CCM General 5 — Questions and Answers
Question 1: Which of the following BEST describes the case management concept of 'transitional care'?
- Permanently transferring a client to another case manager
- A set of actions ensuring care coordination as clients move between healthcare settings (Correct answer)
- Switching a client from one insurance plan to another
- Transitioning a case manager from one employer to another
Correct answer: A set of actions ensuring care coordination as clients move between healthcare settings
Transitional care encompasses coordinated actions that ensure safe, effective handoffs between settings such as hospital to home or SNF.
Question 2: Social determinants of health (SDOH) that a case manager should routinely screen for include all of the following EXCEPT:
- Housing instability
- Food insecurity
- Physician's malpractice history (Correct answer)
- Transportation barriers
Correct answer: Physician's malpractice history
SDOH screening focuses on upstream factors affecting client health such as housing, food, and transportation, not provider credentials.
Question 3: A client with end-stage heart failure asks about hospice care. The case manager should explain that hospice is appropriate when:
- The client has no family to provide support
- Life expectancy is 6 months or less if the illness runs its normal course (Correct answer)
- All curative treatments have been tried and failed
- The client is unconscious or unable to make decisions
Correct answer: Life expectancy is 6 months or less if the illness runs its normal course
Hospice eligibility under Medicare requires a physician certification that life expectancy is 6 months or less if the disease follows its expected course.
Question 4: Which law prohibits insurance companies from discriminating against individuals based on pre-existing health conditions in the individual and small group markets?
- HIPAA
- The Affordable Care Act (ACA) (Correct answer)
- COBRA
- ERISA
Correct answer: The Affordable Care Act (ACA)
The ACA prohibits health insurers in the individual and small group markets from denying coverage or charging higher premiums based on pre-existing conditions.
Question 5: A case manager is evaluating a client's functional status after stroke. Which standardized tool is MOST commonly used to measure activities of daily living (ADL) independence?
- Mini-Mental State Examination (MMSE)
- Barthel Index (Correct answer)
- Glasgow Coma Scale
- SF-36 Health Survey
Correct answer: Barthel Index
The Barthel Index is a widely validated scale measuring independence in 10 ADLs including feeding, bathing, dressing, and mobility.
Question 6: When a case manager identifies a conflict of interest in a client's situation, the FIRST appropriate action is to:
- Ignore it if it does not affect the immediate care plan
- Disclose the conflict and consult with a supervisor or ethics committee (Correct answer)
- Immediately terminate the professional relationship
- Transfer the case to another department without explanation
Correct answer: Disclose the conflict and consult with a supervisor or ethics committee
Transparency and disclosure followed by supervisory or ethics consultation ensures the conflict is managed appropriately and client interests are protected.
Question 7: Which of the following is a key component of an effective case management outcome evaluation?
- Tracking only the number of phone calls made to clients
- Measuring client health status, satisfaction, and cost-effectiveness against baseline data (Correct answer)
- Evaluating only the case manager's documentation timeliness
- Reporting outcomes only when they are favorable
Correct answer: Measuring client health status, satisfaction, and cost-effectiveness against baseline data
Comprehensive outcome evaluation compares health status, client satisfaction, and resource utilization against baseline to determine case management effectiveness.
CCM General 5
Which of the following BEST describes the case management concept of 'transitional care'?