CCM PRACTICE ABI 36 QUESTIONS with Verified Answers
Answer: A) Care coordination
The case manager links clients with appropriate providers and
... [Show More] 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. - CORRECT ANSWER Case management facilitates the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation.
The case managers primary function is:
A) Care coordination
B) Cost containment
C) Outcomes management
D) Education
Answer: B) Pyromania
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. - CORRECT ANSWER Which of the following psychiatric disabilities is not protected by the Americans with Disabilities Act?
A) Manic depression
B) Pyromania
C) Depression
D) Anxiety
Answer: B) Job accommodation
Rationale:
Allowing an individual with a wheelchair to raise the height of their desk to accommodate the wheelchair is an example of a job accommodation. A job accommodation is focused on access for an individual. Other examples of job accommodations include voice recognition software and braille keyboards. - CORRECT ANSWER Raising the height of a desk to provide access by a wheelchair is an example of a:
A) Job modification
B) Job accommodation
C) Job restructuring
D) Building Modification
Answer: A) The patient will be required by law to continue making the premium on the policy
Rationale:
The purchasing party becomes the beneficiary and takes responsibility for paying the premium. The money received from a viatical settlement is usually free from federal income tax but may impact eligibility for Medicaid. There are no restrictions on how the money received from a viatical settlement can be used. - CORRECT ANSWER Your client is considering a viatical settlement to help cover medical expenses. All of the following are true about viatical settlements except:
A) The patient will be required by law to continue making the premium on the policy.
B) The money received from a viatical settlement is usually free from federal income tax.
C) The money received from a viatical settlement may impact eligibility for Medicaid.
D) There are no restrictions on how the money received from a viatical settlement can be used.
answer B )
Quality and cost-efficient outcomes
Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. - CORRECT ANSWER Case Management promotes what kind of outcomes?
A) Those that can be obtained for the lowest cost
B ) Quality and cost-efficient outcomes
C) Patient determined outcomes
D) Provider recommended outcomes
Answer: A) The patient will be required by law to continue making the premium on the policy
Resource:
Rationale: The purchasing party becomes the beneficiary and takes responsibility for paying the premium. The money received from a viatical settlement is usually free from federal income tax but may impact eligibility for Medicaid. There are no restrictions on how the money received from a viatical settlement can be used. - CORRECT ANSWER Your client is considering a viatical settlement to help cover medical expenses. All of the following are true about viatical settlements except:
A) The patient will be required by law to continue making the premium on the policy.
B) The money received from a viatical settlement is usually free from federal income tax.
C) The money received from a viatical settlement may impact eligibility for Medicaid.
D) There are no restrictions on how the money received from a viatical settlement can be used.
Answer: B) Encourage the patient to explore her feelings regarding this - CORRECT ANSWER Mary is a 37-year-old mother of two who is paralyzed from the waist down after a motor vehicle accident. She tells her case manager, "I can never be a good mom from this wheelchair." The case manager should:
A) Ignore the comment.
B) Encourage the patient to explore her feelings regarding this.
C) Tell the client she is lucky to be alive, and should be thankful.
D) Report her to social services.
Answer: A) Maintenance - CORRECT ANSWER The health coach is working with a client in a smoking cessation program. The client makes the statement, "I have not had a cigarette in 9 months." The case manager knows the client is in which stage of change?
A) Maintenance
B) Action
C) Preparation
D) Contemplation
Answer: A) Maintenance
Answer: A) Maintenance
Answer: B) Discuss barriers to compliance with the member. - CORRECT ANSWER The first thing for the case manager to do when a client is not compliant with the plan of care is to:
A) Close the member to case management.
B) Discuss barriers to compliance with the member.
C) Notify the client's physician.
D) Request a mental evaluation.
Answer: B) Living will. - CORRECT ANSWER The legal document that directs healthcare, specifically which treatments should be withheld, or withdrawing life support measures is:
A) Medical power of attorney.
B) Living will.
C) Advance directive.
D) Do not resuscitate order
Answer: C) Collaborative
Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. - CORRECT ANSWER Case Management is what type process?
A) Independent
B) Organizational
C) Collaborative
D) Educational
Rationale: Medicare Part B benefits include:
• Physician and surgeon
• Outpatient services
• Home health
• DME
• Emergency Room
• Physical therapy
• Ambulance - CORRECT ANSWER Medicare Part B benefits include which of the following?
