CCM Exam 90 Questions with Verified Answers,100% CORRECT, Exams of Business Economics

Download CCM Exam 90 Questions with Verified Answers,100% CORRECT and more Exams Business Economics in PDF only on Docsity! CCM Exam 90 Questions with Verified Answers Precertification is also known as: - CORRECT ANSWER prospective review The CCM is with a patient who is discussing suicidal thoughts. The MOST important question to ask the patient is - CORRECT ANSWER Do you have a plan The Health Effectiveness Data and Information Set (HEDIS) is - CORRECT ANSWER a widely used set of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA) Telephonic case managers often have patients in multiple states, which requires them to need - CORRECT ANSWER a Nurse Licensure Compact The LEAST effective conflict strategy is: - CORRECT ANSWER avoidance Under the Americans with Disabilities Act (ADA), this category defines adjustments to work procedures - CORRECT ANSWER job modification, It defines the adjustments to work procedures In a workers' compensation setting, three-point contact refers to - CORRECT ANSWER the injured worker, provider, and employer. Three-point contact is integral in the initial assessment and includes contact with the injured worker (client), provider (a doctor, chiropractor, or mid-level provider), and employer (to explore modified duty options). The claims adjuster is the referral source The CCM who works for a hospital understands that she has a working relationship with the hospital. The title of her relationship is - CORRECT ANSWER agent. The CCM is the agent, and the hospital is the principal A good tool for the CCM to evaluate a patient's engagement in their health care is - CORRECT ANSWER The Patient Activation Measure (PAM) helps to evaluate patient engagement. Following up with elderly clients to ensure that they have received their flu and pneumonia vaccinations is an example of: - CORRECT ANSWER illness prevention. The CCMC Standards for Professional Conduct advocacy section lists specific duties for the case manager. The duty NOT included in this section is - CORRECT ANSWER practicing within the boundaries of their professional credentials. The denominator represents - CORRECT ANSWER The denominator is the equal number of parts in a whole (e.g., eight slices of pizza in a whole pizza) Carly just took her exam to become a certified case manager and is excited to use the CCM designation. However, she is aware she can't use the designation until she is notified by CCMC because she would be violating the Standards for Professional Conduct regarding - CORRECT ANSWER conflict of interest. Carly should not use the CCM credentials until notified by CCMC The 5 Whys are used in: - CORRECT ANSWER Six Sigma's analyze phase. Six Sigma uses the 5 Whys in analyzing deviation from a desired outcome Some ________________ may refuse medical treatments because they believe prayer will heal them - CORRECT ANSWER Christian Scientists. One of the tenets of Christian Science is that the physical world, including illness, is a human misperception or illusion that can be resolved through prayer A tool used to determine whether hospice is appropriate for the patient is known as - CORRECT ANSWER Palliative Performance Scale is the tool used to measure the appropriateness of hospice for a patient. One of the measures of the CAHPS is - CORRECT ANSWER care coordination. CAHPS is a patient satisfaction survey, and one of the measures of satisfaction deals with care coordination The implementation of a new initiative with a finite timespan and specific deliverable is known as: - CORRECT ANSWER project management. The Project Management Institute describes a project as "a temporary endeavor undertaken to create a unique product, service or result." Project management applies skills, tools, and techniques to the project to meet the project goals. A residential option for intellectually disabled clients that provides assistance with activities of daily living is known as: - CORRECT ANSWER ICF-ID. All states have at least one intermediate care facility for intellectually disabled (ICF-ID) clients. This definition also encompasses group homes where clients receive twenty-four-hour supervision. A quick health information screening test to assess general literacy, numeracy, and comprehension skills is called the: - CORRECT ANSWER Newest Vital Sign. URAC standards require: - CORRECT ANSWER that a physician be available for consultation. Risk management focuses on strategies to reduce the incidence of organizational loss. This involves the use of reactive activities. Another term for reactive activity in risk management is: - CORRECT ANSWER damage control. Reactive activities in risk management are known as damage control. A reactive risk