CCM Exam Prep – All Topics | Complete Study Pack with
Verified Questions & Correct Answers | Latest Update
2025/2026
Case management correct 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 correct answers characterized by advocacy,
communication, and resource management and promotes quality and cost-effective
interventions and outcomes.
Glagow Coma Scale correct 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 correct 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 correct answers sees a disability as a construct of society
Medicare Prospective Payment System correct answers hospitals paid a pre-
determined rate for each Medicare admission. Each patient is classified into a DRG.
PHQ-9 correct answers Client assessment tool for depression
Braden Scale correct answers Client assessment tool for pressure sore risk
Clinical Pathway correct 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 correct answers Client assessment tool to measure physical and mental health.
Medicare correct 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 correct 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 correct answers clinical/outcome
financial
functional/outcome
satisfaction
behavior
process
*episode or continuum
**individual or population
Measuring performance: Process correct 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 correct 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 correct 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' correct answers ex. self-monitoring of
blood sugar
Measuring performance: Financial correct answers ex. fewer ED visits, ALOS
decreased
Women's Health and Cancer Rights Act of 1998 correct 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 correct 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 correct 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 correct 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 correct answers 63 days or longer that a subscriber has been without
health insurance coverage (not including waiting periods)
Waiting period correct 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 correct 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 correct 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 correct 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.
Certification of creditable coverage correct answers Documentation that is provided
automatically by the plan or issuer when the individual loses coverage or becomes
entitled to elect COBRA continuation coverage and when an individual's COBRA
continuation covearage ceases ; Be provided if requested before loss of coverage or
within 24 months of loss of coverage. May be provided through use of model certificate
Nondiscrimination requirements correct answers Inividuals cannot be excluded from
coverage under the terms of the plan based on specified factors related to health status.
Health plans cannot establish rules of eligibility based on healht status related factors"
such as health status, medical condition, claims experience, receipt of health care,
medical history, genetic information, evidence of insurability or disablity. Insurer cannot
drop a patient from coverage because it knows that the patient will require a liver
transplant next year. Cannot charge more for premiums based on health status.
, Security of health information and electronic signature standards correct answers
provides a uniform level of protection of all health information that is housed or
transmitted electronically. pertains to the individual.
Tax Equity and Fiscal Responsibility ACT of 1982 correct answers the purpose of this
act is to control the rising cost of providing health care services to medicare
beneficiaries and has incentives for cost containment. The act:1. established a case
based reimbursement system (DRG) payment system determined the cost of care for
selected diagnoses while also placing limits on rate increases in hospital venues. 2.
Exempted medical rehabilitation from DRGs. Rehabiliation would continue as a cost
based reimbursement system with limits. 3. Amended social security act so that group
health plans pay before medicare for active employees 65-69 years old and for their
spouses in the same age group. 4. revised Age discrimination act by requiring
employers to offer health benefits to active employees 65-69 and their spouses in the
same age bracket. 5. establish peer review organizations to reduce costs associated
with the hospital stays of medicare and medicaid patients. Also established hospice
benefit.
The Mental Health Parity Act of 1996 correct answers A statute that forbids health plans
from placing lifetime or annual limits on mental health coverage that are less generous
than those placed on medical or surgical benefits. Excluded substance abuse. If a plan
does cover mental health, it cannot set a separate dollar limit from medical care. Other
limits allowed: limited number of annual outpatient visits; Limited number of annual
inpatient days; a per visit fee; Higher deductibles and copayments without parity in
medical and surgical benefits. If a parity would require an increase of 1% or more in its
health care costs, the plan would be exempt.
The Pregnancy discrimination act correct answers is an amendment to Title VII stating
that employment discrimination based on pregnancy, childbirth, or related medical
conditions is prohibited as a form of sex discrimination
Newborns and Mother's Health Protection Act of 1996 correct answers Health plans
may not restrict benefits for any hospital length of stay in connection with child birth for
new born or her bother to less than 48 hours following a normal vaginal delivery or less
than 96 hours following a delivery by cesarean section. They may not require providers
to request for authorization for up to 48/96 hours . May not increase an individuals
coinsurance for any later portion of a 48 hour /96 hour hospital stay. 3. they cannot
provide monetary payments to encourage a mother to accept less than minimum
protections available under NMHPA. They cannot penalizeor other wise reduce or limit
the reimbursement of an attending provider because the provider furnished care to a
mother or newborn in accordance to NMHPA. They cannot provide monetary or other
incentives to an attending provier to induce the provider to furnish care to a mother or
new born in a manner inconsistent with the NMHPA.
