CCM-CHAPTER ONE: CARE DELIVERY AND
REIMBURSEMENT METHODS EXAM WITH ALL CORRECT
& 100% VERIFIED ANSWERS|ALREADY GRADED A+
Payer-based Settings, including public health insurance programs ✔Correct Answer-Medicare,
Medicaid, and state-funded programs
Payer-based Settings, private health insurance program ✔Correct Answer-Occupational health,
disability, group health insurance, managed care organization
Palliative care, home care, and hospice case managers combine the role of caregiver with case
manager. In addition to hands-on nursing responsibilities, they also ✔Correct Answer-1. Liaise with
providers, 2. Communicate with treating physicians, 3, Provide patient and family education, 4.
Assess for and coordinate additional services and Durable Medical Equipment, 5. Provide SN care.
Worker's compensation case management focuses on vocational activities, collaborating with the
employer to get the employee back to work. The case manager will ✔Correct Answer-1. Facilitate
communication between the employer, claims adjuster, attorneys, union representative, state
administrative agency,and providers, 2. Coordinate care between multiple healthcare providers, 3.
Monitor progress, 4. Utilization review, 5. Obtain precertification when necessary, 6. Perform job
analysis, 7. Accompany injured workers during physician appointments.
Client autonomy ✔Correct Answer-the right of clients to make decisions about their medical care
without their case manager trying to influence the decision. client autonomy does allow for case
manager to educate the patient but does not allow the case manager to make the decision for the
client
ADL's measure the level of independence on performing six basic activities ✔Correct
Answer-"DEATH" Dressing/bathing, Eating, Ambulating, Toileting, Hygiene. If I can't do these, I would
rather be dead.
The IADLs tool assesses the ability to perform 8 independent living skills that are more complex than
the basic ADLs assessment. These include: ✔Correct Answer-Shopping, Using the telephone,
Paying bills/Budgeting, Food preparation, Housekeeping, Laundry, Using transportation, Handling
medications.
Interdisciplinary Care Team (ICT) definition? ✔Correct Answer-is a group of healthcare
professionals from various professional disciplines who work together to manage the physical,
psychological, and spiritual needs of the patient may include: physicians, nurses, case manager, social
worker, physical therapist, occupational therapist, chaplain, Dietitian, Pharmacist.
Accelerated Death Benefit ✔Correct Answer-allowing an insured person with a terminal illness to
use some of the policy's benefit prior to dying. The ADB is deducted from the amount the
beneficiaries receive at death. There are restrictions on how the money can be used; generally it can
be used for long-term care and medical expenses.
Viatical Settlements ✔Correct Answer-A life insurance policy is personal property, meaning it can
be sold. A viatical settlement sells the life insurance policy of a person with a terminal or life-
, threatening illness, and a life expectancy of less than five years to a third party for cash. 1. No
restrictions on how this money can be used. 2. The purchasing party then becomes the beneficiary
and takes responsibility for paying the premium. 3. The insured are normally paid 50 and 80% of the
face value of the policy. This amount is dependent on life expectancy, interest rates, and cost of
premium. 4. the money is free from federal income tax. 5. earnings may impact eligibility for
medicaid.
Reverse Mortgages ✔Correct Answer-for a homeowner and age 62 or older. 1. the patient borrows
against his/her home's value without having to leave the home or make payments. 2. The funds can
be distributed by: lump sum/fixed monthly installments/lines of credit; 3. if use the line of credit is
the most popular choices and often will not be considered an asset for Medicaid eligibility. 4. The
amount of money received will be determined by the home's value, the age of the borrower, and
current interest rates; 5. for both spouses to be listed on the reverse mortgage deed, they must both
be 62 or older.
Extra-Contractual Benefits ✔Correct Answer-are benefits not covered under the health plan but
are given to the insured due to the cost savings for the health insurance plan.
