CCM MULTIPLE CHOICE STUDY
QUESTIONS AND ANSWERS
All of the following are true regarding coordination of benefits
(COB) except:
A) COB prevents double payment for services when a
subscriber has health insurance coverage from two or more
sources.
B) COB is voluntary.
C) COB determi...
All of the following are true regarding coordination of benefits
(COB) except:
A) COB prevents double payment for services when a
subscriber has health insurance coverage from two or more
sources.
B) COB is voluntary.
C) COB determines which insurer pays first when the insured
is covered under more than one health insurance policy.
D) COB coordinates workers' compensation with health
insurance coverage. ANSWER Answer: D) COB coordinates
workers' compensation with health insurance coverage.
Rationale: COB does not coordinate benefits with workers
compensation. COB is a voluntary program that prevents
double payment for services when the subscriber has health
insurance from more than one source. COB has rules to
determine which insurer pays first.
Utilization management reviews services to ensure that:
A) each line item on a submitted claim is an appropriate charge
B) they are medically necessary, provided in the most
appropriate care setting, and at or above quality standards.
C) appropriate discharge planning is performed.
D) they are ordered by a physician, provided in the most
appropriate care setting, and exceed quality standards.
ANSWER Answer: B) they are medically necessary, provided in
the most appropriate care setting, and at or above quality
standards.
Resource: CCMC Glossary of Terms
, Rationale: Utilization Management: Review of services to
ensure that they are medically necessary, provided in the most
appropriate care setting, and at or above quality standards.
The case managers role when working with clients with
substance abuse is to:
A) Motivate the client to change.
B) Support the treatment plan and assist in finding resources.
C) Counsel the client.
D) Monitor for substance use. ANSWER Answer: B) Support
the treatment plan and assist in finding resources.
To meet the criteria of medical necessity all of the following
should be present except:
A) It is reasonable
B) It is based on evidence-based standards of care
C) It is appropriate
D) It is custodial ANSWER Answer: D) It is custodial
The Ambulatory Payment Classification System (APC) is used
to determine payment rates for which one of the following under
Medicare?
A) Ambulatory surgery
B) Outpatient rehabilitation and ambulatory surgery
C) ER, hospital-based clinic, observation, and ambulatory
surgery
D) Physician office visits ANSWER Answer: C) ER, hospital-
based clinic, observation and ambulatory surgery
Rationale: The Ambulatory Payment Classification System
(APC) is Medicare's prospective payment system for the
hospital-based clinic, ER, observation, and ambulatory surgery
encounter.
Which would be most appropriate for a 48-year-old nurse who
has a broken leg as the result of a work-related injury?
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