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Quiz Session - Attempts With Random Questions

CCMC CCM Exam Questions

Page 2 of 25

21.

Which of the following is the best definition of "underinsured"?

  • Those who have insurance, but still face financial challenge in care

  • Those who are not insured

  • Those who do not have deductibles

  • Those who have insurance but are below the poverty line

Correct answer: Those who have insurance, but still face financial challenge in care

The term "underinsured" means that, though the patient has insurance, they are still liable for some amount of the high cost of healthcare, putting them at financial risk without further assistance.

The term does not refer to those who are not insured and is not relative to deductibles or the poverty line per se. 

22.

Which of the following most specifically refers to the improvement of physical functioning associated with impairment?

  • Physical therapy

  • Occupational therapy

  • Rehabilitation

  • Rehabilitative services

Correct answer: Physical therapy

Physical therapy, or physiotherapy, improves physical functioning associated with impairment.

Occupational therapy is the type of therapy aimed at promoting health and well-being through everyday activities. Rehabilitation refers to the restoration of functional ability in general. Rehabilitative services refer to the broad array of interventions that may include physical or psychological restoration of functioning.

23.

Which of the following is the major treatment for PTSD?

  • Pharmacotherapy and counseling together

  • Pharmacotherapy alone

  • Counseling alone

  • Counseling followed by pharmacotherapy

Correct answer: Pharmacotherapy and counseling together

Post Traumatic Stress Disorder (PTSD) is an increasingly-recognized phenomenon among patients. It is a mental illness defined by frightening thoughts, flashbacks, and nervous system maladjustment related to single or sustained trauma. The major treatment is concurrent pharmacotherapy to manage acute symptoms, and counseling in some form to process relevant issues.

24.

With which of the following is an AFO (ankle foot orthotic) mostly concerned?

  • Management of foot drop

  • Management of gait and balance

  • Management of posture

  • Management of pain

Correct answer: Management of foot drop 

An ankle foot orthotic (AFO) is a common orthotic device which is chiefly meant to manage level of foot drop. 

Though gait and balance management, posture management, and pain management are all associated with the function of orthotics, an AFO is mainly concerned with foot drop. 

25.

Are home modifications covered under workers' compensation?

  • Yes, in some circumstances

  • No, in no circumstances

  • Yes, in all circumstances

  • No, unless otherwise specified within the plan

Correct answer: Yes, in some circumstances 

Workers' compensation can cover home modification in some circumstances. If an insured person has experienced catastrophic injury and experiences permanent disability, the carrier may provide coverage for home modifications that are considered necessary to meet basic standards for a safe and accessible living environment. 

26.

Which of the following is not an expectation identified by the Institutes of Medicine (IOM) that are meant to control healthcare costs?

  • Regular auditing processes

  • Timely provision of care

  • Reasonable cost of care

  • Quality of care

Correct answer: Regular auditing processes

The Institutes of Medicine (IOM) identified three expectations that in their view would help drive down the costs of healthcare. These are:

  • Timely provision of care
  • Reasonable cost of care
  • Quality of care

A regular auditing process was not one of the expectations identified by this body.

27.

Which of the following would be the correct order in which to administer the PHQ-2 and the PHQ-9?

  • PHQ-2 first, then PHQ-9 if warranted

  • PHQ-2 first, then PHQ-9 in all cases

  • PHQ-9 first, then PHQ-2 if warranted

  • PHQ-9 first, then PHQ-2 in all cases

Correct answer: PHQ-2 first, then PHQ-9 if warranted

Screening for depression is crucial in many health assessments performed by case managers. One way this is done is to use the Patient Health Questionnaire-2 (PHQ-2), which is a basic screen for depression, followed by the Patient Health Questionnaire-9 (PHQ-9), which goes into more detail.

28.

Which of the following is the most accurate statement regarding the "lean" approach to healthcare quality?

  • The lean approach seeks to reduce waste

  • The lean approach documents service failures 

  • The lean approach reports client outcomes

  • The lean approach seeks to reduce variation

Correct answer: The lean approach seeks to reduce waste

The "lean" approach to healthcare quality involves a variety of systems and measures designed to reduce waste and improve efficiency to increase value. 

This approach does not explicitly address service failures, nor does it report client outcomes. Though it may reduce variation, its focus is on value addition and waste reduction or elimination. 

29.

What does "provisional" mean in terms of accreditation?

  • A score of 70 to 80 percent

  • Probational status

  • Temporary status

  • A score of 60 percent

Correct answer: A score of 70 to 80 percent

In terms of accreditation, a provisional status means a score of 70 to 80 percent on the indicated criteria. 

It is not a matter of probationary or temporary status.

30.

With which of the following is Continuous Quality Improvement (CQI) concerned?

