CCM exam prep - all topics questions
and answers91
Wheelchair passage width - ANSWERS -32" at a point and 36" continuously
mimimum wheelchair passing width - ANSWERS -60"
Wheelchair turning space - ANSWERS -60"
Case management - ANSWERS -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 - ANSWERS -characterized by advocacy, communication, and
resource management and promotes quality and cost-effective interventions and outcomes.
Glagow Coma Scale - ANSWERS -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 - ANSWERS -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 - ANSWERS -sees a disability as a construct of society
,Medicare Prospective Payment System - ANSWERS -hospitals paid a pre-determined rate for
each Medicare admission. Each patient is classified into a DRG.
PHQ-9 - ANSWERS -Client assessment tool for depression
Braden Scale - ANSWERS -Client assessment tool for pressure sore risk
Clinical Pathway - ANSWERS -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 - ANSWERS -Client assessment tool to measure physical and mental health.
Medicare - ANSWERS -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 - ANSWERS -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 - ANSWERS -clinical/outcome
financial
functional/outcome
satisfaction
behavior
process
,*episode or continuum
**individual or population
Measuring performance: Process - ANSWERS -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 - ANSWERS -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 - ANSWERS -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' - ANSWERS -ex. self-monitoring of blood sugar
Measuring performance: Financial - ANSWERS -ex. fewer ED visits, ALOS decreased
Women's Health and Cancer Rights Act of 1998 - ANSWERS -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 - ANSWERS -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 - ANSWERS -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 - ANSWERS -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 additional special enrollment periods. 7. reduce maximum HMO affiliation period to less
than 2 months.
Break in coverage - ANSWERS -63 days or longer that a subscriber has been without health
insurance coverage (not including waiting periods)
Waiting period - ANSWERS -period of time specified by health insurance contract that occurs
between signing up for insurance and the beginning of health insurance coverage. Cannot be
counted as creditible coverage time. Individuals can use COBRA from their previous employers
for health insurance
Establishing waiting period - ANSWERS -HIPAA does not prohibit plans from establishing a
waiting period. But the waiting period and the pre-existing conditions exclusions must start at
the same time and run concurrently.
Creditable Coverage - ANSWERS -For the purpose of the Health Insurance Portability and
Accountability Act, coverage under virtually any type indivual or group health care plan without
a break in coverage of 63 days or more. Cannot be taken into account when determining a
significant break in coverage. Only coverage after the 63 day break will be counted. Any
coverage before the 63 day break will not be considered.
COBRA - ANSWERS -Consolidated Omnibus Budget Reconciliation Act; law to provide
terminated employees or those who lose insurance coverage because of reduced work to be
able to buy group insurance for themselves and their families for a limited amount of time.
and answers91
Wheelchair passage width - ANSWERS -32" at a point and 36" continuously
mimimum wheelchair passing width - ANSWERS -60"
Wheelchair turning space - ANSWERS -60"
Case management - ANSWERS -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 - ANSWERS -characterized by advocacy, communication, and
resource management and promotes quality and cost-effective interventions and outcomes.
Glagow Coma Scale - ANSWERS -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 - ANSWERS -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 - ANSWERS -sees a disability as a construct of society
,Medicare Prospective Payment System - ANSWERS -hospitals paid a pre-determined rate for
each Medicare admission. Each patient is classified into a DRG.
PHQ-9 - ANSWERS -Client assessment tool for depression
Braden Scale - ANSWERS -Client assessment tool for pressure sore risk
Clinical Pathway - ANSWERS -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 - ANSWERS -Client assessment tool to measure physical and mental health.
Medicare - ANSWERS -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 - ANSWERS -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 - ANSWERS -clinical/outcome
financial
functional/outcome
satisfaction
behavior
process
,*episode or continuum
**individual or population
Measuring performance: Process - ANSWERS -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 - ANSWERS -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 - ANSWERS -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' - ANSWERS -ex. self-monitoring of blood sugar
Measuring performance: Financial - ANSWERS -ex. fewer ED visits, ALOS decreased
Women's Health and Cancer Rights Act of 1998 - ANSWERS -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 - ANSWERS -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 - ANSWERS -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 - ANSWERS -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 additional special enrollment periods. 7. reduce maximum HMO affiliation period to less
than 2 months.
Break in coverage - ANSWERS -63 days or longer that a subscriber has been without health
insurance coverage (not including waiting periods)
Waiting period - ANSWERS -period of time specified by health insurance contract that occurs
between signing up for insurance and the beginning of health insurance coverage. Cannot be
counted as creditible coverage time. Individuals can use COBRA from their previous employers
for health insurance
Establishing waiting period - ANSWERS -HIPAA does not prohibit plans from establishing a
waiting period. But the waiting period and the pre-existing conditions exclusions must start at
the same time and run concurrently.
Creditable Coverage - ANSWERS -For the purpose of the Health Insurance Portability and
Accountability Act, coverage under virtually any type indivual or group health care plan without
a break in coverage of 63 days or more. Cannot be taken into account when determining a
significant break in coverage. Only coverage after the 63 day break will be counted. Any
coverage before the 63 day break will not be considered.
COBRA - ANSWERS -Consolidated Omnibus Budget Reconciliation Act; law to provide
terminated employees or those who lose insurance coverage because of reduced work to be
able to buy group insurance for themselves and their families for a limited amount of time.
