CCM COMPREHENSIVE EXAM QUESTIONS AND ANSWERS
RATED A+
✔✔Acute Care - ✔✔Acute care is a care setting where a patient is treated for a brief but
severe episode of illness. The term is generally associated with care rendered in an
emergency department, ambulatory care clinic, or other short-term stay facility. The
most common acute care setting is a traditional hospital, which typically offers both
inpatient and outpatient care in specialty areas including but not limited to emergency
care, intensive care, coronary care, cardiology, surgical services, psychiatric care and
childbirth and pediatric care. The function and goal of acute medical care is to diagnose
and treat the presenting condition or illness and return the person to his/her state of
health prior to the episode.
Acute care settings often have full-time physicians and hospital staff who are available
24 hours a day. They may offer higher nurse-to-patient ratios, including licensed nursing
staff especially trained in acute care. Acute care hospitals often also have social
workers, dieticians, physician specialists, pharmacists and rehabilitation staff on-site.
✔✔long-term acute care hospital - ✔✔A long-term acute care hospital is an acute care
hospital that specializes in the treatment and rehabilitation of medically complex
patients who require an extended stay in a hospital setting. LTACs are focused on
patients with serious medical problems that require intense, special treatment for a long
time (usually about 20-30 days). These patients often transfer from intensive care units
in traditional hospitals. It would not be unusual for a LTAC patient to need ventilator or
other life support medical assistance. The typical LTAC patient is older with three to six
concurrent active diagnoses, or someone who has suffered an acute episode on top of
several chronic illnesses.
✔✔Long term care - ✔✔Long-term care is a concept that encompasses a full continuum
of care provided in a wide variety of settings. It includes everything from long term acute
care to nursing home care to assisted living and even hospice care. Such care can be
provided in almost every conceivable setting, from an individual's home to a retirement
community or even a long-term acute care hospital. Long-term care settings provide a
variety of services and supports to meet health or personal care needs over an
extended period of time. Most long-term care is non-skilled personal care assistance,
such as help performing everyday activities of daily living (ADLs), which are:
bathing
dressing
using the toilet
transferring (to or from bed or chair)
caring for incontinence
eating.
The goal of long-term care services is to help you maximize your independence and
functioning at a time when you are unable to be fully independent.
✔✔SNFs - ✔✔Nursing homes, also called skilled nursing facilities (SNF) or
convalescent care facilities, provide a wide range of services, including nursing care,
,24-hour supervision, assistance with activities of daily living, and rehabilitation services
such as physical, occupational, and speech therapy. Some people need nursing home
services for a short period of time for recovery or rehabilitation after a serious illness or
operation, while others need longer stays because of chronic physical, health, or
cognitive conditions that require constant care or supervision
✔✔Acute inpatient rehabilitation - ✔✔A special type of rehab care often required when
an individual's medical status requires more intense services that can't reasonably be
provided in an alternative setting. Such care settings might be in a hospital or skilled
nursing facility or a free-standing facility and are licensed and certified and primarily
promote special rehabilitative health care services rather than general medical and
surgical services. Examples of conditions requiring acute inpatient rehabilitation include,
but are not limited to, individuals with significant functional disabilities associated with
stroke, spinal cord injuries, acquired brain injuries, major trauma and burns.
The goal is the restoration of a disabled person to self-sufficiency or maximal possible
functional independence. An inpatient rehabilitation program utilizes an inter-disciplinary
coordinated team approach that typically involves a minimum of three (3) hours of
rehabilitation services daily. These services may include physical therapy, occupational
therapy, speech therapy, cognitive therapy, respiratory therapy, psychology services,
prosthetic/orthotic services, or a combination thereof.
✔✔FIM (Functional Independence Measure) - ✔✔is the most widely accepted functional
assessment measure in use in the rehabilitation community. The FIM(TM) is an 18-item
ordinal scale, used with all diagnoses within a rehabilitation population. It is viewed as
most useful for assessment of progress during inpatient rehabilitation.
✔✔What is Case management - ✔✔it is a cross-disciplinary and interdependent
specialty practice.
✔✔Case management is - ✔✔a means for improving clients' health and promoting
wellness and autonomy through advocacy, communication, education, identification of
service resources, and facilitation of service. Case management is guided by the
principles of autonomy, beneficence, nonmaleficence, and justice
✔✔primary function of case managers - ✔✔to advocate for clients/support systems
✔✔Case managers' first duty - ✔✔coordinating care that is safe, timely, effective,
efficient, equitable, and client-centered.
