CCMC CCM Exam Questions

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181.

Which of the following is the least necessary piece of documentation in terms of notification of case closure?

  • Confidentiality agreement

  • Date of case closure

  • Reason for closure 

  • Method of notification

Correct answer: Confidentiality agreement

A notification regarding case closure would need to contain documentation regarding the date of case closure, the reason for case closure, and the method of notification of case closure.

By the time of case closure, confidentiality agreements should already be on file.

182.

Who is responsible for the information in a Health Risk Assessment?

  • The patient

  • The case manager

  • The primary care physician

  • Medicare

Correct answer: The patient

A Health Risk Assessment (HRA) is a self-reporting tool used in case management that helps the case manager and client come to an understanding about health risks. Ultimately, though the case manager may assist, the instrument depends on the disclosure of items known only to the patient. 

The case manager, primary care physician, and Medicare likely do not know the necessary information and cannot be responsible for accurate information in a HRA.

183.

Which of the following would be the best definition of the ethical value of fidelity?

  • Loyalty and dedication to clients

  • The right of people to act on their own behalf

  • Treating equals equally

  • Telling the truth

Correct answer: Loyalty and dedication to clients

Fidelity refers to the ethical value of loyalty and dedication to clients.

Autonomy refers to the right of people to act on their own behalf. Treating equals equally describes the ethical value of justice. Telling the truth refers to the ethical value of veracity.

184.

Which of the following is the most likely cause of malpractice suits?

  • The relationship between provider and patient

  • Poor outcomes

  • Negligence 

  • Lack of competence

Correct answer: The relationship between provider and patient

The relationship between provider and patient is responsible for 53% of calls to malpractice attorneys, superseding other such causes as poor outcomes, negligence, and lack of competence.

185.

What is the primary role of the case manager in health coaching?

  • Support the client in achieving goals

  • Educate the client about treatments

  • Convince the client to aim for better health outcomes

  • Instruct the client about disease process

Correct answer: Support the client in achieving goals

The primary role of the case manager in health coaching is to support the client in achieving goals. These will be goals of the client's choosing, based on a communication process that puts the client in the driver's seat. 

Health coaching is not primarily about education about treatments or instructions about any disease process. It is also not aimed at pushing or convincing the client to do anything they do not wish to do.

186.

How many parties are needed for a trust?

  • Three

  • One

  • Two

  • Four

Correct answer: Three

A trust requires three parties; a donor of funds, a trustee or manager, and a beneficiary. 

187.

Can family members of SSDI recipients receive benefits under SSDI?

  • Yes, in some circumstances

  • No, under no circumstances

  • No, unless also receiving SSI

  • No, unless also receiving Medicare

Correct answer: Yes, in some circumstances

Family members of those receiving Social Security Disability Income, or SSDI, can, in some circumstances, receive benefits. These include spouses over 62 years old, an unmarried child of 18 or 19 years of age if that child is still attending high school, spousal caregivers of disabled children, and others.

This benefit to family members is not relative to SSI or Medicare. 

188.

Which of the following is the purpose of job accommodation?

  • To help a specific individual perform a specific job

  • To help anyone perform a specific job

  • To help a specific individual perform any job

  • To help anyone perform any job

Correct answer: To help a specific individual perform a specific job

The purpose of job accommodation is to help a specific individual perform a specific job. It is based on a highly individualized assessment made in relationship to the exact job a person is expected to perform. 

189.

Which of the following is the first step in the health coaching process? 

  • Relationship building 

  • Motivational interview

  • Goal setting 

  • Assessment

Correct answer: Relationship building 

The first step in the health coaching process is the establishment of a relationship between case manager and patient. Many of the outcomes of patient-case manager relationships are due to the nature of the rapport that is constructed first, before anything else.

The next stage would be a motivational interview, which is a complex process of assessing and motivating the patient. Following this would be goal setting, once the rapport is built and motivation is secured. Assessment per se is not a recognized stage in the process, but to the extent necessary would take place after rapport building. 

190.

What score is considered a failing score in an accreditation process?

  • Less than 70 percent

  • Less than 60 percent

  • Less than 50 percent

  • Less than 40 percent

Correct answer: Less than 70 percent

An accreditation process is considered a failure if the evaluation on the indicated criteria returns a score of less than 70 percent.

