECT ANSWER Hospital Name the 5 "based" acute care management models. - CORRECT ANSWER Unit, Complete, Disease, Practice, Primary Which acute care management model is patients on a specific unit? - CORRECT ANSWER Unit Which acute care management model is admission to discharge? - CORRECT ANSWER Complete Which acute care management model is following the patient according to illness? - CORRECT ANSWER Disease Which acute care management model is according to the physician? - CORRECT ANSWER Practice Which acute care management model is primary nurse following throughout hospitalization? - CORRECT ANSWER Primary Name the 6 domains of Case Management. - CORRECT ANSWER CM principles/strategies; CM Concepts; Healthcare Reimbursement; Healthcare Management/Delivery; Vocational Concepts What are the 4 key functions of a CM? - CORRECT ANSWER Plan, Assess, Facilitate, Advocate Which function of CM is coordinating/implementing the care plan, maintaining communication and expediting care. - CORRECT ANSWER Facilitator Which function of CM ensures client's needs are identified and addressed? - CORRECT ANSWER Assessor Which function of CM regards long/short term goals in collaboration with the client, client's family and practitioners. - CORRECT ANSWER Planner Is health coaching primary or secondary prevention? If so, why? - CORRECT ANSWER Secondary; disease is already there What is the goal of health coaching? - CORRECT ANSWER Lessen impact of dx/manage the disease One's own ________________ = one's belief in their own ability to succeed. - CORRECT ANSWER Self-efficacy Which kind of planning analyzes the needs of present and future needs through the life expectancy. - CORRECT ANSWER Life-Care planning Which kind of planning is used by attorneys to identify and determine future costs for the client and is the groundwork for settlements (personal/medical liability) - CORRECT ANSWER Life-Care planning T/F Life-Care planning is usually done for those who are able to manage INDEPENDENTLY. - CORRECT ANSWER F ________is an assessment tool to identify function of self-care/level of independence and determines limitations. - CORRECT ANSWER ADL In reference to ADL's, define DEATH. - CORRECT ANSWER Dress; Eat; Ambulate; Toilet; Hygiene What is the definition of iADL's? - CORRECT ANSWER Instrumental activities of daily living What are the skills needed to maintain independent living that requires cognitive, emotional and physical capacity. - CORRECT ANSWER iADL's What is POMA and what is it used for? - CORRECT ANSWER Assess mobility, gait, and balance ___________are cognitive abilities that allow a person to prioritize and plan. - CORRECT ANSWER Executive Functions Name the 5 stages of change. - CORRECT ANSWER precontemplation, contemplation, preparation, action, maintenance This stage of change is NO intention to take action on health/any other goal. - CORRECT ANSWER Precontemplation This stage of change is when a person may consider change in the next 6 months but is not committed to it. - CORRECT ANSWER Contemplation This stage of change is when a person plans to actively change in the next 1 month. - CORRECT ANSWER Preparation This stage of change is when a person has made and stuck with a change for at least 6 months. - CORRECT ANSWER Active This stage of change is when a person has stuck with a change for 6+months. - CORRECT ANSWER Maintenance Name the 3 components of the health triangle. - CORRECT ANSWER Emotional, Physical, Social _____________is the exchanging of ideas, thoughts and feelings between individuals. - CORRECT ANSWER Interpersonal communication Name 3 types of interpersonal communication. - CORRECT ANSWER Dyadic, Group, Public This type of interpersonal communication involves 2 people. - CORRECT ANSWER Dyadic This type of interpersonal communication involves 3+ people. - CORRECT ANSWER Group This type of interpersonal communication involves large groups of people. - CORRECT ANSWER Public __________is a fundamental part of interpersonal communication that's focused on attention and suspension of one's own frame of reference. - CORRECT ANSWER Active Listening Name the 4 components of communication. - CORRECT ANSWER Sender, Message, Context, Reciever ___________is a client-centered approach to allow a client to discover motivation for change and is designed to avoid confrontation. - CORRECT ANSWER Motivational Interviewing What is OARS? - CORRECT ANSWER Open ended questions Affirmations Reflections Summaries This part of OARS motivational interviewing starts with "how" "what" "tell me about" - CORRECT ANSWER Open-Ended questions This part of OARS motivational interviewing involves helping the client see themselves in a positive way and acknowledges and supports the