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
Which ethical principle requires a case manager to act in the best interest of the client, even when it conflicts with institutional policies?
Answer: Beneficence
Beneficence obligates case managers to promote client welfare and act in the client's best interest above all.
A case manager is coordinating discharge for a patient with complex needs. Which tool is MOST useful for ensuring all team members share the same care goals?
Answer: Interdisciplinary care conference
An interdisciplinary care conference aligns all team members around shared goals and promotes coordinated discharge planning.
Under HIPAA, which of the following is a permitted disclosure of protected health information (PHI) WITHOUT patient authorization?
Answer: Treatment coordination among providers
HIPAA permits PHI disclosure for treatment, payment, and healthcare operations without explicit patient authorization.
A client with a new spinal cord injury is refusing rehabilitation services. The case manager's first action should be to:
Answer: Explore the client's concerns and reasons for refusal
Exploring the client's concerns respects autonomy while identifying barriers that may be addressable through education or support.
The PRIMARY goal of utilization management in case management is to:
Answer: Ensure appropriate use of healthcare resources
Utilization management ensures clients receive necessary, appropriate, and cost-effective care at the right level of service.
Which accreditation body sets standards specifically for case management programs in managed care organizations?
Answer: URAC
URAC (formerly the Utilization Review Accreditation Commission) accredits health utilization management and case management programs.
A case manager notices a client's treatment plan has not been updated in six months despite significant functional decline. This situation represents a failure of:
Answer: Ongoing monitoring and reassessment
Ongoing monitoring and reassessment is a core case management function that ensures the plan of care remains relevant to the client's current status.