CCM LATEST 2026 TEST PAPER QUESTIONS AND ANSWERS
RATED A+
✔✔Medicare Part B - ✔✔Outpatient care. Extends Medicare to supplemental
treatments, and physicians
✔✔Minimum Data Set (MDS) - ✔✔assessment to used in SNF to place patients in RUG
to determine reimbursement
✔✔Medical durable power of attorney - ✔✔a legal document that names a surrogate
decision-maker in the event the patient is unable to make decisions
✔✔Network model HMO - ✔✔HMO contract directly with IPA, medical groups &
independent Physicians forming a provider Network, organized referrals
✔✔Nonmaleficence - ✔✔do no harm
✔✔Per diem - ✔✔daily allowance
✔✔Point of Service (POS) - ✔✔a combination of a PPO and HMO plan using a
contracted network of providers and PCP as Gate Keeper to control referrals. out-of-
network services incur higher deductible
✔✔Pre-admission Certification - ✔✔utilization review process that examines proposed
Services before admission
✔✔Pre-Authorization/Pre-Certification - ✔✔process of obtaining & documenting
approval for health plan befor delivery of Medical Services
✔✔Preferred Provider Organization - ✔✔PPO, preferred provider group/ organization
where group of medical providers provide medical services on a negotiated fee
✔✔Primary care physician (PCP) - ✔✔provider who assumes ongoing responsibility for
overall health treatment of a patient
✔✔Prospective review - ✔✔Reviewing possible hospitalization before admission to
determine necessity and LOS
✔✔HEDIS HealthCare Effectiveness Data Information Set - ✔✔performance
measurement set for MCO to set quality of systems
✔✔Quality Assurance - ✔✔Use of activities and programs ensuring quality of patient
care
,✔✔Quality Improvement - ✔✔process used to identify and resolve deficiencies and
improve care outcomes
✔✔Reasonable Accommodation - ✔✔make an existing facility accessible and usable for
individuals with disabilities; can include job adaptation for individuals
✔✔Resource utilization groups (RUGs) - ✔✔classifiies SNF patients into 7 major
hierarchies and 44 groups, based on MDS for reimbursement
✔✔Root Cause Analysis (RCA) - ✔✔process to identify underlying factors that
contribute to variation in outcomes in sentinel event
✔✔Risk Sharing - ✔✔HMO &PROVIDER share financial risk/rewards of caring for plan
members
✔✔Self-insured - ✔✔an employer that meets the state legal and financial requirements
to assume all of its health care costs for its employees
✔✔Staff Model HMO - ✔✔Physicians are on the staff of the HMO and provide care
exclusively for the health plan enrollees
✔✔Third Party Administrator (TPA) - ✔✔an organization separate from the insurer that
handles administrative functions such as review claims & UR
✔✔Veracity - ✔✔truthfulness
✔✔Work Adjustment - ✔✔use of simulated work activity to develop work behaviors,
attitudes, characteristics
✔✔Work hardening - ✔✔Rehab real/simulared work activities designed to restore
physical function
✔✔Methadone - ✔✔Strong opioid agonist, heroin treatment
✔✔stop loss - ✔✔insurance that is brought by insurers to limit loss for Catastrophic,
unpredictable incidents
✔✔Tort - ✔✔a wrongful act or infringement of a right leading to civil legal liability
✔✔State children's health insurance program (SCHIP) - ✔✔state insurance for low
income. uninsured children not eligible for medicaid
✔✔Medicare - ✔✔A federal program insurance: 65 or older, disabled, ESRD(dialysis or
transplant)
, ✔✔Medicare Part A - ✔✔Pays a 100% days 1-60 for each benefit period, patient pays
deductible
✔✔Medicare Part D - ✔✔Prescription Drug Coverage
✔✔Medicare part C - ✔✔allows participants to choose a Medicare Advantage plan,
HMO type coverage
✔✔Medigap - ✔✔supplemental insurance plans that help pay expenses not covered by
Medicare
✔✔benefit period - ✔✔a specified amount of time during which benefits will be paid.
✔✔Rehabilitation Act of 1973 - ✔✔Act that prohibits discrimination based on physical or
mental disabilities.