client's struggles and hard work - CORRECT ANSWER Affirmations This part of OARS motivational interviewing involves resolving ambivalence, demonstrating interest, empathy, and understanding. Helps member to clarify, manage conflict, and explore reason for change. - CORRECT ANSWER Reflections This part of OARS motivational interviewing involves the client hearing a rundown of their own concerns and opportunities to correct errors in understanding. - CORRECT ANSWER Summaries What is evocation in regards to Motivational Interviewing? - CORRECT ANSWER drawing out client's ideas for solution to the problem What type of barrier to communication involves distractions of background noise, non-private setting? - CORRECT ANSWER Physical Interference What type of barrier to communication involves pain, hunger, anxiety, etc? - CORRECT ANSWER Physiological Interference What type of barrier to communication involves cognitive defects and information overload? - CORRECT ANSWER Barriers to Process Information What type of barrier to communication involves prejudices, culture, etc? - CORRECT ANSWER Perceptual Barriers What type of barrier to communication involves difficulty reaching a person? - CORRECT ANSWER Structural Barriers Name the 5 types of conflict resolution. - CORRECT ANSWER Collaboration Negotiation Accomodation Competitive Avoidance This type of conflict resolution meets the needs of ALL parties. - CORRECT ANSWER Collaboration This type of conflict resolution is PARTIAL win for all. - CORRECT ANSWER Negotiation Name the 2 types of negotiation in conflict resolution. - CORRECT ANSWER Hardball/Aggressive Cooperative This type of negotiation aims to result in a winner/loser. - CORRECT ANSWER Hardball/Aggressive This type of negotiation seeks win-win outcome and results best for everyone. - CORRECT ANSWER Cooperative This type of conflict resolution meets the needs of the OTHER party at the expense of own needs. - CORRECT ANSWER Accomodation This type of conflict resolution takes a firm stand and is used in fast decisions. - CORRECT ANSWER Competitive This type of conflict resolution AVOIDS conflict by allowing default action. - CORRECT ANSWER Avoidance What is the MOST desirable type of conflict resolution and the LEAST desirable? - CORRECT ANSWER Collaborative; Avoidance What does negotiation start with? - CORRECT ANSWER Preparation What's the best way to approach negotiating? - CORRECT ANSWER Est problems and goals with the other party, determine areas you agree on and work towards compromise ___________describes the knowledge, skills, ability, confidence a person has that allows them to become actively engaged in managing their own health. - CORRECT ANSWER Client/Patient Activation T/F Client/Patient activation is NOT very specific necessarily to the client. - CORRECT ANSWER F Name and describe the 4 levels of client/patient activation? - CORRECT ANSWER 1 - Overwhelmed/Disengaged 2 - Increase awareness but lack knowledge 3 - begin to take action 4 - knows importance of self-management What is PAM? - CORRECT ANSWER Patient Activation Measure Name 2+ activation barriers. - CORRECT ANSWER Not ready Don't think they can change Don't have a plan Don't have support _________builds on client activation and is doing the work of patient activation (ex. Exercising regularly, obtaining preventative care, etc). - CORRECT ANSWER Client Engagement _________is the ability to understand basic health information. - CORRECT ANSWER Health Literacy _________is considered the NEWEST vital sign and is a tool that tests literacy skills for both ____ & ____. - CORRECT ANSWER Health Literacy ICD stands for ______________________________. - CORRECT ANSWER international classification of diseases What do ICD codes tell you? - CORRECT ANSWER Diagnosis/reason for encounter THE PROBLEM __________are alphanumeric designations that represent diseases or conditions - CORRECT ANSWER ICD _______ are used to determine DRG which determines ___________. - CORRECT ANSWER ICD; Reimbursement T/F. ICD codes are a standard diagnosis code used by all providers around the world. - CORRECT ANSWER T ICD-10-PCS. PCD is defined as ____________________ and is the __________ ___________ _______ ______. - CORRECT ANSWER Procedural Coding System; Inpatient hospital procedural code What does CPT stand for? It is used to describe the ________ or _________ provided. - CORRECT ANSWER Current procedural terminology Treatment provided/clinical procedures ____________is the numeric code that describes a diagnostic, medical or surgical service and procedure for the benefit of physicians, coders and payers. - CORRECT ANSWER The ________ and _______ work hand-in-hand to provide information about what service was performed