191.

Which of the following would be considered a measure of structure?

  • Accreditation status

  • Percentage of patients screened for colon cancer

  • Percentage of patients screened for heart disease

  • Adherence rates

Correct answer: Accreditation status

Measures of structure assess the healthcare entity's ability to meet the needs of its patients. One example would be accreditation status, as this would directly influence the ability of the entity to provide care.

Percentages of patients screened for colon cancer or heart disease would be considered measures of process, as they measure what the healthcare entity is doing. Adherence rates would be an example of a measure of outcome, as it measures the results of what the healthcare entity is doing. 

192.

Which of the following refers to support and assistance offered at a distance to help people remain living in their own home?

  • Telecare

  • Telematics

  • Telehealth

  • Telenursing

Correct answer: Telecare

Telecare is support and assistance offered at a distance in order to assist a person in maintain living in their own home.

Telematics refers to the general connection between telecommunications (remote communications) and informatics (data processing and retrieval). Telehealth refers to the remote delivery of healthcare services and clinical information. Telenursing refers to the provision of services remotely by one or more nursing professionals.

193.

How old must a person be to have a reverse mortgage as an option?

  • 62

  • 55

  • 30

  • There is no age requirement

Correct answer: 62

A reverse mortgage is an option sometimes used by homeowners who are 62 years old or older. In a reverse mortgage, the patient borrows against the home's value without leaving the home or making payments. 

194.

What does the FIM Instrument measure?

  • Disability

  • Recovery from injury

  • Low-income program eligibility

  • Eligibility to work

Correct answer: Disability

The FIM Instrument (originally referred to as the Functional Independence Measure) is a validated, functional measure of disability. It is a standard instrument used by CMS, private health care entities, and others.

The FIM Instrument does not measure recovery from injury, low-income program eligibility, or eligibility to work.

195.

What are Core Measures?

  • Evidence-based standards for patient care

  • Evidence-based standards for process improvement in healthcare

  • Commonly understood standards for patient care

  • Commonly understood standards for process improvement in healthcare

Correct answer: Evidence-based standards for patient care

Core Measures are evidence-based standards for patient care identified by the Centers for Medicare and Medicaid Services. They are intended to create a common language of quality across healthcare systems.

196.

Who actually administers Medicare?

  • The Centers for Medicare & Medicaid Services

  • State governments through legislation

  • Regional accrediting bodies

  • Private physicians

Correct answer: The Centers for Medicare & Medicaid Services

Medicare is a public benefit program administered by the Centers for Medicare and Medicaid Services. 

State governments, regional accrediting bodies, and private physicians definitely interface with the Medicare system, but the program is ultimately administered by the federal government.

197.

What is the reimbursement model under capitation?

  • A regular fee for all services

  • A single fee for some services

  • A single fee for all services

  • Fees paid for individual services

Correct answer: A regular fee for all services

Capitation is a reimbursement model whose defining characteristic is a regular fee paid for all services. It is the typical structure used by Health Management Organizations (HMOs).

198.

Which of the following would not be considered a level of care?

  • Hospital

  • Intensive care unit

  • Telemetry

  • Definitive observation unit

Correct answer: Hospital

A level of care is a measure of the effort made to treat a patient properly, and can differ from the place of care. At a hospital, one may be involved in many different levels of care, such as intensive care, telemetry, and definitive observation.

199.

With respect to HMOs, which of the following types of provider is the key figure in determining type of HMO?

  • Physician

  • Case manager 

  • Utilization review coordinator

  • Discharge planner

Correct answer: Physician

Health Maintenance Organizations (HMO) are organizations that manage the care of individuals mainly through the organization and activity of physicians. The main distinguishing feature of the type of HMO is the management and reimbursement structure of physicians within that HMO.

Case managers, utilization review coordinators, and discharge planners are less central in determining the type of HMO.

200.

Which of the following is false about medical necessity?

  • It is the same across health plans

  • It determines what is reimbursed

  • Only medically necessary items are covered

  • It varies by health plan

Correct answer: It is the same across health plans

Medical necessity is the doctrine that only evidence-based, appropriate, and necessary items are covered by a healthcare plan. What is deemed medically necessary will be reimbursed; what is not will not be. What is considered medically necessary varies by health plan.