CCM ACTUAL 2026 STUDY GUIDE QUESTIONS AND
ANSWERS RATED A+
✔✔Pharmacy Benefit Management (PBM) - ✔✔services used to control the cost of
prescription drugs
✔✔COBRA - ✔✔Consolidated Omnibus Budget Reconciliation Act insurance coverage
after job loss
✔✔COBRA - ✔✔ability to retain Insurance due to a catastrophic change ex: job loss,
decreasing work, divorce, lasts up to 36 months at a higher rates
✔✔Mental Status Exam - ✔✔broad preliminary assessment of behavior and mental
state
✔✔PHQ-9 - ✔✔assessment that evaluates degree of depression
✔✔DSM-IV - ✔✔A guide used for the diagnosis of psychiatric and mental health
disorders
✔✔Cost-benefit analysis - ✔✔economic model that compares the monetary savings and
benefits of a decision
✔✔Hard Savings - ✔✔directly related to case manager's actions, ex: decrease length of
stay, price negotiations
✔✔Soft savings - ✔✔cost savings that can't be measured, ex: avoidance of hospital
readmission
✔✔case management plan - ✔✔plan developed by IDT Healthcare team in relations to
Patient diagnosis problems and surgical procedures
✔✔First level reviews - ✔✔conducted while the patient is in the hospital, care is review
for appropriateness
✔✔Outcome and Assessment information set OASIS - ✔✔a nursing assessment
instrument completed by Home Health agencies at the time the patient has entered for
Home Health Services score determines Home Health Resource Group (HHRG)
✔✔Quality Indicator - ✔✔Measures of outcomes
✔✔Functional Independence Measures Instrument (FIM) - ✔✔used in the Inpatient
Rehab setting measures the individual level of Independence/ dependence in ADLs
, ✔✔Managed Care - ✔✔is a Cost Containment Healthcare System overseen by an
organization other than the physician or patient
✔✔Bundled reimbursement - ✔✔care is reimbursed according to expected cost for a
clinical episode of care
✔✔SSDI eligibility requires - ✔✔individual must be unable to perform the work they
previously did and the disability must be expected to last at least one year or result in
death
✔✔Rancho Los Amigos - ✔✔assessment to used to assess cognitive functioning after a
traumatic brain injury
✔✔Axis I - ✔✔Clinical disorders (depression, anxiety)
✔✔Axis II - ✔✔personality disorders and developmental disorders
✔✔Axis III - ✔✔General medical conditions
✔✔Axis IV - ✔✔Psychosocial and environmental problems
✔✔Axis V - ✔✔Global Assessment of Functioning that allows the clinician to rate the
level of danger to one's self and functioning
✔✔Glasgow Coma Scale (GCS) - ✔✔measures level of coma in the acute phase of an
injury
✔✔Health risk assessment (HRA) - ✔✔a tool to assess a patient's health status, risk of
negative health outcomes, and readiness to change behaviors
✔✔HRA components - ✔✔questionnaire, risk calculation, and feedback
✔✔Due diligence - ✔✔reasonable steps taken by a person in order to avoid negligent
action.
✔✔Pallative care - ✔✔care for seriously ill persons focused on providing relief from
symptoms
✔✔Disorientation - ✔✔lack of awareness of self, place, and/or time seen in multitude of
conditions
✔✔Benchmarking - ✔✔Method of measuring quality by comparing performance against
industry leaders
ANSWERS RATED A+
✔✔Pharmacy Benefit Management (PBM) - ✔✔services used to control the cost of
prescription drugs
✔✔COBRA - ✔✔Consolidated Omnibus Budget Reconciliation Act insurance coverage
after job loss
✔✔COBRA - ✔✔ability to retain Insurance due to a catastrophic change ex: job loss,
decreasing work, divorce, lasts up to 36 months at a higher rates
✔✔Mental Status Exam - ✔✔broad preliminary assessment of behavior and mental
state
✔✔PHQ-9 - ✔✔assessment that evaluates degree of depression
✔✔DSM-IV - ✔✔A guide used for the diagnosis of psychiatric and mental health
disorders
✔✔Cost-benefit analysis - ✔✔economic model that compares the monetary savings and
benefits of a decision
✔✔Hard Savings - ✔✔directly related to case manager's actions, ex: decrease length of
stay, price negotiations
✔✔Soft savings - ✔✔cost savings that can't be measured, ex: avoidance of hospital
readmission
✔✔case management plan - ✔✔plan developed by IDT Healthcare team in relations to
Patient diagnosis problems and surgical procedures
✔✔First level reviews - ✔✔conducted while the patient is in the hospital, care is review
for appropriateness
✔✔Outcome and Assessment information set OASIS - ✔✔a nursing assessment
instrument completed by Home Health agencies at the time the patient has entered for
Home Health Services score determines Home Health Resource Group (HHRG)
✔✔Quality Indicator - ✔✔Measures of outcomes
✔✔Functional Independence Measures Instrument (FIM) - ✔✔used in the Inpatient
Rehab setting measures the individual level of Independence/ dependence in ADLs
, ✔✔Managed Care - ✔✔is a Cost Containment Healthcare System overseen by an
organization other than the physician or patient
✔✔Bundled reimbursement - ✔✔care is reimbursed according to expected cost for a
clinical episode of care
✔✔SSDI eligibility requires - ✔✔individual must be unable to perform the work they
previously did and the disability must be expected to last at least one year or result in
death
✔✔Rancho Los Amigos - ✔✔assessment to used to assess cognitive functioning after a
traumatic brain injury
✔✔Axis I - ✔✔Clinical disorders (depression, anxiety)
✔✔Axis II - ✔✔personality disorders and developmental disorders
✔✔Axis III - ✔✔General medical conditions
✔✔Axis IV - ✔✔Psychosocial and environmental problems
✔✔Axis V - ✔✔Global Assessment of Functioning that allows the clinician to rate the
level of danger to one's self and functioning
✔✔Glasgow Coma Scale (GCS) - ✔✔measures level of coma in the acute phase of an
injury
✔✔Health risk assessment (HRA) - ✔✔a tool to assess a patient's health status, risk of
negative health outcomes, and readiness to change behaviors
✔✔HRA components - ✔✔questionnaire, risk calculation, and feedback
✔✔Due diligence - ✔✔reasonable steps taken by a person in order to avoid negligent
action.
✔✔Pallative care - ✔✔care for seriously ill persons focused on providing relief from
symptoms
✔✔Disorientation - ✔✔lack of awareness of self, place, and/or time seen in multitude of
conditions
✔✔Benchmarking - ✔✔Method of measuring quality by comparing performance against
industry leaders
