CCM exam prep Exam with Questions
and Correct Answers 2025
Case management - CORRECT ANSWERS a collaborative process that assesses, plans,
implements, coordinates, monitors and evaluates the options and services required to
meet the client's health and human services needs.
Case Management Characteristics - CORRECT ANSWERS characterized by advocacy,
communication, and resource management and promotes quality and cost-effective
interventions and outcomes.
Glasgow Coma Scale - CORRECT ANSWERS Client assessment tool that measures
level of coma in the acute phase of injury it is an objective way of recording the conscious
state of a person. Eye opening, Best verbal, best motor. < 8 coma, 13-15 mild injury.
Strengths Based Model - CORRECT ANSWERS assesses clients capacities and potential
resources as well as problems and current unmet needs. Eliciting capacities and potential
resources as well as problems and current unmet needs.
Independent Living Model - CORRECT ANSWERS sees a disability as a construct of
society
Medicare Prospective Payment System - CORRECT ANSWERS hospitals paid a pre-
determined rate for each Medicare admission. Each patient is classified into a DRG.
PHQ-9 - CORRECT ANSWERS Client assessment tool for depression
Braden Scale - CORRECT ANSWERS Client assessment tool for pressure sore risk
Clinical Pathway - CORRECT ANSWERS Structured multidisciplinary CM plan designed
to support the implementation of specific clinical guidelines and protocols. They are maps
that guide the healthcare team on usual treatment patterns related to common diagnoses,
conditions and procedures e.g., CHF
,SF-36 - CORRECT ANSWERS Client assessment tool to measure physical and mental
health.
Medicare - CORRECT ANSWERS Established in 1965 under Title XVIII or Social Security
Act. Four Parts A-hospital insurance, B-medical insurance (doctors visits), C-Medicare
Advantage program in a private plan such as HMO, D-prescription drug benefit
Medicare Benefits and Cost Sharing - CORRECT ANSWERS Not covered are:
Acupuncture, chiropractor, cosmetic, custodial home care, dental care, DME
convenience, hearing aids, eyeglasses, foot care, meals on wheels, personal
convenience, prescription drugs, private nurses, routine physical, vision
areas of accountability of case management - CORRECT ANSWERS clinical/outcome
financial
functional/outcome
satisfaction
behavior
process
*episode or continuum
**individual or population
Measuring performance: Process - CORRECT ANSWERS The measure of how many pts
receive a treatment or service i.e. vaccinations, screenings, ex. diabetic foot exam ALSO
practitioner's practice conforming to practice standards.
Measuring performance: Functional outcome - CORRECT ANSWERS The measure
reflects the health state of a patient as a result of health care ex. increased independency
in ADLs, mobility
Measuring performance: Clinical outcome - CORRECT ANSWERS The measure reflects
the health state of a patient as a result of health care ex. blood pressure goals ex. HgA1c
level, wound healing
Measuring performance: behavioral 'process' - CORRECT ANSWERS ex. self-monitoring
of blood sugar
Measuring performance: Financial - CORRECT ANSWERS ex. fewer ED visits, ALOS
decreased
,Women's Health and Cancer Rights Act of 1998 - CORRECT ANSWERS 1. Part of
Omnibus Appropriations Bill. 2. required group health plans to provide coverage for
mastectomies and provide certain reconstructive related services following mastectomies.
Women's health and cancer rights act coverage - CORRECT ANSWERS 1. reconstruction
of the breast. 2. surgery and reconstruction of the other breast 3. breast prothesis
4. treatment for physical complications attendant to the mastectomy
Women's health and cancer rights act prohibitions - CORRECT ANSWERS Health plans
are not allowed to deny anyone coverage for the sole reason of avoiding the requirements
of the act AND cannot induce a physician to limit the care that is required under the act by
penalizing or limiting reimbursement to the physician.