✔✔Case Management Process - ✔✔Screening, Assessing, Stratifying Risk, Planning,
Implementing (Care Coordination), Following-Up, Transitioning (Transitional Care),
Communicating Post Transition, and Evaluating
✔✔Case Management Plan of Care - ✔✔Describes:
, The client's problems, needs, and desires, as determined from the findings of the
client's assessment.
The strategies, such as treatments and interventions, to be instituted to address the
client's problems and needs.
The measurable goals - including specific outcomes - to be achieved to demonstrate
resolution of the client's problems and needs, the time frame(s) for achieving them, the
resources available and to be used to realize the outcomes, and the desires/motivation
of the client that may have an impact on the plan
✔✔Level of Care - ✔✔The intensity and effort of health and human services and care
activities required to diagnose, treat, preserve, or maintain clients' health. Level of care
may vary from least to most complex, least to most intense, or prevention and wellness
to acute care and services
✔✔The High Level Case Management Process - ✔✔Case managers navigate the
phases of the process with careful consideration of the client's cultural beliefs, interests,
wishes, needs, and values. By following the steps, they help clients/support systems to:
Evaluate and understand the care options available to them
Determine what is best to meet their needs
Institute action to achieve their goals and meet their interests/expectations
At the same time, case managers apply:
Relevant state and federal laws.
Ethical principles and standards such as the CCMC's Code of Professional Conduct for
Case Managers with Standards, Rules, Procedures, and Penalties (CCMC, 2009),
which applies to persons holding the CCM® credential.
Accreditation and regulatory standards.
Standards of care and practice such as the CMSA Standards of Practice for Case
Management (CMSA, 2010)
Evidence-based practice guidelines.
And at every phase of the Case Management Process, case managers provide vital
documentation.
✔✔Case Management Process:Screening - ✔✔The Screening phase focuses on the
review of key information related to an individual's health situation in order to identify the
need for health and human services (case management services). The case manager's
objective in screening is to determine if a client would benefit from such services.
Screening promotes early intervention and the achievement of desired outcomes. Key
information gathered during screening may include - to the extent available - risk
stratification category or class, claims data, health services utilization, past and current
health condition, socioeconomic and financial status, health insurance coverage, home
, environment, prior services, physical/emotional/cognitive functioning, psychosocial
network and support system, and self-care ability.
✔✔Case Management Process: Assesssing - ✔✔The Assessing phase involves the
collection of information about a client's situation similar to those reviewed during
screening, however to greater depth. This information may include past and current
health conditions, service utilization, socioeconomic and financial status, insurance
coverage, home condition and safety, availability of prior services,
physical/emotional/cognitive functioning, psychosocial network system, self-care
knowledge and ability, and readiness for change.
The case manager has two primary objectives while assessing:
Identifying the client's key problems to be addressed, as well as individual needs and
interests.
Developing a comprehensive case management plan of care that addresses these
problems and needs.
Additionally, the case manager seeks to confirm or update the client's risk category
based on the information gathered.
Using standardized assessment tools and checklists, the case manager gathers
information telephonically or through face-to-face contact with the client, the client's
support system, and the clinicians involved in the client's care. The case manager also
collects necessary information through a review of current and past medical records,
personal health records
✔✔Case Management Process: Stratifying Risk (1) - ✔✔The Stratifying Risk phase
involves the classification of a client into one of three risk categories - low, moderate,
and high - in order to determine the appropriate level of intervention based on the
client's situation and interests. This classification allows the implementation of targeted
risk category-based interventions and treatments that enhance the client's outcomes
✔✔The Case Management Process: Stratifying Risk (2) - ✔✔When stratifying a client's
risk, a case manager completes a health risk assessment and biomedical screening
based on specific risk factors. These risk factors include the client's blood pressure,
substance use, alcohol use, tobacco use, nutrition habits, exercise habits, blood sugar
level, lipids profile/cholesterol, emotional health, physical health, access to care and
utilization of healthcare services (e.g., emergency department visits or hospitalizations),
psychosocial, financial (e.g., limited income, no insurance, underinsurance), and other
factors, depending on the risk assessment tool/model applied.
✔✔The Case Management Process: Planning - ✔✔Planning phase establishes specific
objectives, goals (short- and long-term), and actions (treatments and services)
necessary to meet a client's needs as identified during the Assessing phase.
