CCM CCM Financial Management & Reimbursement

Question 1

Which federal program provides health coverage primarily to individuals aged 65 and older, directly impacting reimbursement decisions in care management?

Accepted Answer

Medicare

Answer

Medicaid

Answer

CHIP

Answer

TRICARE

Question 2

A care manager is helping a client navigate out-of-pocket costs. Which term describes the fixed amount a patient pays for a covered health care service after meeting their deductible?

Accepted Answer

Copayment

Answer

Premium

Answer

Coinsurance

Answer

Deductible

Question 3

Which reimbursement model pays providers a set amount per patient per month regardless of services rendered, incentivizing preventive care?

Accepted Answer

Capitation

Answer

Fee-for-service

Answer

Per diem

Answer

Bundled payment

Question 4

A CCM is reviewing a client's Explanation of Benefits (EOB). What is the primary purpose of this document?

Accepted Answer

It explains what the insurance paid and what the patient owes

Answer

It is a bill from the provider

Answer

It lists the client's upcoming appointments

Answer

It outlines the client's care plan goals

Question 5

Which term refers to the negotiated maximum amount a health insurance plan will pay for a covered service from an in-network provider?

Accepted Answer

Allowable amount

Answer

Usual and customary rate

Answer

Billed charge

Answer

Balance billing

Question 6

Under the Affordable Care Act (ACA), what is the term for the annual cap on out-of-pocket expenses a patient must pay for covered in-network services?

Accepted Answer

Out-of-pocket maximum

Answer

Lifetime benefit maximum

Answer

Annual deductible cap

Answer

Coinsurance ceiling