A) Inpatient hospital stay, physician and surgeon, outpatient service and emergency room
B) Physician and surgeon, outpatient services, home health and physical therapy
C) Inpatient hospital stay, skilled nursing facility stay, home health care, and hospice
D) Physician and surgeon, skilled nursing facility stay and outpatient services
Answer: B) Physician and surgeon, outpatient services, home health and physical therapy
Rationale: Indemnity plans offer the most flexibility because they do not have restrictions which provider the insured can use. Indemnity benefits usually pay after the provider has billed the patient, the insured person is reimbursed by the company. Also know as fee-for-service where providers are paid for each service performed, as opposed to capitation. - CORRECT ANSWER The type of insurance plan that offers the most flexibility is the:
A) Point-of-Service Plan (POS)
B) Health Maintenance Origination (HMO)
C) Preferred Provider Organization (PPO)
D) Indemnity Plan
Answer: D) Indemnity Plan
Rationale: Health insurance contracts usually define medical necessity as care that is appropriate, reasonable and necessary. Unfortunately, these are subjective terms and determination of medical necessity can vary based on the interpretation of these terms - CORRECT ANSWER Which of the following is true about medical necessity?
A) All health plans use the same criteria to determine medical necessity.
B) The criteria to determine medical necessity varies by health plan.
C) Denying claims due to lack of medical necessity is a cost containment practice.
D) If a doctor orders it, it is medically necessary.
Answer: B) The criteria to determine medical necessity varies by health plan.
Rationale: 5 Stages of Change
1. In the pre-contemplation stage, the individual does not intend to take action in the foreseeable future.
2. In the contemplation stage, the individual considers a change in the next six months but has not committed to it. He may be open to information on the benefits of change and how to successfully do so.
3. In the preparation stage, the client actively plans to make changes within the next month and may have taken small steps toward change.
4. The action is the stage when the individual has successfully made a change and has sustained it for less than six months.
5. When the individual has sustained the change for more than 6 months maintenance has been achieved. - CORRECT ANSWER The health coach is working with a client in a hypertension program. The client makes the statement, "I know I need to make some changes in my lifestyle, I'm just not sure where to begin." The case manager knows the client is in which stage of change?
A) Pre-Contemplation
B) Action
C) Preparation
D) Contemplation
Answer: D) Contemplation
Resource: CCMC Glossary of Terms
Rationale: Health Maintenance Organization (HMO): An organization that provides or arranges for coverage of designated health services needed by plan members for a fixed prepaid premium. There are four basic models of HMOs: group model, individual practice association (IPA), network model, and staff model. Under the Federal HMO Act, an organization must possess the following to call itself an HMO: (1) an organized system for providing healthcare in a geographical area, (2) an agreed-on set of basic and supplemental health maintenance and treatment services, and (3) a voluntarily enrolled group of people. - CORRECT ANSWER Which of the following is paid a fixed amount per member per month for contracted health care services in a geographical area to voluntarily enrolled group of people?
A) PPO
B) Workers' Compensation
C) HMO
D) Managed Care
Answer: C) HMO
Rationale: Resource utilization groups (RUGs) and minimum data sets (MDS) are used to establish payment rates for skilled nursing facilities and determine reimbursement.The patient is assessed using the Minimum Data Set (MDS) assessment tool. Based on the MDS, the patient is placed on a RUG. The RUG determines the facility's reimbursement rate. - CORRECT ANSWER Resource Utilization Groups (RUG) and Minimum Data Sets (MDS) are used to determine payment rates for which one of the following under Medicare?
A) Skilled Nursing Facility (SNF)
B) Inpatient rehabilitation
C) Acute care hospitals
D) Home health agencies
Answer: A) Skilled Nursing Facility
Rationale: The motivational Interview is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior. The motivational interview is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. - CORRECT ANSWER Case managers use the motivational interview to:
A) Motivate and inspire the client to make necessary changes.
B) Help clients to explore and resolve ambivalence.
C) Determine if the client is appropriate for case management.
D) Assess the clients phycological status.