  • Outcomes and processes

  • Outcomes and decisions

  • Processes and decisions

  • Outcomes, processes, and decisions

Correct answer: Outcomes and processes

Continuous Quality Improvement (CQI) is part of total quality management that uses rigorous processes to achieve ongoing improvement in healthcare outcomes and processes.

It is not concerned with decisions except as part of process improvement.

31.

Which of the following relationships should exist between systematic methods and types of evidence?

  • Systematic methods should be based on scientific evidence

  • Systematic methods should be based on anecdotal evidence 

  • Systematic methods do not need objective evidence 

  • Systematic methods exist independently of types of evidence

Correct answer: Systematic methods should be based on scientific evidence

When assessing quality indicators in healthcare based on systematic method, scientific evidence should be used whenever possible. This allows for an evidence-based, impartial assessment of the circumstances.

Anecdotal evidence, while valuable, is not the ideal fit for systematic method. Systematic methods do need evidence, and that evidence should be as objective as possible to be effective.

32.

Which of the following does EHR refer to?

  • Electronic health record

  • Electronic health rating

  • Electronic healthcare renewal

  • Electronic healthcare reciprocity

Correct answer: Electronic health record 

An electronic health record (EHR) is a real-time patient health record with access to evidence-based decision support tools. The intention of these records is to reduce error, inform decision-making, and increase efficiency.

33.

Is there a deductible for hospice coverage under Medicare Part A?

  • No

  • Yes, after the first benefit period

  • Yes, after 30 days

  • Yes, it is a per diem rate assessed after decease

Correct answer: No

Hospice care takes the place of other Medicare benefits during the time when it is being administered to a patient. There is never a deductible due to the patient.

34.

Which of the following would be most characteristic of retrospective utilization management?

  • A review of care that has already occurred

  • Review of upcoming care

  • Review of care that is underway

  • Appealing a decision

Correct answer: A review of care that has already occurred

There are three types of utilization review: prospective, concurrent, and retrospective. Retrospective utilization review deals with care that has already taken place.

Prospective utilization review engages in a prior determination of necessity to authorize an upcoming treatment. Concurrent utilization review deals with care that is underway. A review or appeal might be possible at any stage of utilization review, and is not necessarily part of any in particular.

35.

Is full time nursing covered under the Home Health Care benefit, according to Medicare Part A?

  • No

  • Yes, in all circumstances

  • Yes, for 30 days

  • Yes, if there has been a qualifying stay

Correct answer: No

Full time nursing is not covered under the Home Health Care benefit, according to Medicare Part A. A home health aide would be covered under some circumstances.

This lack of coverage is not a function of benefit days or qualifying stay.

36.

Do clients have the right to an expedited review of benefit denial?

  • Yes, in some circumstances 

  • No, in no circumstances 

  • Yes, in all circumstances

  • No, unless initiated by the payer

Correct answer: Yes, in some circumstances 

In some circumstances, particularly in cases of emergency, clients have the right to an expedited review of benefit denial. This will usually be completed in 24 hours.

This review is generally initiated by the client and/or their representative.

37.

Which of the following is not considered part of the "triad" of quality of care?

  • Outcomes

  • Access

  • Quality

  • Cost of care

Correct answer: Outcomes

The Institute of Medicine conceptualizes a "triad" in terms of quality of care that includes access, quality, and cost of care. This is often combined with other quality indicators to further analyze healthcare quality.

Outcomes are not considered part of this "triad".

38.

For which of the following are InterQual Level of Care Criteria not available?

  • Custodial care

  • Acute pediatric care

  • Acute rehabilitation

  • Long term acute care

Correct answer: Custodial care

InterQual Level of Care Criteria are designed to help healthcare organizations and personnel in assessing clinical appropriateness of patients for various levels of care. They are available for such things as acute pediatric care, acute rehabilitation, long term acute care, and others.

These criteria are not available for custodial care.

39.

Which of the following accurately describes the method of assessment in the FIM Instrument?

  • Level of assistance required for certain domains

  • Level of adjustment needed to return to work

  • Level of care required to prevent injury

  • Level of functioning in cognitive ability

Correct answer: Level of assistance required for certain domains

The FIM Instrument (Functional Independence Measure) is a tool that measures the level of assistance required by the patient in 18 different domains, such as cognition, locomotion, self-care, and toileting.

The FIM Instrument does not address return to work, injury prevention per se, nor does it only address level of functioning in cognitive ability. 

40.

Which of the following is true regarding a case rate?

  • It is a flat fee paid to a provider

  • It is not inclusive

  • It is assessed by physician

  • It is assessed according to geographic region

Correct answer: It is a flat fee paid to a provider

A case rate is an inclusive, flat fee paid to a provider based on the model of a single fee for all services related to a given treatment or condition.

It is not assessed according to physician or geographic region.

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