RATED A+
✔✔Acute Care - ✔✔Acute care is a care setting where a patient is treated for a brief but
severe episode of illness. The term is generally associated with care rendered in an
emergency department, ambulatory care clinic, or other short-term stay facility. The
most common acute care setting is a traditional hospital, which typically offers both
inpatient and outpatient care in specialty areas including but not limited to emergency
care, intensive care, coronary care, cardiology, surgical services, psychiatric care and
childbirth and pediatric care. The function and goal of acute medical care is to diagnose
and treat the presenting condition or illness and return the person to his/her state of
health prior to the episode.
Acute care settings often have full-time physicians and hospital staff who are available
24 hours a day. They may offer higher nurse-to-patient ratios, including licensed nursing
staff especially trained in acute care. Acute care hospitals often also have social
workers, dieticians, physician specialists, pharmacists and rehabilitation staff on-site.
✔✔long-term acute care hospital - ✔✔A long-term acute care hospital is an acute care
hospital that specializes in the treatment and rehabilitation of medically complex
patients who require an extended stay in a hospital setting. LTACs are focused on
patients with serious medical problems that require intense, special treatment for a long
time (usually about 20-30 days). These patients often transfer from intensive care units
in traditional hospitals. It would not be unusual for a LTAC patient to need ventilator or
other life support medical assistance. The typical LTAC patient is older with three to six
concurrent active diagnoses, or someone who has suffered an acute episode on top of
several chronic illnesses.
✔✔Long term care - ✔✔Long-term care is a concept that encompasses a full continuum
of care provided in a wide variety of settings. It includes everything from long term acute
care to nursing home care to assisted living and even hospice care. Such care can be
provided in almost every conceivable setting, from an individual's home to a retirement
community or even a long-term acute care hospital. Long-term care settings provide a
variety of services and supports to meet health or personal care needs over an
extended period of time. Most long-term care is non-skilled personal care assistance,
such as help performing everyday activities of daily living (ADLs), which are:
bathing
dressing
using the toilet
transferring (to or from bed or chair)
caring for incontinence
eating.
The goal of long-term care services is to help you maximize your independence and
functioning at a time when you are unable to be fully independent.
✔✔SNFs - ✔✔Nursing homes, also called skilled nursing facilities (SNF) or
convalescent care facilities, provide a wide range of services, including nursing care,
,24-hour supervision, assistance with activities of daily living, and rehabilitation services
such as physical, occupational, and speech therapy. Some people need nursing home
services for a short period of time for recovery or rehabilitation after a serious illness or
operation, while others need longer stays because of chronic physical, health, or
cognitive conditions that require constant care or supervision
✔✔Acute inpatient rehabilitation - ✔✔A special type of rehab care often required when
an individual's medical status requires more intense services that can't reasonably be
provided in an alternative setting. Such care settings might be in a hospital or skilled
nursing facility or a free-standing facility and are licensed and certified and primarily
promote special rehabilitative health care services rather than general medical and
surgical services. Examples of conditions requiring acute inpatient rehabilitation include,
but are not limited to, individuals with significant functional disabilities associated with
stroke, spinal cord injuries, acquired brain injuries, major trauma and burns.
The goal is the restoration of a disabled person to self-sufficiency or maximal possible
functional independence. An inpatient rehabilitation program utilizes an inter-disciplinary
coordinated team approach that typically involves a minimum of three (3) hours of
rehabilitation services daily. These services may include physical therapy, occupational
therapy, speech therapy, cognitive therapy, respiratory therapy, psychology services,
prosthetic/orthotic services, or a combination thereof.
✔✔FIM (Functional Independence Measure) - ✔✔is the most widely accepted functional
assessment measure in use in the rehabilitation community. The FIM(TM) is an 18-item
ordinal scale, used with all diagnoses within a rehabilitation population. It is viewed as
most useful for assessment of progress during inpatient rehabilitation.
✔✔What is Case management - ✔✔it is a cross-disciplinary and interdependent
specialty practice.
✔✔Case management is - ✔✔a means for improving clients' health and promoting
wellness and autonomy through advocacy, communication, education, identification of
service resources, and facilitation of service. Case management is guided by the
principles of autonomy, beneficence, nonmaleficence, and justice
✔✔primary function of case managers - ✔✔to advocate for clients/support systems
✔✔Case managers' first duty - ✔✔coordinating care that is safe, timely, effective,
efficient, equitable, and client-centered.
