CCM Exam Study August 2017-Abi's 91 Questions with Verified Answers
The most effective cost containment strategy used in pharmacy benefits management
... [Show More] is:
A) Volume purchase discounts.
B) Use of mail order pharmacies.
C) Use of a preferred drug list.
D) Use of generic drugs. - CORRECT ANSWER Answer: D) Use of generic drugs.
Rationale: While all of these strategies are used to contain costs in pharmacy benefits management, the most cost effective strategy is to use generic medications in lieu of name brand drugs.
Case management facilitates the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation.
The case manager's primary function is:
A) Care coordination
B) Cost containment
C) Outcomes management
D) Education - CORRECT ANSWER Answer: A) Care coordination
The case manager links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client- centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all—the clients, their support systems, the providers, and the payers. All four are case management functions, but the primary function the case manager is coordination of care.
Case managers facilitate client autonomy and wellness through:
A) Persuasion, financial incentives, and communication.
B) Assessing, goal setting, and service facilitation.
C) Caregiver education and resource management.
D) Advocacy, communication, and education. - CORRECT ANSWER Answer D) Advocacy, communication, and education.
http://ccmcertification.org/.../definition-and-philosophy-cas...
Case management facilitates the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, 4 education, resource management, and service facilitation.
Which organization assists with the employment and retention employees with disabilities by providing information on job accommodations?
A) Americans with Disabilities Act (ADA)
B) Job Accommodation Network (JAN)
C) U. S. Department of Labor
D) American Civil Liberties Union (ACLU) - CORRECT ANSWER Answer: B) Job Accommodation Network (JAN)
Resource: http://askjan.org/blog/?page_id=2
Rationale: The Job Accommodation Network is a service provided by the U.S. Department of Labor's Office of Disability Employment Policy (ODEP). JAN's mission is to facilitate the employment and retention of workers with disabilities by providing information on job accommodations. JAN represents the most comprehensive resource for job accommodations available.
A health coach is working with a client on weight loss. What is the most important thing the healthcoach should do when setting goals?
A) Set small, achievable goals for the client.
B) Set long term goals for the client to have a normal BMI.
C) Not make the client aware of the goal, so that they do not feel pressured.
D) Assist the client to set goals that are meaningful to the client based on information obtained during the motivational interview - CORRECT ANSWER Answer: D) Assist the client to set goals that are meaningful to the client based on information obtained during the motivational interview.
Resource:
Rationale: During the motivational interview, the health coach helps the client discover issues that are most concerning to the client and discovers the inner motivations to make necessary changes. This information can then be used to make goals that are meaningful to the client, increasing the likelihood of successfully achieving the goals. The health coach should not make goals for the client but should assist the client in setting goals.
Which of the following takes place prior to services being rendered to determine if the requested service is medically necessary?
A) Concurrent review
B) Pre-certification
C) Retrospective review
D) Review for referral to case management - CORRECT ANSWER Answer: B) Pre-certification
Resource: CCMC Glossary of Terms
Rationale: Pre-certification: The process of obtaining and documenting advanced approval from the health plan by the provider before delivering the medical services needed. This is required when services are of a non-emergent nature.
It is important for the case manager to understand which of the following regarding spirituality?
A) Spirituality is separate from religion and therefore spiritual beliefs can be challenged with the patient.
B) Religious beliefs and spiritual beliefs are the same.
C) The client's spiritual beliefs often impact choices clients make regarding their health care.
D) The topic of spirituality should not be introduced by the case manager, but they may continue the conversation if brought up by the client. - CORRECT ANSWER Answer: C) The client's spiritual beliefs often impact choices clients make regarding their health care.
Resource:
Rationale: Spirituality is a broad concept with many perspectives. In general, it includes a sense of connection to something bigger than ourselves. For some people, spirituality is synonymous with religion, but a person does not have to have a religious belief to be spiritual. It is important for the case manager to have an understanding of clients' spiritual and religious views, as the views often impact choices they make in regard to healthcare.
A carpenter retires after 20 years of service with retiree health insurance benefits. He accepts a full time position with an apartment complex as a handyman the following month. When he becomes sick, which health insurance policy will pay first?
A) His spouse's health insurance policy
B) His retiree health insurance policy
C) His current employers health insurance policy
D) His current employers health insurance policy and his retiree health insurance policy will split the cost 50/50 - CORRECT ANSWER Answer: C) His current employers health insurance policy
Resource:
Rationale: The COB rules state the insurance plan that covers an active employee is primary over the plan that covers a laid-off or retired employee.