Coordination of Benefits (COB) for employee ✔Correct Answer-1. Medicaid always pays last; 2. If
an insurance plan does not have a COB provision, it must pay primary; 3. the longest is primary; 4.
The insurance plan covering the client as an employee is the primary payer over the plan covering as
a dependent, which pays secondary; 5. covers an active employee is primary over a retiree/laid-off
employee; 6. covers an active employee is primary over a COBRA plan which is secondary.
COB for dependents of married parents ✔Correct Answer-the parent whose birthday comes first in
the year is primary for the children.
COB for dependents of non-married parents ✔Correct Answer-if both plans cover the client as a
dependent, and the parents are not married, primary coverage is determined by the court. 2. If no
court determination has been made, the parent with custody is primary, followed by the spouse of
the parent with custody, and finally the plan of the parents without custody.
COB for Medicare ✔Correct Answer-1. Age 65 or older and retried, Medicare is primary; 2. Age 65
or older and covered due to the patient or his spouse working for an employer with 20 or more
employee, the employer plan is primary; 3.Age 65 or older and covered due to patient or spouse
working for employer with fewer than 20 employees, Medicare is primary.
Disability between Workers' Compensation and STD/LTD ✔Correct Answer-1. Workers' comp
provides replacement of lost wages and a medical benefit for the work-related injury. STD and LTD
only cover a portion of the wages, typically 50-70%, and begin after a waiting period. 2. Workers'
comp is mandated to be paid by the employer. LTD and STD can be provided by employers as part of
a benefits package. 3. LTD purchased from an agent is not taxed; whereas LTD as part of a benefit
package is taxed. SSDI is paid for by a tax on the employer and the employee.
Disability-Worker Compensation ✔Correct Answer-including wage replacement, medical benefit,
work related, and no waiting period
Disability-Waiting Period within Workers' Comp, STD, LTD, and SSDI ✔Correct Answer-WC-no
waiting period; STD-usually 7-30 days (ends 90-180 days after day of disability); LTD-usually begins
after STD ends; SSDI-5 months waiting period
REIMBURSEMENT METHODS EXAM WITH ALL CORRECT
& 100% VERIFIED ANSWERS|ALREADY GRADED A+
Payer-based Settings, including public health insurance programs ✔Correct Answer-Medicare,
Medicaid, and state-funded programs
Payer-based Settings, private health insurance program ✔Correct Answer-Occupational health,
disability, group health insurance, managed care organization
Palliative care, home care, and hospice case managers combine the role of caregiver with case
manager. In addition to hands-on nursing responsibilities, they also ✔Correct Answer-1. Liaise with
providers, 2. Communicate with treating physicians, 3, Provide patient and family education, 4.
Assess for and coordinate additional services and Durable Medical Equipment, 5. Provide SN care.
Worker's compensation case management focuses on vocational activities, collaborating with the
employer to get the employee back to work. The case manager will ✔Correct Answer-1. Facilitate
communication between the employer, claims adjuster, attorneys, union representative, state
administrative agency,and providers, 2. Coordinate care between multiple healthcare providers, 3.
Monitor progress, 4. Utilization review, 5. Obtain precertification when necessary, 6. Perform job
analysis, 7. Accompany injured workers during physician appointments.
Client autonomy ✔Correct Answer-the right of clients to make decisions about their medical care
without their case manager trying to influence the decision. client autonomy does allow for case
manager to educate the patient but does not allow the case manager to make the decision for the
client
ADL's measure the level of independence on performing six basic activities ✔Correct
Answer-"DEATH" Dressing/bathing, Eating, Ambulating, Toileting, Hygiene. If I can't do these, I would
rather be dead.
The IADLs tool assesses the ability to perform 8 independent living skills that are more complex than
the basic ADLs assessment. These include: ✔Correct Answer-Shopping, Using the telephone,
Paying bills/Budgeting, Food preparation, Housekeeping, Laundry, Using transportation, Handling
medications.