assessment evaluates claims that have already occurred and need an intervention. The HOS: - CORRECT ANSWER is administered initially and then two years later. Six Sigma uses _____ methodology: - CORRECT ANSWER DMAIC. DMAIC stands for define, measure, analyze, improve, control. A complex health literacy assessment that consists of two parts and typically takes longer than twenty minutes to complete is known as: - CORRECT ANSWER Test of Functional Health Literacy in Adults. The Test of Functional Health Literacy in Adults is a lengthy, complex health literacy assessment. Factors that may influence the way a patient is impacted by a disability include: - CORRECT ANSWER their race. A patient's race may influence the way they are impacted by a disability. The CCM should understand that disabled people of color may face challenges that disabled white people do not face. The work program that is designed for employees with behavioral health issues is referred to as: - CORRECT ANSWER Work Adjustment. CAGE is a screening tool for patients who may have substance use disorders. what does CAGE stand for? - CORRECT ANSWER C—cut down A—annoyed G—guilty E—eye opener The patient who is showing the LOWEST risk of suicidal behavior is: A. Gary, a recent divorcée who frequently goes out drinking. B. Sarah, a recent widow who lives alone. C. Jaime, who is recently unemployed. D. Mark, a recent divorcée with diabetes who is giving away possessions. - CORRECT ANSWER Jaime, who is recently unemployed. Although unemployment increases the risk of suicide, Jaime has the lowest risk out of all the patients listed. A commonly used patient satisfaction tool is the: A. Prescott Gayne. B. Press Ganey. C. PROM. D. PSQ. - CORRECT ANSWER B. Press Ganey. The Press Ganey patient satisfaction measure is a commonly used tool in hospitals. According to the company's website, it works with 33,000 hospitals to develop outcome measures. A line of credit for people over age sixty-two that doesn't affect Medicaid eligibility is called: A. a viatical settlement. B. whole life insurance. C. an interest-only equity line of credit. D. a reverse mortgage. - CORRECT ANSWER D. a reverse mortgage. A reverse mortgage can only be used by homeowners over age sixty-two, and it doesn't affect Medicaid eligibility. Proactive risk management serves to reduce adverse outcomes and potential malpractice claims. This process involves all of the following EXCEPT: A. negligent referral. B. calculation. C. identification. D. controlling the risk. - CORRECT ANSWER negligent referral. A negligent referral is the act of referring a negligent provider to the patient. The CCM may be held liable even if he or she was not aware of the negligence. Malpractice suits may arise for several reasons. The basis for a malpractice suit would NOT include: A. omitting important information from the patient's file. B. committing a harmful act. C. failing to meet an obligation to the patient. D. charging the patient twice for medical services. - CORRECT ANSWER charging the patient twice for medical services. Double billing the patient for services that are covered by their insurance has to be disputed by the patient with the hospital and their insurance company. It is not considered malpractice. The CCM thinks her patient is being financially abused by a family member. A potential sign of financial abuse is: A. The patient is playing bingo more often with her daughter. B. The patient always pays for meals when going to restaurants with her grandson. C. The patient has excellent credit but is falling behind on utility payments. D. The patient spends a lot of money on his daughter's wedding. - CORRECT ANSWER The patient has excellent credit but is falling behind on utility payments. The patient has a history of paying bills on time but is neglecting utility payments. This puts the patient in jeopardy of being without utilities and should be investigated. A one-week event attended by relevant stakeholders of a process to make improvements in that process is known as a: A. Six Sigma kick-off. B. kaizen event. C. LEAN initiative. D. QA event. - CORRECT ANSWER kaizen event. Kaizen is the Japanese word for "improvement," and traditionally has been a quality improvement framework that involves everyone from the CEO to line workers. Kaizen events are usually one week in length and are focused on a pre-identified process that may need improvement. D. Disabled Job Accommodations Website (DJAW). - CORRECT ANSWER Job Accommodation Network (JAN). The Job Accommodation Network (JAN) is the consulting services website run by the US Department of Labor Office of Disability Employment Policy (ODEP). A major difference between the ICD-9 and ICD-10 codes is: A. the ICD-10 codes allow higher reimbursement rates. B. the