CCM Trivia 2 — Questions and Answers
Question 1: Which federal law established the framework for managed care organizations and HMO requirements in the US?
- Social Security Act of 1965
- HMO Act of 1973 (Correct answer)
- ERISA of 1974
- Balanced Budget Act of 1997
Correct answer: HMO Act of 1973
The HMO Act of 1973 provided federal grants and loans to develop HMOs and required employers to offer HMO options, establishing the managed care framework.
Question 2: In case management, what does the acronym 'URAC' stand for?
- Unified Review and Accreditation Commission
- Utilization Review Accreditation Commission (Correct answer)
- Universal Resource and Accreditation Council
- United Registry for Accredited Casework
Correct answer: Utilization Review Accreditation Commission
URAC (Utilization Review Accreditation Commission) is an independent accrediting organization that promotes healthcare quality through accreditation and education.
Question 3: Which model of case management focuses on the patient's own goals and strengths rather than deficits?
- Medical model
- Deficit-based model
- Strengths-based model (Correct answer)
- Paternalistic model
Correct answer: Strengths-based model
The strengths-based model emphasizes identifying and building on a patient's own capabilities, resources, and goals rather than focusing on problems or deficits.
Question 4: What is the primary purpose of a 'utilization review' in a managed care setting?
- To audit billing codes for accuracy
- To evaluate the medical necessity and appropriateness of care (Correct answer)
- To measure patient satisfaction scores
- To credential new healthcare providers
Correct answer: To evaluate the medical necessity and appropriateness of care
Utilization review evaluates whether the care being provided or requested is medically necessary, appropriate, and delivered in the most cost-effective setting.
Question 5: The 'CCMC' that governs the CCM credential is headquartered in which US city?
- Washington, D.C.
- Chicago, Illinois
- Mount Laurel, New Jersey (Correct answer)
- Atlanta, Georgia
Correct answer: Mount Laurel, New Jersey
The Commission for Case Manager Certification (CCMC) is headquartered in Mount Laurel, New Jersey, and administers the CCM credential.
Question 6: Under the ADA, what term describes modifying a job or work environment to enable a qualified individual with a disability to perform essential job functions?
- Reasonable accommodation (Correct answer)
- Functional capacity evaluation
- Vocational retraining
- Job restructuring mandate
Correct answer: Reasonable accommodation
Reasonable accommodation under the ADA refers to modifications or adjustments that enable a qualified person with a disability to perform essential job functions without undue hardship.
Question 7: Which of the following best describes 'capitation' as a payment model?
- Fee paid per individual procedure performed
- Fixed monthly payment per enrolled member regardless of services used (Correct answer)
- Reimbursement based on documented diagnosis-related groups
- Bonus payment tied to quality performance metrics
Correct answer: Fixed monthly payment per enrolled member regardless of services used
Capitation is a fixed, per-member-per-month payment made to a provider to cover all contracted services, shifting financial risk to the provider.
CCM Trivia 2
Which federal law established the framework for managed care organizations and HMO requirements in the US?