CCM Care Coordination & Resource Management 3 — Questions and Answers
Question 1: A care manager is developing a care plan for a recently discharged stroke patient. Which element is ESSENTIAL to prevent 30-day readmission?
- Scheduling elective procedures within 30 days
- Arranging a follow-up appointment within 7 days of discharge (Correct answer)
- Waiting for the patient to report new symptoms
- Transferring care entirely to a home health nurse
Correct answer: Arranging a follow-up appointment within 7 days of discharge
Early post-discharge follow-up within 7 days is a key evidence-based strategy to detect complications and prevent readmission.
Question 2: The concept of 'warm handoff' in care transitions refers to:
- Sending a discharge summary by fax to the next provider
- A direct, real-time introduction between the outgoing and receiving care team members (Correct answer)
- Providing the patient with written instructions only
- Scheduling a future appointment without verbal communication
Correct answer: A direct, real-time introduction between the outgoing and receiving care team members
A warm handoff involves a direct personal introduction or communication between providers to ensure continuity and reduce information loss.
Question 3: Which model specifically uses 'health coaches' and 'community health workers' as part of a care coordination team?
- Case Management Society of America model
- Camden Coalition of Healthcare Providers hot-spotting model
- Chronic Care Model (Correct answer)
- PACE (Program of All-inclusive Care for the Elderly)
Correct answer: Chronic Care Model
The Chronic Care Model incorporates community resources and self-management support, often delivered by health coaches and community health workers.
Question 4: A care manager is prioritizing a caseload of 25 clients. Which client should receive IMMEDIATE attention?
- A stable client with a scheduled follow-up next week
- A client discharged yesterday with no post-acute services arranged (Correct answer)
- A client who called to request a benefits summary
- A client awaiting non-urgent durable medical equipment
Correct answer: A client discharged yesterday with no post-acute services arranged
A newly discharged client with no post-acute services is at high risk of adverse outcomes and requires urgent care coordination.
Question 5: In the context of resource management, 'utilization review' is BEST described as:
- Evaluating a care manager's performance metrics
- Assessing whether healthcare services are medically necessary and appropriate (Correct answer)
- Auditing billing codes for accuracy
- Reviewing patient satisfaction survey results
Correct answer: Assessing whether healthcare services are medically necessary and appropriate
Utilization review evaluates whether specific services are medically necessary, appropriate in setting, and cost-effective.
Question 6: A care manager identifies a client who qualifies for the Supplemental Nutrition Assistance Program (SNAP) but has not enrolled. The BEST action is to:
- Advise the client to look it up online independently
- Provide information and assist with the application process as appropriate (Correct answer)
- Assume the client has already considered and declined SNAP
- Refer only if the client specifically asks for food assistance
Correct answer: Provide information and assist with the application process as appropriate
Proactive assistance with benefit enrollment is a core care management function that addresses social determinants of health.
Question 7: Which organization publishes the Standards of Practice for Case Management used as a professional benchmark in the US?
- American Nurses Association (ANA)
- Case Management Society of America (CMSA) (Correct answer)
- Joint Commission on Accreditation (TJC)
- Centers for Medicare & Medicaid Services (CMS)
Correct answer: Case Management Society of America (CMSA)
CMSA publishes the Standards of Practice for Case Management, which define competencies and ethical practice for the profession.
CCM Care Coordination & Resource Management 3
A care manager is developing a care plan for a recently discharged stroke patient.
Which element is ESSENTIAL to prevent 30-day readmission?