Answer: B) Help clients to explore and resolve ambivalence
Resource:
Rationale: Adaptive families are able to adjust to a crisis. They possess the ability to do the following in order to adapt:
• Be flexible
• Problem solve
• Communicate effectively
• Seek and accept help - CORRECT ANSWER An extended or severe illness will require modifications of family responsibilities. Adaptive families:
A) Rely on a single person to provide all assistance to the patient.
B) Deny the patients condition.
C) Foster patient dependency.
D) Seek and accept help
Answer: B) The case manager should stay focused on the needs of the client, not the client's opinions. Case managers often work with clients who have viewpoints that are different than their own. Which of the following statements are true regarding a Medicare benefit period for inpatient hospital coverage? - CORRECT ANSWER he best way to deal with a patient who expresses extreme prejudice is to:
A) Refuse to work with the client.
B) Provide case management services, avoiding debate.
C) Confront the client about his prejudice and demand he apologizes.
D) Avoid the client and provide the minimal amount of care possible.
Rationale: Medicare defines a benefit period as that period of time that begins the first day of a patient's admission to a hospital, and ends after he or she has been discharged for 60 consecutive days. There is no limit to the number of benefit periods a beneficiary use, but there is a limit to the number of days of care for which a beneficiary may claim payment. Inpatient hospital care is normally limited to 90 days during a benefit period. If the 90 days are exhausted, the beneficiary can elect to use days from a non-renewable "lifetime reserve" of up to 60 additional days of inpatient hospital care. - CORRECT ANSWER A) There is a limit of 6 benefit periods covered during a beneficiary's lifetime.
B) Copayment is required for all days
C) A benefit period ends after the patient has been discharged for 60 consecutive days.
D) There is no limit to the number of days a beneficiary may claim payment for during a benefit period.
Answer: C) A benefit period ends after the patient has been discharged for 60 consecutive days.
Answer: B) Return the employee to work
Resource: CCMC Glossary of Terms
Rationale: Work Hardening is a highly structured, goal-oriented, and individualized intervention program that provides clients with a transition between the acute injury stage and a safe, productive return to work. Treatment is designed to maximize each individual's ability to return to work safely with less likelihood of repeat injury. Work hardening programs are multidisciplinary in nature and use real or simulated work activities designed to restore physical, behavioral, and vocational functions. They address the issues of productivity, safety, physical tolerances, and worker behaviors. - CORRECT ANSWER The primary goal of work hardening is to:
A) Improve the worker's endurance
B) Return the employee to work
C) Determine the maximum amount of work the employee can perform
D) Identify accommodations to assist the employee
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 work ability in the determination of occupational disability status - CORRECT ANSWER Which of the following is used to examine the injured worker as he or she completes activities in a structured setting to identify the current level of function?workability
A) Functional capacity evaluation (FCE)
B) Functional independence measures (FIM)
C) Instrumental activities of daily living (IADL)
D) Job analysis
Answer: A) Functional capacity evaluation (FCE)
Answer: C) Workers' Compensation
Workers' compensation pays for medical care for work-related injuries beginning immediately after the injury occurs. - CORRECT ANSWER Which of the following pays for medical care for work-related injuries?
A ) Short-Term Disability
B ) Long Term Disability
C) Workers' Compensation
D) Employee health benefit
Answer: B) 90 days, but if the 90 days are exhausted, the beneficiary can elect to use days from a non-renewable "lifetime reserve" of up to 60 additional days.
Resource:
Rationale: Inpatient hospital care is normally limited to 90 days during a benefit period. If the 90 days are exhausted, the beneficiary can elect to use days from a non-renewable "lifetime reserve" of up to 60 additional days of inpatient hospital care. - CORRECT ANSWER Medicare Part A pays for how many days of inpatient hospital care during each benefit period?
A) All medically necessary inpatient days
B) 90 days, but if the 90 days are exhausted, the beneficiary can elect to use days from a non-renewable "lifetime reserve" of up to 60 additional days.
C) 60 days
D) 30 days, but if the 30 days are exhausted, the beneficiary can elect to use days from a non-renewable "lifetime reserve" of up to 60 additional days.