and why. Which is which? - CORRECT ANSWER ICD; CPT T/F CPT codes are used for reporting medical services/procedures for billing purposes. - CORRECT ANSWER T ___________is when a billing code makes a patient sound more severely ill than he really is. Consistently doing this is _____________. - CORRECT ANSWER Upcoding; fraud T/F If a patient has been admitted to rule out a suspected condition - CM should code symptoms until a definitive diagnosis is made. - CORRECT ANSWER T Define DRG - CORRECT ANSWER diagnosis-related group ___________are Medicare for inpatient services in an attempt to control costs. - CORRECT ANSWER DRG T/F Patient is placed in a DRG for admission and is billed for each procedure/IP day. - CORRECT ANSWER F; Not for each day or procedure; "bundled" instead T/F DRG does not combine factors including ICD-10 codes. - CORRECT ANSWER F T/F In a DRG, patient's are classified in groups by illness, condition based on secondary/primary diagnosis, age, needs, comorbidities, etc. - CORRECT ANSWER T T/F In a DRG, there is no specific average value or amount of resources necessary for patients in that group. - CORRECT ANSWER F What is CMI defined? - CORRECT ANSWER Case Mix Index ___________of a hospital is used to adjust the average cost per patient (or cost per patient per day) relative to other facilities adjusted average cost. - CORRECT ANSWER CMI T/F A lower CMI means a more complex and resource-intensive case load of patients that will be reimbursed. - CORRECT ANSWER F T/F A high CMI means a more complex and resource intensive case load of patients and will be reimbursed at a higher rate. - CORRECT ANSWER T What is used by CMS to determine hospital reimbursement rates for Medicare/Medicaid beneficiaries to adjust the average cost per patient? - CORRECT ANSWER CMI T/F CMI reflects diversity, complexity and severity of patient illnesses treated at a given hospital/healthcare facility. - CORRECT ANSWER T Define IRF-PPS. - CORRECT ANSWER Inpatient Rehabilitation Facility Prospective Payment System What is the 60% rule? - CORRECT ANSWER IRF 60% rule is intended to distinguish IRFs from other inpatient hospital settings of care The 60% rule specifies that an IRF's patient population must consist of at least 60% of the patients who need intensive rehabilitation services for one or more of 13 specified conditions SOON WILL BE 75% What happens if an Inpatient rehab hospital or unit doesn't comply with the 60% rule? - CORRECT ANSWER Lose IRF payment classification Define ACG - CORRECT ANSWER Adjusted clinical group In order to qualify for CMS coverage of rehab care in an inpatient rehab hospital or rehab unit of an acute hospital for a knee/hip replacement, patient must meet what 3 criteria? - CORRECT ANSWER BMI 50+ Bilateral knee/hip replacement >85 years old ______is a measure of morbidity and to identify patients at highest risk to predict utilization of services to set equitable rates for reimbursement on outpatient basis - CORRECT ANSWER ACG _____is a risk adjustment system that classifies people according to their sex, age, and medical condition. These people have a similar consumption of health resources over a given period of time outpatiently. - CORRECT ANSWER ACG T/F An ACG is used on an inpatient structure. - CORRECT ANSWER F _______indicates how sick a patient is, level of appropriate care and treatment necessary. - CORRECT ANSWER Severity of illness Name and define the 4 levels of severity of illness. - CORRECT ANSWER Acute - w/i 24 hrs Recent - 2/i 1 week New Onset - >1 week Newly Discovered - during this illness period What is the intensity of service? - CORRECT ANSWER services for each SI category ___________is the physical or psychological support for caregivers of those with chronic disease. - CORRECT ANSWER Respite __________is a preexisting condition that extends LOS by at least 1 day in 75% of cases. - CORRECT ANSWER Comorbidity ___________is a condition that occurs during the hospital stay that increases LOS by at least 1 day in 75% of cases. - CORRECT ANSWER Complication Which level of care would be appropriate for someone that may need would care after hospitalization, does not need diagnostic workup, is medically stable, that's a step up from acute and a step down from SNF? - CORRECT ANSWER Subacute Care This type of person would need 3-30 days of rehab and nursing services 5-8 hr/day. - CORRECT ANSWER Transitional Subacute This type of person would need 10-40 days of rehab and nursing services 3-5 hours/day. - CORRECT ANSWER General subacute This type of person would need 60-90 days of rehab and nursing services 3-5 hours/day. - CORRECT ANSWER chronic subacute This type of person would need >25 days of rehab and nursing services 