Which of these is a setting a case manager may work in?
A. Hospital
B. Worker's compensation
C. Neither
D. Both correct answers D. Both
Which is not an attribute of an aggressive negotiation style?
A. Manipulation
B. Frequent successful outcomes
C. Unwillingness to make concessions
D. E...
CCM Exam || with 100% Accurate Solutions.
Which of these is a setting a case manager may work in?
A. Hospital
B. Worker's compensation
C. Neither
D. Both correct answers D. Both
Which is not an attribute of an aggressive negotiation style?
A. Manipulation
B. Frequent successful outcomes
C. Unwillingness to make concessions
D. Excessive demands correct answers B. Frequent successful outcomes
What is the difference between ADL's and Instrumental Activities of Daily Living (IADL's)?
A. ADL's are more challenging skills
B. The IADLs are more challenging skills
C. The IADLs are meant to be done in a group setting
D. The IADLs involve personal grooming. correct answers B. The IADL's are more challenging
skills.
Which evaluative tool can be used to identify depression in patients?
A. Tricare
B. Diagnostic and Statistical Manual of Mental Disorders (DSM)
C. Patient Health Questionnaire-9 (PHQ-9)
D. Utilization Review Accreditation Commission (URAC) correct answers C. PHQ-9
Which of these describes acute diseases?
A. Rapid onset and duration over six months.
B. Rapid onset and a short duration.
C. Inherited condition that can be cured.
D. Incurable but may or may not be inherited. correct answers B. Rapid onset and a short
duration.
When must a case manager review a client's medications?
A. When she first obtains the case.
B. After every time the client is hospitalized.
C. After every time the client visits the doctor.
D. All of the above. correct answers D. All of the above
Which case management step involves reviewing information to decide a patient's
appropriateness for case management services?
A. Case Planning
B. Assessment
C. Stratifying Risk
D. Screening correct answers D. Screening
,Which important activity should be included during the transitioning step of the case
management process?
A. Assessing whether the client is ready for transfer to another level of care.
B. Assessing the effectiveness of the case management plan.
C. Assessing the patient's knowledge of their health conditions.
D. Assessing the patient's belief in self-efficacy. correct answers A. Assessing whether the client
is ready for transfer to another level of care.
Which assessment tool evaluates areas of function for self-care?
A. Activities of Daily Living (ADL)
B. Behavioral Assessment
C. Patient Health Questionnaire
D. Health Risk Assessment correct answers A. Activities of Daily Living (ADL)
What assessment tool is used to pre-screen patients for depression?
A. PHQ-9
B. Instrumental Activities of Daily Living
c. PHQ-2
D. Wellness screenings correct answers C. PHQ-2
Case manager Mary is preparing to move her patient from an acute hospital setting to a skilled
nursing facility. What should Mary keep in mind during this transition of care?
A. Her patient needs to understand the reason for moving to another level of care.
B. Her patient needs to have all their medications with them.
C. Her patient is at risk for adverse outcomes.
D. Her patient needs to be educated on self-management. correct answers C. Her patient is at risk
for adverse outcomes.
What best describes the role of an Interdisciplinary team?
A. Work in a group to manage a patient's transition of care.
B. Work in a group to develop policies and processes of patient care.
C. Work in a group to review adverse events of care.
D. Work in a group to manage the physical, psychological, and spiritual needs of the patient.
correct answers D. Work in a group to manage the physical, psychological, and spiritual needs of
the patient.
Hospice care provides:
A. End of life care for only Medicare patients with a terminal illness.
B. End of life care, including palliative care, to patients with a terminal illness.
C. End of life care that excludes palliative care to patients with a terminal illness.
D. End of life care for only Medicaid patients with a terminal illness. correct answers B. End of
life care, including palliative care, to patients with a terminal illness.
Which statement about Social Security Disability Income (SSDI) is true?
A. It is a needs-based benefit.
,B. There is no waiting period.
C. It is funded by Social Security taxes paid by workers and employers.
D. Eligibility is based on income. correct answers C. It is funded by Social Security taxes paid by
workers and employers.
Coordination of benefits is designed to:
A. Maximized benefits to patients.
B. Provide a reimbursement methodology when there is more than one payment source.
C. Provide a replacement for lost wages as well as medical coverage.
D. Assure the contractual requirements for coverage are met. correct answers B. Provide a
reimbursement methodology when there is more than one payment source.
Which of the following is not a payment methodology?
A. Fee for service
B. Prospective payment
C. Accountable care
D. Bundled case rate correct answers C. Accountable care
Selling a life insurance policy to a third party for cash is called a:
A. Reverse mortgage
B. Viatical settlement
C. Actuarial calculation
D. Accelerated death benefit correct answers B. Viatical settlement
Medicare Part D covers:
A. Home care
B. Inpatient rehab
C. Prescription medications
D. Outpatient PT/OT correct answers C. Prescription medications
Precertification is:
A. The process of applying for health insurance.
B. The required amount of time one must work before becoming eligible for coverage.
C. The waiting period for disability.
D. The process of obtaining approval before medical treatment occurs. correct answers D. The
process of obtaining approval before medical treatment occurs.
What form of coverage does not have a waiting period?
A. Short term disability insurance
B. Long term disability insurance
C. Workers' compensation
D. Social Security Disability correct answers C. Workers' compensation
Medicare Part A will cover a patient in a skilled nursing facility if:
A. Their PCP orders the stay and it is medically necessary.
B. It is medically necessary and immediately follows a hospital stay of at least one week.
, C. The patient lives alone and can't care for himself.
D. It follows within 30 days of a hospital stay of at least 3 days and is medically necessary.
correct answers D. It follows within 30 days of a hospital stay of at least 3 days and is medically
necessary.
A patient in an Exclusive Provider Organization (EPO) plan decides to go out-of-network to
receive care. This decision means he will:
A. Be subject to a large deductible and copay
B. Not be covered under the health plan for the services provided
C. Will be covered
D. Be converted to a fee-for-services plan correct answers B. Not be covered under the health
plan for the services provided.
The insurance case manager requests information from the hospital case manager about a
patient's current status including labs, vitals, and wound healing. This is:
A. A retrospective review
B. A concurrent review
C. A peer to peer review
D. A prospective review correct answers B. A concurrent review
A copayment is a :
A. Specific amount paid at the time of the service for specified services
B. Your monthly premium
C. The amount of the premium paid after your employer contributes
D. The amount you must pay before your insurance begins paying correct answers A. Specific
amount paid at the time of the service for specified services
The case management process includes:
A. Assessing, planning, implementing, coordinating, monitoring, and evaluating
B. Quality improvement, analysis, and monitoring
C. Contacting the client, validating insurance, coordinating care, and billing
D. Assessing, diagnosing, coordinating, and utilization management correct answers A.
Assessing, planning, implementing, coordinating, monitoring, and evaluating
An Accelerated Death Benefit is appropriate for:
A. A beneficiary who is disabled, either physically or mentally
B. A patient who is a homeowner aged 62 or older
C. A patient who is terminally ill and has a life insurance policy he can sell to a third party
D. A patient who is terminally ill and has a life insurance policy he can receive funds from
during the terminal illness correct answers D. A patient who is terminally ill and has a life
insurance policy he can receive funds from during the terminal illness
Which answer best describes the impact of Medication Adherence?
A. Nearly 50-75% of adults are medication non-adherent in one or more ways
B. 50% of hospital and skilled nursing admissions are due to medication nonadherence
C. Money is the most common cause of medication nonadherence
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