The goal of the job analysis in work rehabilitation is to identify:
A) Essential job functions and requirements
B) The strengths and abilities of the employee
C) The company culture
D) Average productivity per employee - CORRECT ANSWER Answer: A) Essential job functions and requirements
Resource:
Rationale: The primary focus of a job analysis is identifying the essential functions and requirements of the job. This may include essential duties, tasks, skills, tools and equipment used, environment and scheduling.
Which of the following psychiatric disabilities is not protected by the Americans with Disabilities Act?
A) Manic depression
B) Pyromania
C) Depression
D) Anxiety - CORRECT ANSWER Answer: B) Pyromania
Resource:
Rationale: The Americans with Disabilities Act prohibits workplace discrimination against individuals with, or with a history of, psychiatric disabilities not controlled by medication. It does not, however, protect criminal diagnoses, such as pyromania or kleptomania.
Which of the following psychiatric disabilities is not protected by the
Americans with Disabilities Act?
A) Post-traumatic stress syndrome
B) Kleptomania
C) Depression
D) Bipolar disorder - CORRECT ANSWER Answer: B) Kleptomania
Rationale: The Americans with Disabilities Act prohibits workplace discrimination against individuals with, or with a history of, psychiatric disabilities not controlled by medication. It does not however, protect criminal diagnoses, such as pyromania or kleptomania.
Which one of the following is used to evaluate an injured worker and assist in determining job placement, job accommodation, or return to work after injury or illness?
A) Functional capacity evaluation (FCE)
B) Functional independence measures (FIM)
C) Instrumental activities of daily living (IADL)
D) Job analysis - CORRECT ANSWER Answer: A) Functional capacity evaluation (FCE) Resource: CCMC Glossary of terms
Rationale: Functional Capacity Evaluation (FCE): A systematic process
of assessing an individual's physical capacities and functional abilities. The FCE matches human performance levels to the demands of a specific job or work activity or occupation. It establishes the physical
level of work an individual can perform. The FCE is useful in determining job placement, job accommodation, or return to work after injury or illness. FCEs can provide objective information regarding functional workability in the determination of occupational disability status.
The Americans with Disabilities Act protects individuals with drug addiction in which of the following employment situations?
A) The individual is applying for employment and has active drug use.
B) The individual is employed, found positive for drug use but has agreed to start a rehabilitation program.
C) An applicant who is not qualified for the position but successfully completed a drug rehabilitation program.
D) An employee with a recently found history of drug use, who has been successfully rehabbed and is no longer using drugs. - CORRECT ANSWER Answer: D) An employee with a recently found history of drug use, who has been successfully rehabbed and is no longer using drugs.
Resource:
Rationale: The Americas with Disabilities Act provides protection for qualified applicants and employees with drug addiction if they have been successfully rehabilitated and no longer use drugs or alcohol. It does not protect employees who are currently using drugs or alcohol.
Mr. Jenkins has advanced Alzheimers and requires 24 care. Which of the following may help cover his cost at an Alzheimer's care facility?
A) Long Term Disability Insurance
B) Long Term Care Insurance
C) His medical benefit
D) Unemployment Compensation - CORRECT ANSWER Answer: B) Long Term Care Insurance
Resource:
Rationale: A long-term care policy may offset some or all of the cost of long-term care. These policies vary widely, but usually, have a limit on the dollar amount or number of years one can receive the benefit.
A woman is hospitalized for a c-section. She is covered by her own employer health plan and as a dependent by her husband's employer health plan. According to COB, which health plan pays first?
A) Family Medical Leave Act (FMLA)
B) Her short term disability policy
C) Her employee health plan
D) Her husband's employee health plan - CORRECT ANSWER Answer: C) Her employee health plan
Resource:
Rationale: Under COB rules, the insurance plan covering the individual as an employee is the primary payer.
When dealing with a maladaptive family, the case manager should:
A) Encourage them to have a single caregiver provide all assistance to the patient so that here is consistency.
B) Refer them to support groups or family counseling.
C) Close the member to case management as there will be no benefit from the service.
D) Arrange for placement of the patient into an appropriate facility. - CORRECT ANSWER Answer: B) Refer them to support groups or family counseling.
Resource:
Rationale: The case manager can make a referral to family counseling or support groups. She can also encourage the family to maintain as much of their normal routine as possible.
Ms. Waters is 65 years old and recently diagnosed with liver cancer. She tells you she has only worked "under the table" as a babysitter for family and friends. She has never been formally employed. Which of the following is she most likely to receive.