Can states modify HIPAA's portability requirement - CORRECT ANSWERS Yes. HIPAA
requirements do not supercede state requirements. Stricter laws prevail. States can 1.
shorten the 6 month look back period. 2. shorten 12 month maximum pre-existing
condition exclusion period.3. increase the 63 day/significant break in coverage 4. increase
30 day period for newborns, adopted children, children placed in adoption and pregnant
women. 5. Expand the prohibitions on conditions and people to whom a pre-existing
condition exclusion period may be applied beyond exceptions. 6. reduce additional special
enrollment periods. 7. reduce maximum HMO affiliation period to less than 2 months.
Break in coverage - CORRECT ANSWERS 63 days or longer that a subscriber has been
without health insurance coverage (not including waiting periods)
Waiting period - CORRECT ANSWERS period of time specified by health insurance
contract that occurs between signing up for insurance and the beginning of health
insurance coverage. Cannot be counted as creditible coverage time. Individuals can use
COBRA from their previous employers for health insurance
Establishing waiting period - CORRECT ANSWERS HIPAA does not prohibit plans from
establishing a waiting period. But the waiting period and the pre-existing conditions
exclusions must start at the same time and run concurrently.
Creditable Coverage - CORRECT ANSWERS For the purpose of the Health Insurance
Portability and Accountability Act, coverage under virtually any type indivual or group
health care plan without a break in coverage of 63 days or more. Cannot be taken into
account when determining a significant break in coverage. Only coverage after the 63 day
break will be counted. Any coverage before the 63 day break will not be considered.
, COBRA - CORRECT ANSWERS Consolidated Omnibus Budget Reconciliation Act; law
to provide terminated employees or those who lose insurance coverage because of
reduced work to be able to buy group insurance for themselves and their families for a
limited amount of time.
Certification of creditable coverage - CORRECT ANSWERS Documentation that is
provided automatically by the plan or issuer when the individual loses coverage or
becomes entitled to elect COBRA continuation coverage and when an individual's COBRA
continuation covearage ceases ; Be provided if requested before loss of coverage or within
24 months of loss of coverage. May be provided through use of model certificate
Nondiscrimination requirements - CORRECT ANSWERS Inividuals cannot be excluded
from coverage under the terms of the plan based on specified factors related to health
status. Health plans cannot establish rules of eligibility based on healht status related
factors" such as health status, medical condition, claims experience, receipt of health care,
medical history, genetic information, evidence of insurability or disablity. Insurer cannot
drop a patient from coverage because it knows that the patient will require a liver transplant
next year. Cannot charge more for premiums based on health status.
Security of health information and electronic signature standards - CORRECT ANSWERS
provides a uniform level of protection of all health information that is housed or transmitted
electronically. pertains to the individual.
Tax Equity and Fiscal Responsibility ACT of 1982 - CORRECT ANSWERS the purpose of
this act is to control the rising cost of providing health care services to medicare
beneficiaries and has incentives for cost containment. The act:1. established a case based
reimbursement system (DRG) payment system determined the cost of care for selected
diagnoses while also placing limits on rate increases in hospital venues. 2. Exempted
medical rehabilitation from DRGs. Rehabiliation would continue as a cost based
reimbursement system with limits. 3. Amended social security act so that group health
plans pay before medicare for active employees 65-69 years old and for their spouses in
the same age group. 4. revised Age discrimination act by requiring employers to offer
health benefits to active employees 65-69 and their spouses in the same age bracket. 5.
establish peer review organizations to reduce costs associated with the hospital stays of
medicare and medicaid patients. Also established hospice benefit.
The Mental Health Parity Act of 1996 - CORRECT ANSWERS A statute that forbids health
plans from placing lifetime or annual limits on mental health coverage that are less
generous than those placed on medical or surgical benefits. Excluded substance abuse. If
a plan does cover mental health, it cannot set a separate dollar limit from medical care.