6-9 hours/day. - CORRECT ANSWER Long-term transitional subacute Which level of care would be appropriate for someone needing intense multidisciplinary therapy that can tolerate 3+ hours of therapy 5-7 days per week and is medically stable? - CORRECT ANSWER Inpatient Rehab Where can an inpatient rehab be? - CORRECT ANSWER acute care hospital; long-term acute care hospital Define and describe a IRF-PAI. - CORRECT ANSWER Inpatient rehab facility patient assessment instrument determines rate of pay for patients admitted to rehab hospitals What type of care would be appropriate for >25 days + with no upper limit on LOS, can be freestanding or inside a hospital requiring acute care. - CORRECT ANSWER LTAC What is LTAC/LTAH? - CORRECT ANSWER Long-term acute care/hospital T/F In a subacute care facility, the person may/may not be medically stable. - CORRECT ANSWER F What type of care facility is 24-hr nursing and personal care, is complex but generally stable and is less intense than IP rehab, where care is driven by the nurses and not the doctors. - CORRECT ANSWER SNF T/F At a SNF, they are required to tolerate 3+ hours of therapy/day. - CORRECT ANSWER F T/F A physician is required to visit a SNF patient daily. - CORRECT ANSWER F A SNF like a nursing home is an example of a ________. - CORRECT ANSWER Extended care facility (ECF) What level of assistance is more assistance than custodial care, not covered by most insurance companies, is medically stable but requires some nursing interventions to maintain stability. - CORRECT ANSWER Intermediate Home Health Care is considered what level of assistance? - CORRECT ANSWER Intermediate Home Health requires a physician to review the plan of care every _____days and the member must be deemed ______________ for Medi_____ approval. - CORRECT ANSWER 60; home bound, CARE In a _____________, a person may receive intensive rehab of a day program or be outpatient, or receive home health. These are all examples. - CORRECT ANSWER Community Medical Rehab In a ________program, a person is in intensive rehab several hours/day but does not need to be IP. - CORRECT ANSWER Day Program In this program, a person attends rehab 30 min-1 hour and goes home the same day. - CORRECT ANSWER Outpatient Rehab T/F Custodial care requires a licensed professional. - CORRECT ANSWER F T/F In an assisted living home, a person can receive medical care. - CORRECT ANSWER F T/F Assisted living is generally covered by insurance. - CORRECT ANSWER F What is aging in place? - CORRECT ANSWER Choose to stay at own living environment despite physical/mental decline In this facility, a person has been unsuccessful with OP treatment but is not appropriate for IP treatment with Drugs/Addiction - CORRECT ANSWER Residential Treatment Facility T/F In a group home, they get support, therapy and training while living in a community, assisted with ADL's and BH problems. - CORRECT ANSWER T T/F In a developmentally disabled group home, members can get 24/7 care. - CORRECT ANSWER T ______are designed for Altzheimer's patients while a family works outside the home and is fairy cost effective - CORRECT ANSWER Adult Day Care _____are health focused programs with RN's, PT, OT and are a day program. - CORRECT ANSWER Adult Day Heathcare programs Hospice or palliative care: end of life care with equal attention to physical, spiritual and psych care. - CORRECT ANSWER Hospice Hospice or palliative care: Pt has terminal illness with life expectancy of <6 months. - CORRECT ANSWER Hospice T/F If a patient in hospice lives >6 months, a physician can extend the coverage every 90 days. - CORRECT ANSWER F - every 60 days T/F In hospice, room and board is NOT covered. - CORRECT ANSWER T T/F In hospice, DNR must be enacted before enrollment - CORRECT ANSWER F Hospice or palliative care: relieve symptoms and can be used in conjunction with primary treatment that can potentially cure. - CORRECT ANSWER Palliative Hospice or palliative care: NOT dependent on prognosis - CORRECT ANSWER Palliative Hospice or palliative care: Started EARLY on in the diagnosis - CORRECT ANSWER Palliative ADA - CORRECT ANSWER Americans with Disabilities Act Administrative Law - CORRECT ANSWER That branch of public law that deals with the various organizations of federal, state, and local governments which prescribes in detail the manner of their activities ADMINISTRATIVE SERVICE - CORRECT ANSWER An insurance company or third party administrator (TPA) that delivers administrative services to an employer group. This usually requires the employer to be at risk for the cost of healthcare services provided, which the ASO processes and manages claims Which is billed under hospitalization? LTAC or Subacute - CORRECT ANSWER LTAC