A) Medicare
B) Unemployment
C) Medicaid
D) Social Security Disability Insurance (SSDI) - CORRECT ANSWER Answer: C) Medicaid
Resource:
Rationale: Medicare, SSDI, and unemployment are all insurances funded by employees wages. As Ms. Waters has never paid into these, she would not be eligible to receive these benefits. Medicaid is based on need, not work history. Of the choices, Ms. Waters is most likely to receive Medicaid.
Which of the following is not Durable Medical Equipment?
A) Wheelchair
B) CPAP
C) Enteral feeding pump
D) Wound care supplies - CORRECT ANSWER Resource: CCMC Glossary of terms; https://secure.ssa.gov/poms.nsf/lnx/0600610200
Rationale: Durable Medical Equipment (DME): Equipment needed by patients for self-care. Usually, it must withstand repeated use, is used for
a medical purpose, and is appropriate for use in the home setting.
Medicare provides health insurance benefits to all of the following except:
A) A 65-year-old receiving Social Security Benefit
B) A 25-year-old receiving Social Security Disability for 5 months
C) A 52-year-old diagnosed with Lou Gehrig's Disease 3 months ago
D) A 12-year-old diagnosed with End Stage Renal Disease (ESRD) requiring dialysis - CORRECT ANSWER Answer: B) A 25-year-old receiving Social Security Disability for 5 months
Resource:
Rationale: Medicare provides health insurance benefits to people:
• 65 or older who have made payroll tax contributions for 10 years (40 quarters) or more
• Who have specific long-term disability (been entitled to Social Security Disability benefits for at least 24 months after a 5-month coordination period, for a total of 29 months)
• Have Lou Gehrig's Disease (waiting period is waived)
• Diagnosed with permanent kidney failure (ESRD), requiring dialysis or transplant
Eligibility criteria for Supplemental Security Income (SSI) based on disability includes inability to work based on a physical/mental disability as well as
A) age 62 or older.
B) age 65 or older.
C) having a work history and accumulation enough work credits
D) meeting income and resource guidelines. - CORRECT ANSWER Answer: D) meeting income and resource guidelines.
Resource:
Rationale: Supplemental Security Income (SSI) is a need-based program for people who are ineligible for Social Security Disability Insurance (SSDI) due to never working or not accumulating enough work credits. The disability criteria are the same as for SSDI.
In regard to the psychosocial aspects of chronic illness and disability it is important for the case manager to know:
A) All patients with a catastrophic illness or injury will suffer from depression.
B) All patients who suffer a spinal cord injury will have similar psychological responses.
C) That case managers are not to deal with psychological aspects and should refer the client to a psychologist or counselor.
D) The more self-efficacy a client has, the more likely he or she will persevere when obstacles arise. - CORRECT ANSWER Answer: D) The more self-efficacy a client has, the more likely he or she will persevere when obstacles arise.
Resource:
Rationale: Not all patients will be affected in the same way by a chronic or catastrophic illness. How an individual is affected may be influenced by numerous factors, including:
• Age
• Gender
• Race
• Coping styles
• Past experiences
• Social support
• Family support
• Socioeconomic status
• Culture
Case managers can educate, support and counsel patients. Self-efficacy is on's belief in his or her own ability to succeed. The more self-efficacy a client possess, the more likely he or she will persevere when obstacles arise.
Asking the client questions such as "Are you confident filling out medical forms by yourself?" and "How well do you understand your medical conditions?" are ways that the case manager can assess for:
A) Health literacy.
B) Illiteracy.
C) Compliance with the plan of care.
D) Language barriers. - CORRECT ANSWER Answer: A) Health literacy.
Resource:
Rationale: Health literacy is the ability to obtain, communicate, process,
and understand basic health information.Signs that a patient may have low health literacy include making statements that another family member handles their medications, or deferring questions about their health history to a family member.
An 8-year-old patient is admitted for the 4th time in 9 months due to exacerbation of a chronic illness due to noncompliance. The best first action of the case manager should be to:
A) Assess for the reasons for noncompliance.
B) Report the parents to child protective services.
C) Obtain a social worker consult.
D) Arrange for around the clock caregivers for the child upon discharge. - CORRECT ANSWER Answer: A) Assess for the reasons for noncompliance.
Resource:
Rationale: The case manager should first determine the reasons for noncompliance. Based on these findings she can then proceed with other steps.
A 68-year-old continues to work full time at a small company with 9 employees. He also received Medicare. When he developed pneumonia and is hospitalized, which plan pays primary?
