Chronic Disease Management & Care Coordination Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Chronic Disease Management & Care Coordination flashcards as text
A care coordinator is working with a patient who consistently misses follow-up appointments. Which motivational interviewing technique is MOST appropriate as a first step?
Answer: Asking open-ended questions to explore the patient's barriers and perspective
Open-ended questions are the foundational motivational interviewing technique for exploring patient ambivalence and identifying barriers without triggering defensiveness.
Which of the following BEST describes 'care fragmentation' in chronic disease management?
Answer: Disconnected care delivery where providers lack shared information and coordination
Care fragmentation occurs when multiple providers treat a patient without shared information or coordination, leading to duplicated tests, missed diagnoses, and conflicting treatments.
For Medicare patients with two or more chronic conditions, Chronic Care Management (CCM) services under CMS require at least how many minutes of non-face-to-face clinical staff time per month?
Answer: 20 minutes
CMS CPT code 99490 for Chronic Care Management requires at least 20 minutes of non-face-to-face clinical staff time per calendar month for eligible Medicare patients.
A care coordinator receives a patient's health information from a specialist without a signed release of information. Under HIPAA, this situation:
Answer: May be permitted for treatment purposes between providers involved in care, but policies must be followed
HIPAA's treatment exception permits sharing protected health information between treating providers without explicit patient authorization, but organization-specific policies and minimum necessary standards still apply.
Which chronic disease self-management program (CDSMP) is recognized by the CDC as an evidence-based community intervention?
Answer: Stanford Chronic Disease Self-Management Program
The Stanford Chronic Disease Self-Management Program (CDSMP) is a CDC-recognized, evidence-based workshop program shown to improve self-efficacy and health outcomes across multiple chronic conditions.
A 68-year-old patient with hypertension, diabetes, and depression declines a mental health referral. The care coordinator's BEST response is to:
Answer: Explore barriers to acceptance, provide psychoeducation, and leave the door open for future discussion
Exploring barriers, providing education, and maintaining an open therapeutic relationship respects patient autonomy while continuing to address an unmet mental health need.
A registry in chronic care management is PRIMARILY used to:
Answer: Identify and monitor all patients with a specific condition to ensure timely preventive care and follow-up
Disease registries are population-level tools that track all patients with a condition, enabling proactive outreach, gap identification, and systematic quality monitoring.