Verified Questions & Correct Answers | Latest Update
2025/2026
Case management correct 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 correct answers characterized by advocacy,
communication, and resource management and promotes quality and cost-effective
interventions and outcomes.
Glagow Coma Scale correct 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 correct 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 correct answers sees a disability as a construct of society
Medicare Prospective Payment System correct answers hospitals paid a pre-
determined rate for each Medicare admission. Each patient is classified into a DRG.
PHQ-9 correct answers Client assessment tool for depression
Braden Scale correct answers Client assessment tool for pressure sore risk
Clinical Pathway correct 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 correct answers Client assessment tool to measure physical and mental health.
Medicare correct 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 correct 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 correct answers clinical/outcome
financial
functional/outcome
satisfaction
behavior
process
*episode or continuum
**individual or population
Measuring performance: Process correct 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 correct 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 correct 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' correct answers ex. self-monitoring of
blood sugar
Measuring performance: Financial correct answers ex. fewer ED visits, ALOS
decreased
Women's Health and Cancer Rights Act of 1998 correct 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 correct 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 correct 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 correct 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 correct answers 63 days or longer that a subscriber has been without
health insurance coverage (not including waiting periods)
Waiting period correct 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 correct 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 correct 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 correct 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.
Certification of creditable coverage correct answers Documentation that is provided
automatically by the plan or issuer when the individual loses coverage or becomes
entitled to elect COBRA continuation coverage and when an individual's COBRA
continuation covearage ceases ; Be provided if requested before loss of coverage or
within 24 months of loss of coverage. May be provided through use of model certificate
Nondiscrimination requirements correct answers Inividuals cannot be excluded from
coverage under the terms of the plan based on specified factors related to health status.
Health plans cannot establish rules of eligibility based on healht status related factors"
such as health status, medical condition, claims experience, receipt of health care,
medical history, genetic information, evidence of insurability or disablity. Insurer cannot
drop a patient from coverage because it knows that the patient will require a liver
transplant next year. Cannot charge more for premiums based on health status.
, Security of health information and electronic signature standards correct answers
provides a uniform level of protection of all health information that is housed or
transmitted electronically. pertains to the individual.
Tax Equity and Fiscal Responsibility ACT of 1982 correct answers the purpose of this
act is to control the rising cost of providing health care services to medicare
beneficiaries and has incentives for cost containment. The act:1. established a case
based reimbursement system (DRG) payment system determined the cost of care for
selected diagnoses while also placing limits on rate increases in hospital venues. 2.
Exempted medical rehabilitation from DRGs. Rehabiliation would continue as a cost
based reimbursement system with limits. 3. Amended social security act so that group
health plans pay before medicare for active employees 65-69 years old and for their
spouses in the same age group. 4. revised Age discrimination act by requiring
employers to offer health benefits to active employees 65-69 and their spouses in the
same age bracket. 5. establish peer review organizations to reduce costs associated
with the hospital stays of medicare and medicaid patients. Also established hospice
benefit.
The Mental Health Parity Act of 1996 correct answers A statute that forbids health plans
from placing lifetime or annual limits on mental health coverage that are less generous
than those placed on medical or surgical benefits. Excluded substance abuse. If a plan
does cover mental health, it cannot set a separate dollar limit from medical care. Other
limits allowed: limited number of annual outpatient visits; Limited number of annual
inpatient days; a per visit fee; Higher deductibles and copayments without parity in
medical and surgical benefits. If a parity would require an increase of 1% or more in its
health care costs, the plan would be exempt.
The Pregnancy discrimination act correct answers is an amendment to Title VII stating
that employment discrimination based on pregnancy, childbirth, or related medical
conditions is prohibited as a form of sex discrimination
Newborns and Mother's Health Protection Act of 1996 correct answers Health plans
may not restrict benefits for any hospital length of stay in connection with child birth for
new born or her bother to less than 48 hours following a normal vaginal delivery or less
than 96 hours following a delivery by cesarean section. They may not require providers
to request for authorization for up to 48/96 hours . May not increase an individuals
coinsurance for any later portion of a 48 hour /96 hour hospital stay. 3. they cannot
provide monetary payments to encourage a mother to accept less than minimum
protections available under NMHPA. They cannot penalizeor other wise reduce or limit
the reimbursement of an attending provider because the provider furnished care to a
mother or newborn in accordance to NMHPA. They cannot provide monetary or other
incentives to an attending provier to induce the provider to furnish care to a mother or
new born in a manner inconsistent with the NMHPA.