Other limits allowed: limited number of annual outpatient visits; Limited number of annual
inpatient days; a per visit fee; Higher deductibles and copayments without parity in medical
and Correct Answers 2025
Case management - CORRECT ANSWERS a collaborative process that assesses, plans,
implements, coordinates, monitors and evaluates the options and services required to
meet the client's health and human services needs.
Case Management Characteristics - CORRECT ANSWERS characterized by advocacy,
communication, and resource management and promotes quality and cost-effective
interventions and outcomes.
Glasgow Coma Scale - CORRECT ANSWERS Client assessment tool that measures
level of coma in the acute phase of injury it is an objective way of recording the conscious
state of a person. Eye opening, Best verbal, best motor. < 8 coma, 13-15 mild injury.
Strengths Based Model - CORRECT ANSWERS assesses clients capacities and potential
resources as well as problems and current unmet needs. Eliciting capacities and potential
resources as well as problems and current unmet needs.
Independent Living Model - CORRECT ANSWERS sees a disability as a construct of
society
Medicare Prospective Payment System - CORRECT ANSWERS hospitals paid a pre-
determined rate for each Medicare admission. Each patient is classified into a DRG.
PHQ-9 - CORRECT ANSWERS Client assessment tool for depression
Braden Scale - CORRECT ANSWERS Client assessment tool for pressure sore risk
Clinical Pathway - CORRECT ANSWERS Structured multidisciplinary CM plan designed
to support the implementation of specific clinical guidelines and protocols. They are maps
that guide the healthcare team on usual treatment patterns related to common diagnoses,
conditions and procedures e.g., CHF
,SF-36 - CORRECT ANSWERS Client assessment tool to measure physical and mental
health.
Medicare - CORRECT ANSWERS Established in 1965 under Title XVIII or Social Security
Act. Four Parts A-hospital insurance, B-medical insurance (doctors visits), C-Medicare
Advantage program in a private plan such as HMO, D-prescription drug benefit
Medicare Benefits and Cost Sharing - CORRECT ANSWERS Not covered are:
Acupuncture, chiropractor, cosmetic, custodial home care, dental care, DME
convenience, hearing aids, eyeglasses, foot care, meals on wheels, personal
convenience, prescription drugs, private nurses, routine physical, vision
areas of accountability of case management - CORRECT ANSWERS clinical/outcome
financial
functional/outcome
satisfaction
behavior
process
*episode or continuum
**individual or population
Measuring performance: Process - CORRECT ANSWERS The measure of how many pts
receive a treatment or service i.e. vaccinations, screenings, ex. diabetic foot exam ALSO
practitioner's practice conforming to practice standards.
Measuring performance: Functional outcome - CORRECT ANSWERS The measure
reflects the health state of a patient as a result of health care ex. increased independency
in ADLs, mobility
Measuring performance: Clinical outcome - CORRECT ANSWERS The measure reflects
the health state of a patient as a result of health care ex. blood pressure goals ex. HgA1c
level, wound healing
Measuring performance: behavioral 'process' - CORRECT ANSWERS ex. self-monitoring
of blood sugar
Measuring performance: Financial - CORRECT ANSWERS ex. fewer ED visits, ALOS
decreased
,Women's Health and Cancer Rights Act of 1998 - CORRECT ANSWERS 1. Part of
Omnibus Appropriations Bill. 2. required group health plans to provide coverage for
mastectomies and provide certain reconstructive related services following mastectomies.
Women's health and cancer rights act coverage - CORRECT ANSWERS 1. reconstruction
of the breast. 2. surgery and reconstruction of the other breast 3. breast prothesis
4. treatment for physical complications attendant to the mastectomy
Women's health and cancer rights act prohibitions - CORRECT ANSWERS Health plans
are not allowed to deny anyone coverage for the sole reason of avoiding the requirements
of the act AND cannot induce a physician to limit the care that is required under the act by
penalizing or limiting reimbursement to the physician.
