CCMC CCM Exam Questions

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41.

How often does the NCQA announce new HEDIS measures?

  • Every year 

  • Every two years

  • Every five years

  • When requested to do so by Medicare

Correct answer: Every year 

The National Committee for Quality Assurance (NCQA) publishes new HEDIS (Healthcare Effectiveness Data and Information Set) measures every year, along with the timelines for submission of these performance standards. 

This frequency is not dictated by Medicare, and is regular in frequency. 

42.

Which of the following refers to therapy aimed at promoting health and well-being through everyday activities?

  • Occupational therapy

  • Physical therapy

  • Physiotherapy

  • Rehabilitation

Correct answer: Occupational therapy

Occupational therapy is the type of therapy aimed at promoting health and well-being through everyday activities. 

Physical therapy, or physiotherapy, improves physical functioning associated with impairment. Rehabilitation refers to the restoration of functional ability in general. 

43.

Which of the following refers to a patient's specific knowledge, ownership, and skill set regarding their condition?

  • Activation

  • Empowerment

  • Engagement

  • Efficacy

Correct answer: Activation

In case management, activation refers to the individual's specific knowledge, ownership, and skill set regarding their condition. It is distinguished by the total mobilization of the patient's effort to be an active director (as much as is possible) of their own treatment.

Empowerment refers to the provision of education and resources to a client or their caregivers. Engagement is a measure of how involved a patient is in their treatment. Efficacy refers to how effective a treatment is.

44.

Which of the following is the most accurate statement about Prevention Quality Indicators (PQI)?

  • They represent cases in which good quality care can prevent further intervention 

  • They represent areas in which a hospital can improve its processes 

  • They represent areas in which a patient should change their lifestyle 

  • They are descriptions of recommended changes within a healthcare organization

Correct answer: They represent cases in which good quality care can prevent further intervention 

Prevention Quality Indicators (PQI) are identifiers of cases in which good quality care presented in a given situation can prevent further medical intervention. One example might be the rate of low birth weight; appropriate intervention could forestall future issues.

PQI do not refer to process improvement, lifestyle change on the part of patients, or recommended organizational changes.

45.

Of the following, which of the following would be least likely to appear on a cost-benefit report? 

  • Psychosocial history

  • Diagnosis 

  • Total cost without case management intervention

  • Total cost savings

Correct answer: Psychosocial history

A cost-benefit report provides a summary of case management intervention and is meant to indicate the value of case management intervention. It would usually include such things as the diagnosis and summary of interventions, as well as calculations such as the total cost without case management intervention and total cost savings.

An extensive psychosocial history, though important, would be the least likely of the listed items to be a part of this report. 

46.

What is the purpose of the AHRQ?

  • To publish clinical practice guidelines

  • To advocate for legislation about clinical matters

  • To demonstrate quality projects in healthcare

  • To raise awareness of healthcare gaps

Correct answer: To publish clinical practice guidelines

The Agency for Healthcare Research and Quality (AHRQ) is part of the federal government. It publishes clinical practice guidelines in order to create a higher quality experience in healthcare.

47.

Which of the following accurately defines the five stages of change?

  • Pre-contemplation, Contemplation, Preparation, Action, Maintenance

  • Preparation, Contemplation, Planning, Action, Maintenance

  • Pre-contemplation, Consideration, Planning, Action, Maintenance

  • Pre-contemplation, Consideration, Preparation, Action, Maintenance

Correct answer: Pre-contemplation, Contemplation, Preparation, Action, Maintenance

The five stages of change are a widely-used model describing how people go through a change process. The five stages are: 

  • Pre-contemplation: The person is unaware there is a need for change
  • Contemplation: The person is ambivalent about the need for change
  • Preparation: The person is taking concrete steps toward change
  • Action: The person is enacting a change plan
  • Maintenance: Change is underway and must be supported

People can proceed rapidly or slowly through these stages, and can move backward and forward in them.

48.

Which of the following is a type of managed care organization?

  • Preferred Provider Organizations (PPO)

  • Health Treatment Organizations (HTO)

  • Care and Treatment Organizations (CTO)

  • Physician Referral Organizations (PRO)

Correct answer: Preferred Provider Organizations (PPO)

The two types of managed care organization are Preferred Provider Organizations (PPO) and Health Maintenance Organizations (HMO).

Health Treatment Organizations (HTO), Care and Treatment Organizations (CTO), and Physician Referral Organizations (PRO) are all fabricated terms.

49.

Which of the following most operates on the premise of negotiating costs for services?

  • Preferred Provider Organizations (PPO)

  • Health Maintenance Organizations (HMO)

  • Market Captiation Organizations (MCO)

  • Physician Cost Organizations (PCO)

Correct answer: Preferred Provider Organizations (PPO)

Preferred Provider Organizations (PPO) operate on the premise of negotiating costs for services among healthcare providers. The benefit to the provider for this negotiation is to be a part of a referral network.

Health Maintenance Organizations (HMO) operate on the principle of preventative care and the gatekeeper provider model, with a yearly fee assessed to the member.

Market Captiation Organizations (MCO) and Physician Cost Organizations (PCO) are both fabricated terms.

50.

Which of the following formal health literacy instruments is only available in English?

