CCM CCM Financial Management & Reimbursement 2

Question 1

Which Medicare part specifically covers prescription drugs for eligible beneficiaries?

Accepted Answer

Medicare Part D

Answer

Medicare Part D is the optional prescription drug benefit plan available to Medicare beneficiaries.

Question 2

A care manager notices a client is receiving services from a provider outside their HMO network. What financial risk does this create for the client?

Accepted Answer

Higher or full out-of-pocket costs

Answer

Out-of-network providers in an HMO typically result in significantly higher or total out-of-pocket costs for the patient, as the plan may not cover those services.

Question 3

Which term describes the process by which a health insurer reviews a request for a specific treatment or medication before it is provided to determine coverage?

Accepted Answer

Prior authorization

Answer

Prior authorization requires insurer approval before a service is rendered to confirm it is medically necessary and covered.

Question 4

A CCM is assisting an uninsured low-income client. Which joint federal-state program should the care manager explore first for potential coverage?

Accepted Answer

Medicaid

Answer

Medicaid is a joint federal-state program providing health coverage to eligible low-income individuals and families.

Question 5

Which payment model groups all services related to a single episode of care into one payment, shared among all providers involved?

Accepted Answer

Bundled payment

Answer

Bundled payments cover all services for a defined episode of care under one aggregate payment distributed among participating providers.

(CCM) Certified Care Manager Practice Test

(CCM) Certified Care Manager Practice Test

CCM CCM Financial Management & Reimbursement 2