Can states modify HIPAA's portability requirement - CORRECT ANSWERS Yes. HIPAA
requirements do not supercede state requirements. Stricter laws prevail. States can 1.
shorten the 6 month look back period. 2. shorten 12 month maximum pre-existing
condition exclusion period.3. increase the 63 day/significant break in coverage 4. increase
30 day period for newborns, adopted children, children placed in adoption and pregnant
women. 5. Expand the prohibitions on conditions and people to whom a pre-existing
condition exclusion period may be applied beyond exceptions. 6. reduce additional special
enrollment periods. 7. reduce maximum HMO affiliation period to less than 2 months.
Break in coverage - CORRECT ANSWERS 63 days or longer that a subscriber has been
without health insurance coverage (not including waiting periods)
Waiting period - CORRECT ANSWERS period of time specified by health insurance
contract that occurs between signing up for insurance and the beginning of health
insurance coverage. Cannot be counted as creditible coverage time. Individuals can use
COBRA from their previous employers for health insurance
Establishing waiting period - CORRECT ANSWERS HIPAA does not prohibit plans from
establishing a waiting period. But the waiting period and the pre-existing conditions
exclusions must start at the same time and run concurrently.
Creditable Coverage - CORRECT ANSWERS For the purpose of the Health Insurance
Portability and Accountability Act, coverage under virtually any type indivual or group
health care plan without a break in coverage of 63 days or more. Cannot be taken into
account when determining a significant break in coverage. Only coverage after the 63 day
break will be counted. Any coverage before the 63 day break will not be considered.
, COBRA - CORRECT ANSWERS Consolidated Omnibus Budget Reconciliation Act; law
to provide terminated employees or those who lose insurance coverage because of
reduced work to be able to buy group insurance for themselves and their families for a
limited amount of time.
Certification of creditable coverage - CORRECT ANSWERS Documentation that is
provided automatically by the plan or issuer when the individual loses coverage or
becomes entitled to elect COBRA continuation coverage and when an individual's COBRA
continuation covearage ceases ; Be provided if requested before loss of coverage or within
24 months of loss of coverage. May be provided through use of model certificate
Nondiscrimination requirements - CORRECT ANSWERS Inividuals cannot be excluded
from coverage under the terms of the plan based on specified factors related to health
status. Health plans cannot establish rules of eligibility based on healht status related
factors" such as health status, medical condition, claims experience, receipt of health care,
medical history, genetic information, evidence of insurability or disablity. Insurer cannot
drop a patient from coverage because it knows that the patient will require a liver transplant
next year. Cannot charge more for premiums based on health status.
Security of health information and electronic signature standards - CORRECT ANSWERS
provides a uniform level of protection of all health information that is housed or transmitted
electronically. pertains to the individual.
Tax Equity and Fiscal Responsibility ACT of 1982 - CORRECT ANSWERS the purpose of
this act is to control the rising cost of providing health care services to medicare
beneficiaries and has incentives for cost containment. The act:1. established a case based
reimbursement system (DRG) payment system determined the cost of care for selected
diagnoses while also placing limits on rate increases in hospital venues. 2. Exempted
medical rehabilitation from DRGs. Rehabiliation would continue as a cost based
reimbursement system with limits. 3. Amended social security act so that group health
plans pay before medicare for active employees 65-69 years old and for their spouses in
the same age group. 4. revised Age discrimination act by requiring employers to offer
health benefits to active employees 65-69 and their spouses in the same age bracket. 5.
establish peer review organizations to reduce costs associated with the hospital stays of
medicare and medicaid patients. Also established hospice benefit.
The Mental Health Parity Act of 1996 - CORRECT ANSWERS A statute that forbids health
plans from placing lifetime or annual limits on mental health coverage that are less
generous than those placed on medical or surgical benefits. Excluded substance abuse. If
a plan does cover mental health, it cannot set a separate dollar limit from medical care.
Other limits allowed: limited number of annual outpatient visits; Limited number of annual
inpatient days; a per visit fee; Higher deductibles and copayments without parity in medical
