General 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 General flashcards as text
When performing a comprehensive needs assessment, which domain is MOST critical for a case manager to evaluate in a client newly diagnosed with a chronic illness?
Answer: Psychosocial and support system factors
Psychosocial factors including social support, mental health, and coping capacity are central to successful chronic disease management.
Which payment model reimburses a fixed amount per patient per month regardless of services utilized?
Answer: Capitation
Capitation pays a fixed monthly amount per enrolled member, incentivizing preventive care and efficient resource use.
A case manager identifies that a client's home environment poses fall risks. The BEST next step is to:
Answer: Refer for a home safety evaluation by an occupational therapist
An occupational therapist home safety evaluation identifies specific hazards and recommends targeted modifications to reduce fall risk.
Which concept describes the ability of a healthcare system to provide care that does not vary in quality because of personal characteristics such as gender, ethnicity, or socioeconomic status?
Answer: Health equity
Health equity means every person has a fair opportunity to attain their highest level of health regardless of social determinants.
A Milliman Care Guideline (MCG) is BEST described as:
Answer: An evidence-based clinical criteria tool used in utilization management
MCG guidelines are evidence-based criteria used to determine appropriate level of care and length of stay during utilization review.
In motivational interviewing, the technique of 'rolling with resistance' means the case manager should:
Answer: Avoid arguing and reflect the client's ambivalence back to them
Rolling with resistance involves acknowledging the client's perspective without argument, reducing defensiveness and maintaining therapeutic rapport.
Which of the following BEST describes a 'catastrophic case' in case management?
Answer: A case involving high costs, complex needs, and long-term care requirements
Catastrophic cases involve severe conditions such as traumatic brain injury or spinal cord injury with high resource utilization and long-term complex needs.