CCM Exam Multiple Choice Questions
and Answers8
Rationale: COB does not coordinate benefits with workers compensation. COB is a voluntary
program that prevents double payment for services when the subscriber has health insurance
from more than one source. COB has rules to determine which insurer pays first.
Utilization management reviews services to ensure that:
A) each line item on a submitted claim is an appropriate charge
B) they are medically necessary, provided in the most appropriate care setting, and at or above
quality standards.
C) appropriate discharge planning is performed.
D) they are ordered by a physician, provided in the most appropriate care setting, and exceed
quality standards. - ANSWERS -Answer: B) they are medically necessary, provided in the most
appropriate care setting, and at or above quality standards.
Resource: CCMC Glossary of Terms
Rationale: Utilization Management: Review of services to ensure that they are medically
necessary, provided in the most appropriate care setting, and at or above quality standards.
The case managers role when working with clients with substance abuse is to:
A) Motivate the client to change.
B) Support the treatment plan and assist in finding resources.
C) Counsel the client.
, D) Monitor for substance use. - ANSWERS -Answer: B) Support the treatment plan and assist in
finding resources.
To meet the criteria of medical necessity all of the following should be present except:
A) It is reasonable
B) It is based on evidence-based standards of care
C) It is appropriate
D) It is custodial - ANSWERS -Answer: D) It is custodial
The Ambulatory Payment Classification System (APC) is used to determine payment rates for
which one of the following under Medicare?
A) Ambulatory surgery
B) Outpatient rehabilitation and ambulatory surgery
C) ER, hospital-based clinic, observation, and ambulatory surgery
D) Physician office visits - ANSWERS -Answer: C) ER, hospital-based clinic, observation and
ambulatory surgery
Rationale: The Ambulatory Payment Classification System (APC) is Medicare's prospective
payment system for the hospital-based clinic, ER, observation, and ambulatory surgery
encounter.
Which would be most appropriate for a 48-year-old nurse who has a broken leg as the result of
a work-related injury?
A) Work hardening
B) Work adjustment
C) Transitional Work Duty
D) Temporary Total Disability - ANSWERS -Answer: C) Transitional Work Duty
and Answers8
Rationale: COB does not coordinate benefits with workers compensation. COB is a voluntary
program that prevents double payment for services when the subscriber has health insurance
from more than one source. COB has rules to determine which insurer pays first.
Utilization management reviews services to ensure that:
A) each line item on a submitted claim is an appropriate charge
B) they are medically necessary, provided in the most appropriate care setting, and at or above
quality standards.
C) appropriate discharge planning is performed.
D) they are ordered by a physician, provided in the most appropriate care setting, and exceed
quality standards. - ANSWERS -Answer: B) they are medically necessary, provided in the most
appropriate care setting, and at or above quality standards.
Resource: CCMC Glossary of Terms
Rationale: Utilization Management: Review of services to ensure that they are medically
necessary, provided in the most appropriate care setting, and at or above quality standards.
The case managers role when working with clients with substance abuse is to:
A) Motivate the client to change.
B) Support the treatment plan and assist in finding resources.
C) Counsel the client.
, D) Monitor for substance use. - ANSWERS -Answer: B) Support the treatment plan and assist in
finding resources.
To meet the criteria of medical necessity all of the following should be present except:
A) It is reasonable
B) It is based on evidence-based standards of care
C) It is appropriate
D) It is custodial - ANSWERS -Answer: D) It is custodial
The Ambulatory Payment Classification System (APC) is used to determine payment rates for
which one of the following under Medicare?
A) Ambulatory surgery
B) Outpatient rehabilitation and ambulatory surgery
C) ER, hospital-based clinic, observation, and ambulatory surgery
D) Physician office visits - ANSWERS -Answer: C) ER, hospital-based clinic, observation and
ambulatory surgery
Rationale: The Ambulatory Payment Classification System (APC) is Medicare's prospective
payment system for the hospital-based clinic, ER, observation, and ambulatory surgery
encounter.
Which would be most appropriate for a 48-year-old nurse who has a broken leg as the result of
a work-related injury?
A) Work hardening
B) Work adjustment
C) Transitional Work Duty
D) Temporary Total Disability - ANSWERS -Answer: C) Transitional Work Duty
