Care Planning and Coordination 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 Planning and Coordination flashcards as text
A case manager is coordinating discharge for a homeless patient with newly diagnosed insulin-dependent diabetes. Which social determinant of health poses the greatest immediate barrier to the care plan?
Answer: Inability to safely store insulin requiring refrigeration
Insulin requires refrigeration; without stable housing, safe medication storage is impossible, making this the most immediate and life-threatening barrier to the diabetes care plan.
Which tool is most commonly used by case managers to screen for health-related social needs that impact care plan development?
Answer: The PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences)
PRAPARE is a validated, standardized tool designed to screen for social determinants of health that affect a patient's care needs and plan.
A case manager receives conflicting care recommendations from a patient's cardiologist and nephrologist regarding fluid management. What is the most appropriate role for the case manager?
Answer: Facilitate a joint consultation between both specialists to reach a consensus plan
Facilitating specialist-to-specialist communication to resolve clinical conflicts is a core case management coordination function that protects patient safety.
Under which circumstance is it appropriate for a case manager to share a patient's protected health information (PHI) with a care team member without explicit patient authorization?
Answer: When sharing information for treatment, payment, or healthcare operations purposes under HIPAA
HIPAA permits PHI disclosure without authorization for treatment, payment, and healthcare operations (TPO) activities among members of the patient's care team.
A case manager is coordinating care for a pediatric patient with a traumatic brain injury. Who is the primary decision-maker for care plan goals?
Answer: The parents or legal guardians, in consultation with the child's care team
Parents or legal guardians are the legal decision-makers for minor children and must be central partners in care plan development, in collaboration with the clinical team.
Which case management activity BEST exemplifies the principle of 'advocacy' in the care planning process?
Answer: Appealing an insurance denial for a medically necessary service on the patient's behalf
Advocacy involves actively representing the patient's interests and needs, including challenging inappropriate denials for medically necessary services.
A case manager is evaluating a care plan for cultural competence. Which action BEST demonstrates culturally responsive care planning?
Answer: Incorporating the patient's cultural beliefs, practices, and preferences as identified through direct assessment
Culturally responsive care planning requires individually assessing each patient's cultural beliefs and preferences and incorporating them into a personalized care plan.