CCM Test Question

The insurance case management requests information from the hospital case manager about a patient's current status including labs, vitals, and wound healing. This is:

A concurrent review

72 yr old male client with a low-income has been losing weight since his wife's death 6 mo ago. He states he does not like to cook and has been living off of junk food since her death. What is the best resource for this client?

A meal delivery service

An Accelerated Death Benefit is appropriate for:

A patient who is terminally ill and has a life insurance policy he can receive funds from during the terminal illness.

Which assessment tool evaluates areas of function for self-care?

Activities of Daily Living

By providing which of the following to the client is the case manager helping to foster self-efficacy?

Affirmation

What is the best description of client engagement?

An engaged client shares information with the healthcare team and takes an active role in care decision.

Which important activity should be included during the transitioning step of the case management process?

Assessing whether the client is ready for transfer to another level of care

The case management process included:

Assessing, planning, implementing, coordinating, monitoring, and evaluating

When the case manager becomes aware of a client's cultural or religious beliefs that conflict with the treatment plan, the case manager should:

Attempt to adjust the treatment plan to work within the cultural/religious limits

Which of the following is not a payment methodology? A. Fee for Services B. Prospective Payment C. Accountable Care D. Bundled Case Rate

C. Accountable Care

Which tool can case managers use to assess for substance abuse or addiction?

CAGE Tool

Which accreditation body targets organizations that focus on medical rehabilitation, durable medical equipment, aging services, and behavioral health programs?

CARF

Shared decision making is best exemplified by which scenarios below?

Clients choose what treatment options they prefer after education from the case manager and provider

Case manager supports Client Empowerment through all the following actions except:

Creating detailed lists for the clients to follow

An example of a hard saving that a case manager can claim?

Decreased length of stay after the case manager recommends to the treating physician that the patient is stable and can be transferred to a lower level of care.

The first thing for the case manager to do when a client is not compliant with the plan of care is to:

Discuss barriers to compliance with the member.

Clients with mental illness such as depression and bipolar disease are at high risk for:

Dual diagnosis

37 year old mother of 2 who is paralyzed from the waist down after a motor vehicle accident. She tells the case manager, "I can never be a good mom from this wheelchair." The case manager should:

Encourage the patient to explore her feelings regarding this

Hospice care provides:

End of life care, including palliative care, to patients with a terminal illness

A Cost-Benefit Analysis:

Formally documents monetary savings related to case management involvement

Quality Indicators can be used to:

Identify Variances

Medicare Part A will cover a patient in a skilled nursing facility if:

It follows within 30 days of a hospital stay of at least 3 days and is medically necessary.

What quality improvement accreditation organization supports Healthcare Effectiveness Data and Information Set (HEDIS)?

National Committee for Quality Assurance (NCQA)

Which answer best describes the impact of Medication Adherence?

Nearly 50-75% of adults are medication non-adherent in one or more ways.

A patient in an Exclusive Provider Organization (EPO) plan decides out-of-network to receive care. This decision means that he will:

Not be covered under the health plan for the services provided

Which assessment tool is used to pre-screen patients for depression?

PHQ-2

Case manager is preparing to move her patient from an acute hospital setting to a skilled nursing facility. What should cm keep in mind during this transition of care?

Patient is at increased risk for adverse outcomes

The value of case management services are demonstrated in patient care reports as demonstrated in each of the following statements except:

Physician's Interventions (pg 232)

The case manager is working with a client in a weight loss program. The client makes the statement, "I have thrown out all of the unhealthy food in the house. I also started collecting healthy recipes and am ready to start my new way of eating on Monday". CM knows the client is in which stage of change?

Preparation

Medicare Part D covers:

Prescription Medications

Coordination of benefits is designed to

Provide a reimbursement methodology when there is more than one payment source

Monitoring healthcare quality is impossible without the use of?

Quality Indicators

What is funded by social security taxes paid by workers and employers

SSDI

Which case management step involves reviewing information to decides a patient's appropriateness for case management services?

Screening

Motivational Interviewing principle of expressing empathy is best explained by which of the following:

Seeing things as the client sees them through reflective listening

A copayment is a:

Specific amount paid at the time of the service for specified services

Which factor below is the best indication a family is adapting to changing dynamics?

Stress levels are managed within the family unit

Health coaching's purpose is to:

Support, encourage, and empower clients to reach their goals

After suffering this type of injury/incident, a Neuropsychological evaluation is often required:

TBI

During the initial exam and on subsequent interactions with the client, case managers should assess:

Temporary or permanent functional changes Physiological, psychological, or social problems Problems functioning in the community

Precertification is:

The process of obtaining approval before medical treatment occurs

When interpreting data, what 2 elements must be taken into consideration?

Validity and Reliability

Selling a life insurance policy to a third party for cash is called:

Viatical Settlement

Patient lives with his adult dtr and her husband. He tells the case manager that he has not taken one of his blood pressure meds in a week because he ran out and cannot afford to refill it. He goes on to state his checkbook is missing several checks and his account is overdrawn. Patient is most likely experiencing?

Victim of FINANCIAL abuse

What best describes the role of an interdisciplinary team?

Work in a group to manage the physical, psychological, and spiritual needs of the patient.

What form of coverage does not have a waiting period?

Workers' Compensation