✔✔Case Management Process - ✔✔Screening, Assessing, Stratifying Risk, Planning,
Implementing (Care Coordination), Following-Up, Transitioning (Transitional Care),
Communicating Post Transition, and Evaluating
✔✔Case Management Plan of Care - ✔✔Describes:
, The client's problems, needs, and desires, as determined from the findings of the
client's assessment.
The strategies, such as treatments and interventions, to be instituted to address the
client's problems and needs.
The measurable goals - including specific outcomes - to be achieved to demonstrate
resolution of the client's problems and needs, the time frame(s) for achieving them, the
resources available and to be used to realize the outcomes, and the desires/motivation
of the client that may have an impact on the plan
✔✔Level of Care - ✔✔The intensity and effort of health and human services and care
activities required to diagnose, treat, preserve, or maintain clients' health. Level of care
may vary from least to most complex, least to most intense, or prevention and wellness
to acute care and services
✔✔The High Level Case Management Process - ✔✔Case managers navigate the
phases of the process with careful consideration of the client's cultural beliefs, interests,
wishes, needs, and values. By following the steps, they help clients/support systems to:
Evaluate and understand the care options available to them
Determine what is best to meet their needs
Institute action to achieve their goals and meet their interests/expectations
At the same time, case managers apply:
Relevant state and federal laws.
Ethical principles and standards such as the CCMC's Code of Professional Conduct for
Case Managers with Standards, Rules, Procedures, and Penalties (CCMC, 2009),
which applies to persons holding the CCM® credential.
Accreditation and regulatory standards.
Standards of care and practice such as the CMSA Standards of Practice for Case
Management (CMSA, 2010)
Evidence-based practice guidelines.
And at every phase of the Case Management Process, case managers provide vital
documentation.
✔✔Case Management Process:Screening - ✔✔The Screening phase focuses on the
review of key information related to an individual's health situation in order to identify the
need for health and human services (case management services). The case manager's
objective in screening is to determine if a client would benefit from such services.
Screening promotes early intervention and the achievement of desired outcomes. Key
information gathered during screening may include - to the extent available - risk
stratification category or class, claims data, health services utilization, past and current
health condition, socioeconomic and financial status, health insurance coverage, home
, environment, prior services, physical/emotional/cognitive functioning, psychosocial
network and support system, and self-care ability.
✔✔Case Management Process: Assesssing - ✔✔The Assessing phase involves the
collection of information about a client's situation similar to those reviewed during
screening, however to greater depth. This information may include past and current
health conditions, service utilization, socioeconomic and financial status, insurance
coverage, home condition and safety, availability of prior services,
physical/emotional/cognitive functioning, psychosocial network system, self-care
knowledge and ability, and readiness for change.
The case manager has two primary objectives while assessing:
Identifying the client's key problems to be addressed, as well as individual needs and
interests.
Developing a comprehensive case management plan of care that addresses these
problems and needs.
Additionally, the case manager seeks to confirm or update the client's risk category
based on the information gathered.
Using standardized assessment tools and checklists, the case manager gathers
information telephonically or through face-to-face contact with the client, the client's
support system, and the clinicians involved in the client's care. The case manager also
collects necessary information through a review of current and past medical records,
personal health records
✔✔Case Management Process: Stratifying Risk (1) - ✔✔The Stratifying Risk phase
involves the classification of a client into one of three risk categories - low, moderate,
and high - in order to determine the appropriate level of intervention based on the
client's situation and interests. This classification allows the implementation of targeted
risk category-based interventions and treatments that enhance the client's outcomes
✔✔The Case Management Process: Stratifying Risk (2) - ✔✔When stratifying a client's
risk, a case manager completes a health risk assessment and biomedical screening
based on specific risk factors. These risk factors include the client's blood pressure,
substance use, alcohol use, tobacco use, nutrition habits, exercise habits, blood sugar
level, lipids profile/cholesterol, emotional health, physical health, access to care and
utilization of healthcare services (e.g., emergency department visits or hospitalizations),
psychosocial, financial (e.g., limited income, no insurance, underinsurance), and other
factors, depending on the risk assessment tool/model applied.
✔✔The Case Management Process: Planning - ✔✔Planning phase establishes specific
objectives, goals (short- and long-term), and actions (treatments and services)
necessary to meet a client's needs as identified during the Assessing phase.