A) His employer health plan
B) Medicare
C) Medicare and the employer health plan split the claim 50/50
D) Workers' compensation - CORRECT ANSWER Answer: B) Medicare
Resource: Rationale:
• Medicare is primary if age 65 or older and retired.
• Medicare is primary when 65 or older and covered under employer plan with less than 20 employees.
• Medicare is primary when age 65 or older and coved on spouses plan, when spouse is working for an employer with less than 20 employees.
• Employer plan is primary when age 65 or older and covered due to working for an employer with 20 or more employees.
• Employer plan is primary when age 65 or older and covered on spouses plan when the spouse is working for an employer with 20 or more employees.
Which system reimburses for home care services based on the OASIS assessment under Medicare?
A) Diagnostic Related Group (DRG)
B) Home Health Resource Group (HHRG)
C) Case Mix Group (CMG)
D) Ambulatory Payment Classification System (APC) - CORRECT ANSWER Answer: B) Home Health Resource Group (HHRG)
Resource: CCMC Glossary of Terms
Rationale: Home Health Resource Group (HHRG): Groupings for prospective reimbursement under Medicare for home health agencies. Placement into an HHRG is based on the OASIS score. Reimbursement rates correspond to the level of home health provided.
Which criteria must be met to be eligible for hospice?
A) A signed DNR.
B) A physician certifies that the patient has a life expectancy of 6 months or less.
C) Intractable pain.
D) The need for palliative care. - CORRECT ANSWER Answer: B) A physician certifies that the patient has a life expectancy of6 months or less.
Resource:
Rationale: The primary criteria for hospice is certification from a physician of a life expectancy of 6 months or less. Although a signed DNR is preferred it is not required in all hospice programs to initiate hospice care. Treatment for intractable pain and palliative care can be provided by a hospice program, but can also be provided by other healthcare providers in the absence of a terminal diagnosis.
Which type of utilization management occurs prior to hospitalization to determine if the requested services are medically necessary?
A) Concurrent Review
B) Prospective Review
C) Retrospective Review
D) Case Management Referral - CORRECT ANSWER Answer: B) Prospective Review
Resource: CCMC Glossary of Terms
Rationale: Prospective Review: A method of reviewing possible hospitalization before admission to determine necessity, and estimated length of stay.
Retrospective Review: A form of medical records review that is conducted after the patient's discharge to track appropriateness of care and consumption of resources.
Which statement by a client would make the case manager question the clients Health Literacy?
A) "I prefer to learn new health information by hearing it."
B) "I don't remember what my doctor said. Ask my daughter, she handles that for me."
C) "I have to keep a list of all my medications and doctors so I can remember them all."
D) "Can you write that down for me?" - CORRECT ANSWER Answer: B) "I don't remember what my doctor said. Ask my daughter, she handles that for me."
Resource:
Rationale: Signs that a patient may have low health literacy include making statements that another person handles their medications, or deferring questions about their health to a family member.
Which system reimburses for Skilled Nursing Facility care based on the MDS assessment tool under Medicare?
A) Diagnostic Related Group (DRG)
B) Resource Utilization Group (RUG)
C) Case Mix Group (CMG)
D) Per diem - CORRECT ANSWER Answer: B) Resource Utilization Group (RUG) Resource: CCMC Glossary of Terms
Rationale: Resource Utilization Group (RUG): Classifies skilled nursing facility patients into 7 major hierarchies and 44 groups. Based on the MDS, the patient is classified into the most appropriate group, and with the highest reimbursement.
The best interpreter to interpret for a transplant client who's primary language is German and speaks "a little English" is:
A) The client's spouse
B) A friend of the client
C) A professional interpreter
D) No interpreter is necessary as the client speaks some English and reading material in German can be provided. - CORRECT ANSWER Answer: C) A professional interpreter
Resource:
Rationale: Although friends and family may be a convenient source of interpretation, they should not be the primary interpreter. The client may not feel comfortable disclosing some information to family members or friends regarding their private health matters. The ability of the client to speak "a little" English does not ensure he is properly understanding the information provided.
Sue is a 25-year-old client with aggressive breast cancer. During your initial assessment, she identified as being a devout Catholic. During your last interactions, she stated she, "does not know why God is punishing her like this. She has always been a good Catholic." Which of the following would be the best to refer Sue to?
A) A support group for breast cancer patients
B) A counselor
C) A psychiatrist
D) A priest - CORRECT ANSWER Rationale: Although Sue may benefit from any of these services, her primary struggle is spiritual. Because of her devout faith, a priest would be the most appropriate initial referral. [Show Less]