Certified Case Manager (CCM) MCQ 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 Certified Case Manager (CCM) MCQ flashcards as text
A case manager working with a Medicare patient notices the patient cannot afford prescribed medications. The FIRST step should be to:
Answer: Assess eligibility for Medicare Extra Help (Low Income Subsidy) and pharmaceutical assistance programs
Medicare Extra Help and manufacturer patient assistance programs are primary resources to address medication affordability for eligible beneficiaries.
The InterQual or Milliman criteria are used in case management primarily to:
Answer: Provide evidence-based guidelines for clinical decision-making in utilization review
InterQual and Milliman Care Guidelines are evidence-based clinical criteria used to evaluate the appropriateness of services and level of care.
Which of the following BEST describes a case manager's role in a multidisciplinary care team meeting?
Answer: Facilitating communication, advocating for the patient, and coordinating the care plan across disciplines
Case managers serve as coordinators and patient advocates within the interdisciplinary team, facilitating collaboration rather than directing clinical care.
A patient with end-stage renal disease (ESRD) asks the case manager about hospice eligibility. The case manager should explain that hospice is appropriate when:
Answer: The patient has less than 12 months to live if disease follows its expected course
Hospice eligibility requires a physician-certified prognosis of 6 months or less to live if the illness runs its normal course.
Which funding source provides case management services for individuals with developmental disabilities through home and community-based waivers?
Answer: Medicaid HCBS waivers
Medicaid Home and Community-Based Services (HCBS) waivers fund case management and support services for individuals with developmental disabilities.
A patient is being discharged after a stroke. A case manager should prioritize which assessment to prevent a 30-day readmission?
Answer: Functional status, caregiver support, and medication adherence capacity
Post-stroke readmission prevention depends on assessing functional deficits, available caregiver support, and the patient's ability to manage medications at home.
Which model of case management integrates behavioral health and medical services to address the whole person?
Answer: Integrated or co-located care model
Integrated care models co-locate or coordinate behavioral health and primary care services to address both physical and mental health needs simultaneously.