CCM Care Coordination & Patient Advocacy 2 — Questions and Answers
Question 1: A care manager is working with a patient who has been discharged from the hospital but refuses to take prescribed medications. What is the most appropriate first step?
- Contact the prescribing physician to change the medications
- Explore the patient's reasons for refusing and identify barriers (Correct answer)
- Document the refusal and close the case
- Notify the patient's family without the patient's consent
Correct answer: Explore the patient's reasons for refusing and identify barriers
Exploring the patient's reasons for refusal is the foundation of patient-centered advocacy and helps identify actionable barriers like cost, side effects, or health literacy issues.
Question 2: Which care coordination model focuses on a primary care provider leading a team-based approach to manage all aspects of a patient's health needs?
- Chronic Care Model
- Patient-Centered Medical Home (PCMH) (Correct answer)
- Transitions of Care Model
- Disease Management Model
Correct answer: Patient-Centered Medical Home (PCMH)
The Patient-Centered Medical Home (PCMH) model designates a primary care provider to coordinate comprehensive, team-based care across all settings.
Question 3: A patient with limited English proficiency needs to discuss a complex treatment plan. What is the most appropriate action for the care manager?
- Use simple English and speak slowly
- Ask the patient's adult child to interpret
- Arrange for a professional medical interpreter (Correct answer)
- Provide written materials in English only
Correct answer: Arrange for a professional medical interpreter
Professional medical interpreters are required under federal law and ensure accurate communication without the liability or conflicts of interest that family interpreters present.
Question 4: When coordinating care for a patient transitioning from acute care to a skilled nursing facility (SNF), which document is most critical to communicate?
- The patient's insurance card information
- A comprehensive medication reconciliation list (Correct answer)
- The patient's prior authorization history
- A list of the patient's preferred providers
Correct answer: A comprehensive medication reconciliation list
Medication reconciliation is essential at care transitions to prevent errors, duplications, and omissions that are among the leading causes of adverse events post-discharge.
Question 5: A care manager notices that a patient's care plan goals conflict with the recommendations of the specialist. The best course of action is to:
- Follow the specialist's recommendations as the clinical expert
- Follow the patient's goals as patient autonomy is paramount
- Facilitate a care conference to align the patient, PCP, and specialist (Correct answer)
- Document the conflict and allow the team to resolve it independently
Correct answer: Facilitate a care conference to align the patient, PCP, and specialist
Facilitating a care conference promotes interprofessional collaboration and ensures the patient's goals and clinical recommendations are reconciled in a shared care plan.
Question 6: Which of the following best describes 'warm handoff' in care coordination?
- Sending a detailed referral letter to a new provider
- Electronically transferring patient records between systems
- A direct real-time introduction between the patient and the receiving provider (Correct answer)
- Scheduling the patient's next appointment before discharge
Correct answer: A direct real-time introduction between the patient and the receiving provider
A warm handoff is a real-time, face-to-face or phone introduction between the outgoing and receiving provider, reducing gaps and improving care continuity.
Question 7: A care manager is advocating for a patient who has been denied a medically necessary procedure by their insurance. The most effective advocacy action is to:
- Advise the patient to pay out-of-pocket to avoid delays
- Submit a peer-to-peer review request with clinical evidence (Correct answer)
- Accept the denial and explore alternative treatments
- File a complaint with the state insurance commissioner
Correct answer: Submit a peer-to-peer review request with clinical evidence
A peer-to-peer review allows the treating clinician to discuss clinical necessity directly with the insurance medical reviewer, which is often the most effective first step in overturning a denial.
CCM Care Coordination & Patient Advocacy 2
A care manager is working with a patient who has been discharged from the hospital but refuses to take prescribed medications.
What is the most appropriate first step?