CCM CCM Financial Management & Reimbursement 1

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

Medicare is the federal health insurance program for individuals aged 65 and older, and understanding its reimbursement structures is essential for care managers.

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

A copayment is a fixed dollar amount paid by the patient for a specific covered service, separate from the 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

Capitation pays a fixed monthly rate per enrolled patient, encouraging cost-effective and preventive care delivery.

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

An EOB is a statement from the insurer detailing what was billed, what the plan covered, and what the patient is responsible for paying.

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

The allowable amount is the maximum negotiated rate the insurer will pay for a service, with the patient responsible for their share of that amount.

(CCM) Certified Care Manager Practice Test

(CCM) Certified Care Manager Practice Test

CCM CCM Financial Management & Reimbursement 1