ACM-RM Certification Exam
Case Managers require certain skills in the planning process. List three skills
1. Advocacy 2. Communication 3. Leadership
What is face to face certification for post acute home healthcare?
A billing requirement for the home health agency, a certification that the patient is homebound, and an attestation by the attending physician that home health services are medically necessary
What does discharge planning and case management involve?
Developing a plan of care that implement's the physicians orders while taking the patients rights and wishes into account
True or False: Case Management and managed care are interchangeable terms?
False, Case Management includes the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patients patients right to self determination
What is the most common metric concurrently associated with a patient's treatment plan?
Length of Stay (LOS)
What should planning for discharge include?
Plan for the day, plan for the stay, and plan for the way
What does it mean when a case manager performs financial assessment?
Reviews current insurance coverage, including prescription benefits
What does a patient's right to choose post acute home services mean?
The case manager must use reasonable due diligence to honor the patient's right to choice, but if providers of choice are not available, the case manager may arrange services with other providers.
What factor drives patient progression through the acute care setting?
The patients clinical coordination and DC plan
In order for a traditional Medicare beneficiary to quality for SNF coverage, her or she must have a 3-day hospital stay meeting what criteria?
The patients stay must be a consecutive inpatient hospital stay, not midnight in observation with one inpatient day
A case manager needs to send a referral, including demographics, H&P, and therapy noted to a home health agency. True or False: No specific patient consent is is required for releasing information related to treatment, payment, or healthcare operations.
True
True or False: In accordance with the CMS DC Planning Conditions of Participation, patients do not have to be offered the choice for post acute services such as home health or SNF
True
True or False: Patients in a licensed inpatient bed on observation status are considered outpatient?
True
When should Code 44 be used?
When the UR committee determines and documents inpatient care is not required, the physician concurs, and the change in status occurs prior to DC or release of the patient
Under the CMS conditions of participation for DC planning for Hospitals, the hospital must provide a DC planning evaluation to the patients identified as high risk, as well as: a) If requested by the patient b) Medicare Advantage patients c) At the request of the insurance case manager d) Observation patients
a) If requested by the patient
A case managers decision related to the selection of the most appropriate mode of transportation to the next level of care includes: a) mobility b) if the patient has a h/o HTN c) payer d) allergies
a) Mobility
The CMS/Medicare Conditions of Participation include guidelines for a) Patient choice in the discharge care provider b) Patient complaint review process c) Teachback methodology d) Standardized patient plan of care
a) Patient choice in the discharge care provider
Under the conditions of participation, CMS sets clear requirements for assessment and discharge planning for those who may suffer an adverse outcome if the assessment is not completed. The need for a DC planning consult may be identified by which of the following: a) admission status b) payer determines which patients need an assessment c) physician consult, patient/caregiver request, and medical record review d) all of the above
c) physician consult, patient/caregiver request, and medical record review