  • Rapid Estimate of Adult Literacy in Medicine (REALM)

  • The Newest Vital Sign

  • Test of Functional Health Literacy Assessment (TOFHLA)

  • Test of Functional Health Literacy Assessment, Short form (S-TOFHLA)

Correct answer: Rapid Estimate of Adult Literacy in Medicine (REALM)

Of the available formal health literacy instruments, many are available in English and Spanish, including The Newest Vital Sign, the Test of Functional Health Literacy Assessment (TOFHLA), and the Test of Functional Health Literacy Assessment, Short form (S-TOFHLA).

The Rapid Estimate of Adult Literacy in Medicine (REALM) is only available in English.

51.

Which of the following mental disorders is the most likely outcome of patient abuse and/or neglect?

  • PTSD

  • Schizophrenia

  • Dissociative Identity Disorder

  • Borderline Personality Disorder

Correct answer: PTSD

When patients are abused and/or neglected, one possible outcome is post traumatic stress disorder (PTSD). This disorder compromises the patient in several ways, including flashbacks, increased reactivity, nightmares, and mood disturbances. 

Schizophrenia, Dissociative Identity Disorder, and Borderline Personality Disorder are not as likely outcomes of abuse and/or neglect.

52.

Which of the following correctly describes SMART goals?

  • Specific, Measurable, Achievable, Realistic, Timely

  • Specific, Measurable, Achievable, Responsible, Timely

  • Specific, Meaningful, Achievable, Responsible, Timely

  • Specific, Measurable, Achievable, Reportable, Timely

Correct answer: Specific, Measurable, Achievable, Realistic, Timely

One standard way of arriving at patient goals for treatment and care is the acronym SMART. It refers to the qualities that good goals have: specific, measurable, achievable, realistic, and timely.

The other answers do not accurately describe SMART goals.

53.

What has been the effect of managed care contracts on price negotiations between case managers and providers?

  • It has decreased the need for price negotiations

  • It has increased the need for price negotiations

  • It has had no effect on price negotiations

  • It has had no effect yet, but that is expected to change 

Correct answer: It has decreased the need for price negotiations

The advent of managed care contracts has decreased the need for price negotiations between case managers and providers, due to the fact that much of what would otherwise be negotiated is now decided in advance.

54.

In the context of the legal terminology of healthcare, which of the following would be the most likely meaning of "best interest"?

  • Helping patients deemed incompetent

  • Improving outcomes for patients in general

  • Improving outcomes for particular patients

  • The overall ethical mandate to do competent care

Correct answer: Helping patients deemed incompetent

In the context of the legal terminology of healthcare, best interest refers to the array of decisions that must be made to assist a patient who has been deemed incompetent when no proxy has been designated and the healthcare team must make decisions for that individual.

In this context, the term does not refer to improving outcomes or the overall ethical mandate to do competent care.

55.

To which of the following groups would TRICARE apply?

  • Service members and their families

  • Federal government workers and their families

  • State government workers and their families

  • The elderly over 65

Correct answer: Service members and their families

TRICARE is the healthcare program for service members and their families.  

It is not intended for all federal government workers, state government workers, or the elderly over 65.

56.

Which of the following refers to one's belief in one's own ability to succeed?

  • Self-efficacy

  • Ambivalence

  • Autonomy

  • Activation

Correct answer: Self-efficacy

Self-efficacy refers to one's belief in one's own ability to succeed and is a key ingredient in successful client outcomes.

Ambivalence refers to a client's experience of conflicting emotions surrounding a decision or change. Autonomy refers to the principle of clients having the right to make their own decisions. Activation, in the case management context, refers to a client taking more active control of their care and its planning.

57.

How long does COBRA coverage last?

  • 18 months

  • 12 months

  • 24 months

  • 6 months

Correct answer: 18 months

The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 allows for alternate coverage in the case of changes to working conditions, such as the loss of a job or hours worked at that job. COBRA coverage usually lasts 18 months, but can be extended.

58.

Which of the following would be considered a measure of process?

  • Percentage of clients screened for heart disease

  • Mortality of patients

  • Adherence rate of patients

  • Control of diabetes in patients

Correct answer: Percentage of clients screened for heart disease

Measures of process are those measures which deal with what a healthcare organization actually does in the care process. One example would be the percentage of clients that are screened for heart disease.

Patient mortality, patient adherence rates, and diabetic control in patients would be considered measures of outcome, as they measure health status of the patient as a result of the care process.

59.

Which of the following is not generally considered a primary component of communication? 

  • Medium

  • Sender

  • Message 

  • Context

Correct answer: Medium

Communication is generally considered to have four components: Sender, message, receiver, and context. 

The medium of communication would be considered part of the message and not a primary component of communication. 

60.

What is a "medical loss ratio"?

  • The ratio of healthcare costs to revenue received

  • The ratio of inpatient to outpatient stays

  • The ratio of utilization to underutilization

  • The ratio of good outcomes to bad outcomes

Correct answer: The ratio of healthcare costs to revenue received

A medical loss ratio is the ratio of healthcare costs to the revenue received. It is calculated by dividing the total medical costs by total revenue.

It is not a calculation based on the type of stay, utilization, or outcomes.