CCM - Certified Case Manager Healthcare Regulations and Compliance Questions and Answers

Question 1

A case manager is completing an admission assessment for a 78-year-old client being admitted to a skilled nursing facility.
To comply with the Patient Self-Determination Act (PSDA), which of the following actions is required?

Accepted Answer

Informing the client of their right to accept or refuse medical treatment and asking if they have an advance directive.

Answer

Ensuring the client's medical power of attorney is a family member.

Answer

Providing the client with a standardized advance directive form to complete immediately.

Answer

Requiring the client to formulate an advance directive before care can be provided.

Question 2

A hospital case manager is participating in a multidisciplinary rounds meeting in a busy, open-style nursing station. The team begins discussing a well-known local celebrity's complex diagnosis and challenging social situation. This action constitutes a potential violation of which federal regulation?

Accepted Answer

Health Insurance Portability and Accountability Act (HIPAA)

Answer

Emergency Medical Treatment and Labor Act (EMTALA)

Answer

The Stark Law

Answer

The Affordable Care Act (ACA)

Question 3

A person presents to a hospital emergency department with acute abdominal pain but has no identification or insurance information. According to the Emergency Medical Treatment and Labor Act (EMTALA), what is the hospital's primary obligation?

Accepted Answer

Provide a medical screening examination to determine if an emergency medical condition exists.

Answer

Arrange an immediate transfer to the nearest public hospital.

Answer

Obtain authorization from a hospital administrator before providing treatment.

Answer

Contact local law enforcement to help identify the individual before initiating care.

Question 4

A hospital-employed physician refers a Medicare patient for home health services to an agency in which the physician has a direct financial ownership interest. This arrangement is most likely to be scrutinized under which federal law?

Accepted Answer

The Physician Self-Referral Law (Stark Law)

Answer

The Patient Safety and Quality Improvement Act (PSQIA)

Answer

The Health Information Technology for Economic and Clinical Health (HITECH) Act

Answer

The False Claims Act (FCA)

Question 5

A case manager is working with a client being treated at a federally-assisted substance use disorder (SUD) program. The client's employer calls the case manager directly, requesting confirmation of the client's treatment dates for an FMLA claim. According to 42 CFR Part 2, what is the case manager's most appropriate action?

Accepted Answer

Inform the employer that the information can only be released with the client's specific written consent that meets Part 2 requirements.

Answer

Provide the dates, as FMLA is a legally protected reason for disclosure.

Answer

Refuse to provide the information under any circumstances to protect the client.

Answer

Tell the employer to obtain a standard court subpoena for the records.

Question 6

Which program, established by the Affordable Care Act (ACA), directly penalizes hospitals by reducing Medicare payments for higher-than-expected rates of 30-day readmissions for specific conditions like heart failure and pneumonia?

Accepted Answer

Hospital Readmissions Reduction Program (HRRP)

Answer

Accountable Care Organization (ACO) Program

Answer

Hospital Value-Based Purchasing (VBP) Program

Answer

Bundled Payments for Care Improvement (BPCI) Initiative