ICD-9 codes were limited to cardiac and renal diagnoses. C. the ICD-10 codes allow for more diagnoses. D. the ICD-10 codes are simplified for ease of use. - CORRECT ANSWER the ICD-10 codes allow for more diagnoses. The ICD-10 expanded the number of codes from 14,400 to over 70,000. A CCM is considering doing research on several of his patients. Before he begins, he should know that: A. research of patients is prohibited. B. research is allowed and may be publicized if the patient gives consent. C. research may be conducted, and the identity of the patient may not be protected if the patient signs an approved authorization form. D. the patient's identity may not be protected if the research is required by law. - CORRECT ANSWER research may be conducted, and the identity of the patient may not be protected if the patient signs an approved authorization form. The patient's identity may not be protected for research if an approved authorization form is signed by the patient. An experimental treatment for research includes: A. randomly selected patients. B. informed consent. C. approval by an ethical review committee. D. case studies. - CORRECT ANSWER case studies. Case studies are a type of observational research. A defined measure that analyzes health care processes is: A. a CMS survey. B. a key performance indicator (KPI). C. an HOS. D. a quality care indicator. (Your Answer) - CORRECT ANSWER a key performance indicator (KPI). A KPI is used to monitor, analyze, and improve health care processes. Long-term disability insurers require claimants to apply for: A. Medicare. B. SNAP. C. private health insurance. D. Social Security Disability Income. - CORRECT ANSWER Social Security Disability Income. Long-term disability insurers require the claimant to apply for Social Security Disability Income, as they can then take an offset of benefits paid. A patient survey on satisfaction with their care at a local hospital is known as a: A. QAS. B. PROM. C. Likert scale. D. patient outreach questionnaire. - CORRECT ANSWER PROM. This is an example of a patient-reported outcome measure (PROM). The Health Outcomes Survey (HOS) focuses on: A. Medicaid beneficiaries. B.Medicare beneficiaries. C. randomly selected discharged patients. D. working-age patients. - CORRECT ANSWER Medicare beneficiaries. The HOS is administered to Medicare patients Mark has been coping with Parkinson's disease for four years. His new CCM knows that to better serve her patient, all the following are true EXCEPT: A. Mark's condition will progress, and she needs to plan ahead. B. Mark's wife may no longer be able to care for him. C. Mark's environment does not impact his illness. D. Individuals' coping skills may vary. - CORRECT ANSWER Mark's environment does not impact his illness. The patient's environment (political, social, or physical) has an influence on the illness. In your role as a workers' compensation case manager, you are assigned to an injured worker who has several herniated lumbar discs. His neurosurgeon has requested preauthorization to perform a lumbar fusion. The injured worker is unsure if he should proceed with surgery and has been doing his own research online. You suggest: A. an independent medical examination. B. a new neurosurgeon. C. more physical therapy. D. a second opinion. - CORRECT ANSWER a second opinion. A second opinion is client-driven, while an independent medical examination is insurer-driven and doesn't allow for one-on-one doctor-patient communication. To determine case management ROI, a case manager could utilize these measures, EXCEPT: A. total cost of care without case management. B. total cost of care with case management. C. total cost of patient hospitalization and discharge case management. D. total cost of case management. - CORRECT ANSWER total cost of patient hospitalization and discharge case management. The total cost of hospitalization and discharge case management in and of itself does not lend itself to determining case management ROI. Which of the following is NOT an example of an evidence-based, clinical decision- making support system? A. InterQual B. Official Disability Guidelines C. ORYX D. Milliman - CORRECT ANSWER ORYX. ORYX is a performance measurement tool tied to accreditation. All of the following statements describe job modification EXCEPT: A. Job modifications focus more on access than job accommodations. B. Job modifications and job accommodations are often used to mean the same thing. C. Job modifications refer to a change in the job description. D. Sharing a job duty could be an example of a job modification. - CORRECT ANSWER Job modifications focus more on access than job accommodations. Job accommodations typically are more individualized than job modifications and refer to access.