Interdisciplinary Care Team (ICT) definition? ✔Correct Answer-is a group of healthcare
professionals from various professional disciplines who work together to manage the physical,
psychological, and spiritual needs of the patient may include: physicians, nurses, case manager, social
worker, physical therapist, occupational therapist, chaplain, Dietitian, Pharmacist.
Accelerated Death Benefit ✔Correct Answer-allowing an insured person with a terminal illness to
use some of the policy's benefit prior to dying. The ADB is deducted from the amount the
beneficiaries receive at death. There are restrictions on how the money can be used; generally it can
be used for long-term care and medical expenses.
Viatical Settlements ✔Correct Answer-A life insurance policy is personal property, meaning it can
be sold. A viatical settlement sells the life insurance policy of a person with a terminal or life-
, threatening illness, and a life expectancy of less than five years to a third party for cash. 1. No
restrictions on how this money can be used. 2. The purchasing party then becomes the beneficiary
and takes responsibility for paying the premium. 3. The insured are normally paid 50 and 80% of the
face value of the policy. This amount is dependent on life expectancy, interest rates, and cost of
premium. 4. the money is free from federal income tax. 5. earnings may impact eligibility for
medicaid.
Reverse Mortgages ✔Correct Answer-for a homeowner and age 62 or older. 1. the patient borrows
against his/her home's value without having to leave the home or make payments. 2. The funds can
be distributed by: lump sum/fixed monthly installments/lines of credit; 3. if use the line of credit is
the most popular choices and often will not be considered an asset for Medicaid eligibility. 4. The
amount of money received will be determined by the home's value, the age of the borrower, and
current interest rates; 5. for both spouses to be listed on the reverse mortgage deed, they must both
be 62 or older.
Extra-Contractual Benefits ✔Correct Answer-are benefits not covered under the health plan but
are given to the insured due to the cost savings for the health insurance plan.
Coordination of Benefits (COB) for employee ✔Correct Answer-1. Medicaid always pays last; 2. If
an insurance plan does not have a COB provision, it must pay primary; 3. the longest is primary; 4.
The insurance plan covering the client as an employee is the primary payer over the plan covering as
a dependent, which pays secondary; 5. covers an active employee is primary over a retiree/laid-off
employee; 6. covers an active employee is primary over a COBRA plan which is secondary.
COB for dependents of married parents ✔Correct Answer-the parent whose birthday comes first in
the year is primary for the children.
COB for dependents of non-married parents ✔Correct Answer-if both plans cover the client as a
dependent, and the parents are not married, primary coverage is determined by the court. 2. If no
court determination has been made, the parent with custody is primary, followed by the spouse of
the parent with custody, and finally the plan of the parents without custody.
COB for Medicare ✔Correct Answer-1. Age 65 or older and retried, Medicare is primary; 2. Age 65
or older and covered due to the patient or his spouse working for an employer with 20 or more
employee, the employer plan is primary; 3.Age 65 or older and covered due to patient or spouse
working for employer with fewer than 20 employees, Medicare is primary.
Disability between Workers' Compensation and STD/LTD ✔Correct Answer-1. Workers' comp
provides replacement of lost wages and a medical benefit for the work-related injury. STD and LTD
only cover a portion of the wages, typically 50-70%, and begin after a waiting period. 2. Workers'
comp is mandated to be paid by the employer. LTD and STD can be provided by employers as part of
a benefits package. 3. LTD purchased from an agent is not taxed; whereas LTD as part of a benefit
package is taxed. SSDI is paid for by a tax on the employer and the employee.
Disability-Worker Compensation ✔Correct Answer-including wage replacement, medical benefit,
work related, and no waiting period
Disability-Waiting Period within Workers' Comp, STD, LTD, and SSDI ✔Correct Answer-WC-no
waiting period; STD-usually 7-30 days (ends 90-180 days after day of disability); LTD-usually begins
after STD ends; SSDI-5 months waiting period