✔✔American Disabilities Act - ✔✔prohibits discrimination in employment ,
accommodatios of people with disabilities
✔✔Biofeedback - ✔✔the process of learning to control bodily awareness or function,
example HR
✔✔EMTALA - ✔✔Emergency Medical Tx and Active Labor Act - anti-"dumping" law
✔✔EMTALA - ✔✔federal law that requires emergency department to stabilize and treat
regardless of ability to pay
✔✔Dual Diagnosis - ✔✔when an individual is diagnosed with both a psychiatric disorder
and a substance use disorder
✔✔Bereavement Counseling - ✔✔type of psychotherapy that helps a person deal with
grief after a loss
✔✔Stages of Change - ✔✔1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
✔✔Transtheoretical Model - ✔✔behavioral model that describes stages of readiness for
change
RATED A+
✔✔Medicare Part B - ✔✔Outpatient care. Extends Medicare to supplemental
treatments, and physicians
✔✔Minimum Data Set (MDS) - ✔✔assessment to used in SNF to place patients in RUG
to determine reimbursement
✔✔Medical durable power of attorney - ✔✔a legal document that names a surrogate
decision-maker in the event the patient is unable to make decisions
✔✔Network model HMO - ✔✔HMO contract directly with IPA, medical groups &
independent Physicians forming a provider Network, organized referrals
✔✔Nonmaleficence - ✔✔do no harm
✔✔Per diem - ✔✔daily allowance
✔✔Point of Service (POS) - ✔✔a combination of a PPO and HMO plan using a
contracted network of providers and PCP as Gate Keeper to control referrals. out-of-
network services incur higher deductible
✔✔Pre-admission Certification - ✔✔utilization review process that examines proposed
Services before admission
✔✔Pre-Authorization/Pre-Certification - ✔✔process of obtaining & documenting
approval for health plan befor delivery of Medical Services
✔✔Preferred Provider Organization - ✔✔PPO, preferred provider group/ organization
where group of medical providers provide medical services on a negotiated fee
✔✔Primary care physician (PCP) - ✔✔provider who assumes ongoing responsibility for
overall health treatment of a patient
✔✔Prospective review - ✔✔Reviewing possible hospitalization before admission to
determine necessity and LOS
✔✔HEDIS HealthCare Effectiveness Data Information Set - ✔✔performance
measurement set for MCO to set quality of systems
✔✔Quality Assurance - ✔✔Use of activities and programs ensuring quality of patient
care
,✔✔Quality Improvement - ✔✔process used to identify and resolve deficiencies and
improve care outcomes
✔✔Reasonable Accommodation - ✔✔make an existing facility accessible and usable for
individuals with disabilities; can include job adaptation for individuals
✔✔Resource utilization groups (RUGs) - ✔✔classifiies SNF patients into 7 major
hierarchies and 44 groups, based on MDS for reimbursement
✔✔Root Cause Analysis (RCA) - ✔✔process to identify underlying factors that
contribute to variation in outcomes in sentinel event
✔✔Risk Sharing - ✔✔HMO &PROVIDER share financial risk/rewards of caring for plan
members
✔✔Self-insured - ✔✔an employer that meets the state legal and financial requirements
to assume all of its health care costs for its employees
✔✔Staff Model HMO - ✔✔Physicians are on the staff of the HMO and provide care
exclusively for the health plan enrollees
✔✔Third Party Administrator (TPA) - ✔✔an organization separate from the insurer that
handles administrative functions such as review claims & UR
✔✔Veracity - ✔✔truthfulness
✔✔Work Adjustment - ✔✔use of simulated work activity to develop work behaviors,
attitudes, characteristics
✔✔Work hardening - ✔✔Rehab real/simulared work activities designed to restore
physical function
✔✔Methadone - ✔✔Strong opioid agonist, heroin treatment
✔✔stop loss - ✔✔insurance that is brought by insurers to limit loss for Catastrophic,
unpredictable incidents
✔✔Tort - ✔✔a wrongful act or infringement of a right leading to civil legal liability
✔✔State children's health insurance program (SCHIP) - ✔✔state insurance for low
income. uninsured children not eligible for medicaid
✔✔Medicare - ✔✔A federal program insurance: 65 or older, disabled, ESRD(dialysis or
transplant)
, ✔✔Medicare Part A - ✔✔Pays a 100% days 1-60 for each benefit period, patient pays
deductible
✔✔Medicare Part D - ✔✔Prescription Drug Coverage
✔✔Medicare part C - ✔✔allows participants to choose a Medicare Advantage plan,
HMO type coverage
✔✔Medigap - ✔✔supplemental insurance plans that help pay expenses not covered by
Medicare
✔✔benefit period - ✔✔a specified amount of time during which benefits will be paid.
✔✔Rehabilitation Act of 1973 - ✔✔Act that prohibits discrimination based on physical or
mental disabilities.
✔✔American Disabilities Act - ✔✔prohibits discrimination in employment ,
accommodatios of people with disabilities
✔✔Biofeedback - ✔✔the process of learning to control bodily awareness or function,
example HR
✔✔EMTALA - ✔✔Emergency Medical Tx and Active Labor Act - anti-"dumping" law
✔✔EMTALA - ✔✔federal law that requires emergency department to stabilize and treat
regardless of ability to pay
✔✔Dual Diagnosis - ✔✔when an individual is diagnosed with both a psychiatric disorder
and a substance use disorder
✔✔Bereavement Counseling - ✔✔type of psychotherapy that helps a person deal with
grief after a loss
✔✔Stages of Change - ✔✔1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
✔✔Transtheoretical Model - ✔✔behavioral model that describes stages of readiness for
change
