Care Coordination & Patient Advocacy Flashcards
7 cards from real CCM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Care Coordination & Patient Advocacy flashcards as text
A care manager is working with a patient who has been discharged from the hospital but refuses to take prescribed medications. What is the most appropriate first step?
Answer: Explore the patient's reasons for refusing and identify barriers
Exploring the patient's reasons for refusal is the foundation of patient-centered advocacy and helps identify actionable barriers like cost, side effects, or health literacy issues.
Which care coordination model focuses on a primary care provider leading a team-based approach to manage all aspects of a patient's health needs?
Answer: Patient-Centered Medical Home (PCMH)
The Patient-Centered Medical Home (PCMH) model designates a primary care provider to coordinate comprehensive, team-based care across all settings.
A patient with limited English proficiency needs to discuss a complex treatment plan. What is the most appropriate action for the care manager?
Answer: Arrange for a professional medical interpreter
Professional medical interpreters are required under federal law and ensure accurate communication without the liability or conflicts of interest that family interpreters present.
When coordinating care for a patient transitioning from acute care to a skilled nursing facility (SNF), which document is most critical to communicate?
Answer: A comprehensive medication reconciliation list
Medication reconciliation is essential at care transitions to prevent errors, duplications, and omissions that are among the leading causes of adverse events post-discharge.
A care manager notices that a patient's care plan goals conflict with the recommendations of the specialist. The best course of action is to:
Answer: Facilitate a care conference to align the patient, PCP, and specialist
Facilitating a care conference promotes interprofessional collaboration and ensures the patient's goals and clinical recommendations are reconciled in a shared care plan.
Which of the following best describes 'warm handoff' in care coordination?
Answer: A direct real-time introduction between the patient and the receiving provider
A warm handoff is a real-time, face-to-face or phone introduction between the outgoing and receiving provider, reducing gaps and improving care continuity.
A care manager is advocating for a patient who has been denied a medically necessary procedure by their insurance. The most effective advocacy action is to:
Answer: Submit a peer-to-peer review request with clinical evidence
A peer-to-peer review allows the treating clinician to discuss clinical necessity directly with the insurance medical reviewer, which is often the most effective first step in overturning a denial.