CERTIFIED CASE MANAGER EXAM 2024-
2025 WITH COMPLETE QUESTIONS AND
ACCURATE ANSWERS RATED A+
Attending Physician Correct Answer The physician primarily
responsible for the inpatient health care of an individual.
AWP Correct Answer Two definitions: "Average wholesale price"
is a calculation used to determine reimbursements for
pharmacies. "Any willing provider" are contractors under HMO
(Health Maintenance Organization) contracts who meet their
provider conditions.
Adverse Selection Correct Answer A group of individuals who
because of socio-economic, regional or cultural criteria are
enrolled in a health plan.
This group is usually experiencing more health issues than the
norm.
Ancillary Providers Correct Answer A subset of care providers
including non-physician providers such as rehabilitation,
transportation, dialysis, etc.
Bed Days Correct Answer The term used to designate length of
hospital stays.
Bed Days per Thousand Correct Answer A hospital management
calculation which factors beds used and days available per 1,000
members.
Bundling Correct Answer The simultaneous billing or contracting
of more than one service
, Capitation Correct Answer The practice of providers supplying
health services to a group for a fixed and prepaid price.
Carve-out Correct Answer Services that are administered and
contracted outside of the primary medical group such as
pharmacy, optical, dental, and mental health.
Co-insurance Correct Answer In addition to the monthly premium
received by an insurer, the co-insurance is paid by the insured
and covers 10-20% of the health care expense.
Co-payment Correct Answer A portion of the cost of services
paid by the insured at the time of services. Amount varies
depending on plan and service provided.
COBRA Correct Answer The 1986 Consolidated Omnibus
Budget Reconciliation Act which allows former employees to
continue healthcare coverage for a limited time through the group
rates of the employer.
Community Rating Correct Answer Group rates of insurance
where each individual in a group pays the same premium based
on projected revenue and expenses of the community in general.
Concurrent Review Correct Answer The process of determining
the
appropriateness of hospital care at the time of service.
Current Procedural Terminology (CPT) Correct Answer A
systematic coding of medical
procedures used for records and
billing.
2025 WITH COMPLETE QUESTIONS AND
ACCURATE ANSWERS RATED A+
Attending Physician Correct Answer The physician primarily
responsible for the inpatient health care of an individual.
AWP Correct Answer Two definitions: "Average wholesale price"
is a calculation used to determine reimbursements for
pharmacies. "Any willing provider" are contractors under HMO
(Health Maintenance Organization) contracts who meet their
provider conditions.
Adverse Selection Correct Answer A group of individuals who
because of socio-economic, regional or cultural criteria are
enrolled in a health plan.
This group is usually experiencing more health issues than the
norm.
Ancillary Providers Correct Answer A subset of care providers
including non-physician providers such as rehabilitation,
transportation, dialysis, etc.
Bed Days Correct Answer The term used to designate length of
hospital stays.
Bed Days per Thousand Correct Answer A hospital management
calculation which factors beds used and days available per 1,000
members.
Bundling Correct Answer The simultaneous billing or contracting
of more than one service
, Capitation Correct Answer The practice of providers supplying
health services to a group for a fixed and prepaid price.
Carve-out Correct Answer Services that are administered and
contracted outside of the primary medical group such as
pharmacy, optical, dental, and mental health.
Co-insurance Correct Answer In addition to the monthly premium
received by an insurer, the co-insurance is paid by the insured
and covers 10-20% of the health care expense.
Co-payment Correct Answer A portion of the cost of services
paid by the insured at the time of services. Amount varies
depending on plan and service provided.
COBRA Correct Answer The 1986 Consolidated Omnibus
Budget Reconciliation Act which allows former employees to
continue healthcare coverage for a limited time through the group
rates of the employer.
Community Rating Correct Answer Group rates of insurance
where each individual in a group pays the same premium based
on projected revenue and expenses of the community in general.
Concurrent Review Correct Answer The process of determining
the
appropriateness of hospital care at the time of service.
Current Procedural Terminology (CPT) Correct Answer A
systematic coding of medical
procedures used for records and
billing.
