CCM Sample Questions

Subject Area: Community Resources and Support

Subject Area: Community Resources and Support
1. A disabled worker becomes entitled to SSDI monthly cash benefits beginning with the first month in which the disabled worker meets five criteria. These includes --
A) A defined disability
B) Filing an application for worker’s compensation benefits
C) Achieving a minimum period of employment covered by Social Security
D) All of the above

The answer is D
Explanation: The other two criteria are that the disabled worker has completed a five month waiting period and has not attained the age of 65. Matkin, p.25

Subject Area: Healthcare Management
2. The case manager has arranged a discharge plan for a 55 year old male diabetic patient. He is to receive home nursing visits, IV antibiotics, and dressing changes to his right foot. His wife calls to say that the nurse, who is scheduled for daily visits has not been to their home for two days, and she is not sure how to bandage the wound. The most appropriate FIRST action on the part of the case manager is to:
A) Contact the home health agency and arrange for an immediate visit by the nurse
B) Direct the patient to the local emergency room
C) Gather more information regarding the patient’s clinical status
D) Contact the primary care physician

The answer is C
Explanation: The first step in the case management process is to apprise the need for intervention by the case manager through gathering and critical, objective evaluation of relevant data. The case manage will conduct a thorough and objective evaluation of the client’s current status, indluding a situational analysis and functional assessment covering multiple elements, including patterns of utilization. CMSA Standard of Practice for Case Management (1995) p. 14

Subject Area: Healthcare Management
3. The injured worker is scheduled to have a laminectomy and asks, "What will be done to my back?" The response should be based on the fact that the physician will remove the herniated disc and:
A) The nerve roots affected by the cord compression
B) A portion of the involved vertebrae’s posterior arches
C) A major portion of the vertebrae in the affected area
D) All of the above

The answer is B
Explanation: In order to reach the disc, the surgeon will need to remove a portioin of the involved vertebrae’s posterior arch. Mosby’s Clinical Nursing (1993) p. 432

Subject Area: Processes and Relationships
4. A patient has been in a facility for six weeks and was making excellent progress until the past two weeks when he has made no progress. What is the next step in managing this case? A) You would leave him in the facility for a few more weeks to see if he starts to improve B) You would recommend an evaluation to determine potential progress C) You would start calling lower level, alternative care sites to evaluate care and cost D) All of the above

The answer is B
Explanation: An evaluation is needed to determine status and potential for alternative care. The case manage must first determine whether there is a new actual or potential problem with the current plan of care before evaluating other levels of care. Health care professionals are constantly being challenged to find innovative ways to maintain quality of care with diminishing resources or changing level of care. Case management has emerged as a viable method of identifying resources and using those resources efficiently while maintaining the appropriate levels of care. Kurec, An Introduction to Case Management, Clinical Laboratory Management Review, Jul-Aug; 10 (4): 346-56 (1996)

Subject Area: Processes and Relationships
5. The tangible benefits of case management which may be documented using a cost-benefit analysis tool or form include all EXCEPT --
A. reduction in service cycle time through more coordinated scheduling
B. reduction in quality defects and related readmissions, prolonged length of stay, repeat surgery and other costs of correction.
C. reduction in the use of more expensive interventions to achieve the same expected outcome.
D. improvement in patient service and satisfaction.

The answer is D
Explanation: Improvement in patient service and satisfaction is an intangible benefit of case management. It may be demonstrated through new and retained customers and contracts, or captured in using other tools like patient satisfaction surveys, but is not part of the monetary comparison of different intervention or decision alternatives. Spath, Measuring the Economic Benefit of Case Management http://www.brownspath.com/original_articles/index.htm (1999)

Subject Area: Psychosocial Intervention
6. Upon meeting your client, a 40 year old Asian woman, you note that throughout the assessment process that she avoids eye contact. Your study of various cultural practices helps you understand that the behavior in this case is related to:
A) Embarrassment about her health problem
B) Passivity
C) Her language barrier
D) A sign of deference

The answer is D
Explanation: Maintaining direct eye contact is considered rude and, or disrespectful in some Asian cultures. American Journal of Nursing, April, 1999

Subject Area: Psychosocial Intervention
7. An amputee is ready for discharge. He has participated in a rehab program that has trained him well to use his prosthesis and care for his needs. Which need is often overlooked when discharging the patient?
A) Follow up with the MD
B) Follow up with the prosthetist
C) His ability to problem solve for himself
D) His ability to drive a car

The answer is C
Explanation: Many problems can occur for this patient. He will experience falls, weight gains/losses affecting his prosthetic fit, and weather conditions. His ability to cope with his disability should be explored. Hoeman, p. 166

Subject Area: Rehabilitation Case Management
8. A 28 year old landscape laborer is unable to return to his previous job and fails to follow up on potential job leads provided by his rehabilitation counselor. At this point, the case manager would: A) Assess the client’s job readiness B) Refer the client for a vocational evaluation C) Recommend a transferable skills analysis D) Review the labor market trends in the client’s immediate area

The answer A
Explanation: Four major components may determine job readiness: physical readiness psychological readiness occupational readiness placement readiness In this case the client is psychologically not ready to return to the job as he neglects to follow up on potential job leads. "Vocational Issues in Disability Management", Health Care and Disability Management, p.203

Subject Area: Rehabilitation Case Management
9. Before making any final equipment recommendations for a client with spinal cord injuries, the case manager will need to do all of the following except:
A) Obtain evaluations of the client’s motor skills, assess his cognitive function, daily living status, and obtain or do an on-site home assessment
B) Include information from all team members
C) Recommend equipment that the client wants
D) Be familiar with the rules and regulations of third party payers

The answer is C
Explanation: Client consent is necessary in terms of equipment recommendations, however, it is important to recommend what the individual needs, not necessarily the equipment that the person wants. The case manager must maintain professional integrity by not abusing funds or prescribing equipment that will not be used. Life Care Planning for Spinal Cord Injury, A Resource Manual for Case Managers, p.48

Subject Area: Service Delivery
10. Subacute care is: I. Expected to be short term II. Designed to return patients to the community III. A relatively new health care delivery system IV. Developed to provide rehabilitation services (PT, OT, and ST) A) I, II and III B) II, III and IV C) I, II and IV D) All of the above

The answer is A
Explanation: Subacute care was relatively unheard of before 1990. Subacute facilities care for patients needing wound care, intensive rehab, cardiac care, pulmonary rehab, pain management and complex medical care according to the National Subacute Care Association in Bethesda, Maryland.

Subject Area: Service Delivery
11. Some of the key provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are:
I. Small group health insurers cannot exclude an employee or dependent from obtaining coverage based on health status.
II. People who have been insured for at least six months must be covered immediately when they join a new group health plan.
III. Once an insurer sells a policy it must renew the plan regardless of the health history of either an individual or group
IV. Available to "eligible individuals"

A) I, II and III
B) I, III and IV
C) II, III, and IV
D) All of the above

The answer is B
Explanation: People who have been insured for at least TWELVE months must be covered immediately when they join a new group health plan. The Managed Care & Group Health Handbook, pp. 379-383