Case Manager Certification Exam Questions and Answers

Case Manager Certification Exam Questions and Answers 1. Provider 2. Services 3. Setting 4. Time 5. Cost - ANSWER-5 rights of utilization review .4 parts of clinical pathway - ANSWER-1. timeline 2. categories of care/activities and interventions 3. intermediate and long term outcome criteria 4. variance tracking are 4 parts of what? .25 - ANSWER-the dollar amount the gifts are limited to to avoid conflict of interest .55 - ANSWER-Medicare will begin coverage of home oxygen with an arterial blood gas result at or above a partial pressure of ___mm Hg while at rest on room air. .80% - ANSWER-medicare covers what percent? .80% - ANSWER-Medicare Part B only covers what percent? .88 - ANSWER-medicare will cover home oxygen if O2 sat is at or below _____% while at rest on room air, exercising on room air or while asleep or a greater than normal fall in oxygen level during sleep (a decrease in arterial PO 2 more than 10 mm Hg, or decrease in arterial oxygen saturation more than 5%) associated with symptoms or signs reasonably attributable to hypoxemia (e.g., impairment of cognitive processes and nocturnal restlessness or insomnia). .211 - ANSWER-federally funded support referral services and crisis management. .A - ANSWER-What part of Medicare covers skilled nursing facility? .abandonment - ANSWER-willful neglect of responsibility of another person by a person who is assigned to care for that patient or by a person in a caregiving position. .access, inspect, copy - ANSWER-HIPAA individual right #3 is the individual’s right to their health information to do what? .accountable care organizations - ANSWER-groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.They decrease fragmentation and improve collaboration. Created from the affordable care act. “medical neighborhood” .Acute care - ANSWER-A hospital the largest Healthcare setting in the United States. Case managers need to ensure tests are done in a timely meander results are given to provider and Healthcare team determines the next step. .ad litem - ANSWER-guardianship appointed to represent a child when the parents conflict or in situations such as abuse. .adults - ANSWER-These learners are autonomous, goal and relevancy oriented, have experience, care about what is practical and need respect. .advanced directive - ANSWER-written statement of medical wishes in the future in the event they are unable to make decisions for themselves. It includes a living will or a durable power of attorney. .affordable care act - ANSWER-this law in 2010 created the innovation center with in the center for medicare and medicaid services which assists with research regarding quality. .aggregate data - ANSWER-data that has a common variable. An example would be diabetes. .all patient refined diagnosis related groups (APDRG) - ANSWER-type of payment with 2 subclasses based on 1. severity of illness (organ system failure or loss of funtion and 2. risk of mortality .Americans with disabilities act - ANSWER-this act established in 1990 has 5 titles. companies cannot discriminate and must make reasonable accommodations if they have 15 or more employees, must have access to public transportation, have access to telecommunication devices, and seek restitution for damage caused by inaccessibility of services. .Appeal - ANSWER-A formal way of lodging a disagreement with a claim payment or benefit denial .arthritis impact measurement scales - ANSWER-health risk assessment: Disease-specific measure of physical, social, and emotional well-being designed as a measure of outcome in arthritis. -scales: mobility, physical activity (walking, bending, lifting), dexterity, household activity (managing money and medications, housekeeping), social activities, activities of daily living, pain, depression, and anxiety. Score range: Range is 0-10 for each section. Total health score 0-60. --> Zero represents good health status, 10 and 60 represent poor health status. .Assess, plan, implement/intervention, monitor/evaluation - ANSWER-4 stages of case management .assult - ANSWER-an intentional tort/act of threatening or attempting to touch without consent. .autonomy - ANSWER-respecting the individual’s right to make their own decisions .Autonomy vs. shame - ANSWER-Erickson 1 1/5-3 .B - ANSWER-What part of Medicare covers durable medical equipment? .balanced budget act - ANSWER-act that gives medicare and medicaid services authority to establish and oversee a program that allows private, national accredited organizations to “deem” weather or not a medicare advantage organization is compliant with medicare requirements. example: JCAHO and NCQA .Balanced Budget Act - ANSWER-Law enacted in 1977 that created the medicare part C + choice program, also knows as the medicare advantage plan, is a managed care option that allows new types of health plans under private companies to cover medicare benefits at a capitated (per enrollee) amount to include hospital and medical, parts A and B. .BASIS-32 - ANSWER-health risk assessment: 32-item Behavior and Symptom Identification Scale. behavioral health assessment tool. - measures the change in self-reported symptom and problem difficulty over the course of treatment. - assesses: Relation to Self and Others, Depression and Anxiety, Daily Living and Role Functioning, Impulsive and Addictive Behavior, Psychosis. - higher score poorer outcome .battery - ANSWER-an intentional tort/act of touching without consent .behavior change - ANSWER-The trans-theoretical model of what includes these 6 steps? pre-contemplation, contemplation, preparation, action, maintenace, termination .benchmarking - ANSWER-ongoing system of measuring things against another. Helpful for providers to increase competitors. .beneficence - ANSWER-do good , well being, prevent or remove from harm .capitation - ANSWER-type of payment to a provider for a group of people assigned to them where there is a fixed cost per person, per time period , not dependent on how often that person utilizes the resources. The provider is contracted under a HMO. per member, per month .Case management - ANSWER-Ensure patients receive quality cost-effective, safe, high quality, evidence-based care in the least restrictive setting .case management - ANSWER-the dynamic and systematic collaborative approach to providing and coordinating health care services to a defined population. - participative process to identify and facility options and services for meeting individual healthcare needs while decreasing fragmentation and duplication of care and increasing quality and cost effective clinical outcomes. .catastrophic and chronic - ANSWER-case management services are needed for patients with what type of injuries or chronic illnesses? .change - ANSWER-likilihood of change increases with the patient’s belief in the ability to what? .chronic conditions - ANSWER-The affordable care act title 2 section 2703 provided a