Answer: B) for families of service members (active, Guard/Reserve, and retired)
Resource: http://www.tricare.mil/
Rationale: TRICARE is the healthcare program for service members (active, Guard/Reserve, and retired) and their families. - CORRECT ANSWER The TRICARE healthcare program is:
A) a Medicare HMO
B) for families of service members (active, Guard/Reserve, and retired)
C) a Medicaid HMO
D) a Medicare Advantage plan
Answer: C) Per Diem
Resource: CCMC Glossary of Terms
Rationale: Per Diem: A daily reimbursement rate for all inpatient hospital services provided in one day to one patient, regardless of the actual costs to the healthcare provider. The rate can vary by service (medical, surgical, mental health, etc.) or can be uniform regardless of the intensity of services. - CORRECT ANSWER Which of the following reimbursement methods has the hospital receiving a fixed amount per day for the patient's inpatient stay, regardless of actual costs?
A) DRG
B) Fee-for-service
C) Per Diem
D) Cost sharing
Answer: B) Medigap is offered by private insurance companies to Medicare recipients to cover out-of-pocket expenses.
Resource:
Rationale: Medigap is offered by private insurance companies to cover out-of-pocket expenses. Medicare Part C a managed care option to obtain coverage for Parts A and B and sometimes D through a private health plan such as an HMO or PPO. - CORRECT ANSWER Which of the following statements is true regarding Medigap supplemental policies?
A) Medigap is also known as Medicare part C.
B) Medigap is offered by private insurance companies to Medicare recipients to cover out-of-pocket expenses.
C) Medigap is a Medicare HMO.
D) Medigap insurance covers individuals who do not qualify for
Medicare.
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. - CORRECT ANSWER 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
Answer: A) Essential job functions and requirements
Answer: D) August 1st
Resource:
Rationale: Medicaid coverage may start retroactively, up to three months prior to the month of application, allowing for coverage of medical expenses incurred prior to the application. - CORRECT ANSWER Mr. Miller became eligible for Medicaid in March. He applied for Medicaid coverage November 1st. When will Mr. Miller's coverage begin?
A) March 1st
B) November 1st
C) December 1st
D) August 1st
D)Emergent - CORRECT ANSWER Pre-certification is never required when medical services are:
A) Routine
B) Elective
C) Urgent
D) Emergent
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. - CORRECT ANSWER 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
Answer: C) Psychological abuse
Resource:
Rationale: Emotional/psychological abuse is inflicting anguish, pain or distress through verbal or nonverbal acts resulting in trauma. Some examples include verbal assaults, insults, threats, coercion, and intimidation. - CORRECT ANSWER Using verbal insults, intimidation, or threats to withhold food as a means of getting an elderly patient to take their medication are examples of:
A) Coercion
B) Physical abuse
C) Psychological abuse
D) Acceptable methods to persuade the patient to take their medication
Answer: C) Work Hardening
Resource: CCMC Glossary of Terms
Rationale: Work Hardening is a highly structured, goal-oriented, and individualized intervention program that provides clients with a transition between the acute injury stage and a safe, productive return to work. Treatment is designed to maximize each individual's ability to return to work safely with less likelihood of repeat injury. Work hardening programs are multidisciplinary in nature and use real or simulated work activities designed to restore physical, behavioral, and vocational functions. They address the issues of productivity, safety, physical tolerances, and worker behaviors. - CORRECT ANSWER Which program prepares an injured employee to return to work by having them perform real or simulated work tasks along with conditioning activities 3-5 days a week?
A) Transitional Work Duty
B) Work Adjustment
C) Work Hardening
D) Work Conditioning
Answer: B) Empower the client to be an informed and active decision maker of his healthcare.
Resource:
Rationale: Case managers empower patients to be informed and active decision makers in their healthcare by explaining treatment options - CORRECT ANSWER When the case manager is explaining the treatment options available and providing education to the client, the goal is to:
A) Lead the client to the most cost efficient treatment plan.
B) Empower the client to be an informed and active decision maker of his healthcare.
C) Have the client make a decision by the end of the discussion.
D) Encourage the client to obtain a second opinion
- CORRECT ANSWER In regard to the definition of medical necessity in insurance contracts, which of the following statements is true?
A) It is determined by the person reviewing and all decisions are final
B) It is clear and concise
C) It is consistent across the industry
D) They are unclear and open to interpretation [Show Less]