CCM Certified Case Manager (CCM) MCQ Questions and Answers 2 — Questions and Answers
Question 1: A case manager discovers a client's employer is pressuring them to return to work before medical clearance. What should the case manager do first?
- Contact the employer to demand they stop
- Document the situation and educate the client about their rights under FMLA and ADA (Correct answer)
- Report the employer to OSHA
- Advise the client to resign
Correct answer: Document the situation and educate the client about their rights under FMLA and ADA
The case manager should document the situation and educate the client about legal protections.
FMLA provides up to 12 weeks of protected leave, and ADA requires reasonable accommodations. Empowering the client with knowledge respects their autonomy and allows informed decisions. Direct employer contact may follow with client consent.
Question 2: Which assessment tool is commonly used to evaluate functional status and ability to perform activities of daily living?
- Glasgow Coma Scale
- Katz Index of Independence in ADL (Correct answer)
- CAGE questionnaire
- PHQ-9
Correct answer: Katz Index of Independence in ADL
The Katz Index assesses a client's ability to perform basic self-care tasks independently.
The Katz Index evaluates six basic functions: bathing, dressing, toileting, transferring, continence, and feeding. It is widely used for care planning, placement decisions, and monitoring functional changes.
Question 3: What is the primary difference between concurrent review and retrospective review in utilization management?
- Concurrent review is more expensive
- Concurrent review occurs during treatment while retrospective review occurs after completion (Correct answer)
- Retrospective review is more accurate
- Concurrent review is only for outpatient settings
Correct answer: Concurrent review occurs during treatment while retrospective review occurs after completion
Concurrent review evaluates care during delivery; retrospective review analyzes care after completion.
Concurrent review allows real-time intervention such as level-of-care changes and discharge planning. Retrospective review evaluates whether services were medically necessary and appropriate after the fact.
Question 4: A client with a traumatic brain injury is being transitioned from acute care. Which rehabilitation setting provides the most intensive therapy?
- Skilled nursing facility
- Inpatient rehabilitation facility (IRF) (Correct answer)
- Home health services
- Outpatient day program
Correct answer: Inpatient rehabilitation facility (IRF)
IRFs provide the highest intensity, requiring at least 3 hours of therapy per day.
CMS requires IRF patients to tolerate at least 3 hours of therapy per day, 5 days per week. Patients must require physician supervision and an interdisciplinary team approach. SNFs provide lower intensity therapy.
Question 5: Under HIPAA, when can a case manager share PHI without written authorization?
- When the case manager believes it's in the client's best interest
- For treatment, payment, and healthcare operations purposes (Correct answer)
- When family members request the information
- When the information is not considered sensitive
Correct answer: For treatment, payment, and healthcare operations purposes
HIPAA permits sharing PHI without authorization for treatment, payment, and healthcare operations (TPO).
TPO exceptions allow sharing for coordinating care with providers, billing and claims processing, and quality improvement and case management activities. Other exceptions include public health reporting and law enforcement with proper authority.
Question 6: What is the 'benefit period' in Medicare Part A coverage?
- The annual enrollment period
- A period beginning when admitted to hospital and ending after 60 consecutive days without inpatient care (Correct answer)
- The 12-month outpatient coverage period
- The lifetime maximum benefit amount
Correct answer: A period beginning when admitted to hospital and ending after 60 consecutive days without inpatient care
A benefit period begins at hospital admission and ends after 60 consecutive days without inpatient care.
Coverage limits reset with each new benefit period. Medicare covers up to 60 days with the initial deductible, days 61-90 with daily coinsurance, and 60 lifetime reserve days with higher coinsurance.
CCM Certified Case Manager (CCM) MCQ Questions and Answers 2
A case manager discovers a client's employer is pressuring them to return to work before medical clearance.
What should the case manager do first?