CCM Certified Case Manager (CCM) MCQ 2 — Questions and Answers
Question 1: A case manager is coordinating care for a patient transitioning from an acute care hospital to a skilled nursing facility. Which action BEST supports a safe transition?
- Sending only the discharge summary to the receiving facility
- Conducting a warm handoff with medication reconciliation and follow-up scheduling (Correct answer)
- Leaving the family to arrange post-discharge services independently
- Discharging the patient once the insurance authorization is obtained
Correct answer: Conducting a warm handoff with medication reconciliation and follow-up scheduling
A warm handoff including medication reconciliation and follow-up scheduling reduces readmission risk and ensures continuity of care.
Question 2: Which ethical principle is most directly applied when a case manager ensures a patient understands all treatment options before agreeing to a care plan?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Nonmaleficence
Correct answer: Autonomy
Autonomy supports the patient's right to make informed decisions about their own care.
Question 3: Under the CCMC Code of Professional Conduct, a case manager who receives a gift from a vendor should:
- Accept it if the value is under $25
- Report it to a supervisor and decline per conflict of interest policies (Correct answer)
- Accept it since it does not affect clinical decisions
- Accept it only if the vendor is already an approved supplier
Correct answer: Report it to a supervisor and decline per conflict of interest policies
CCMC standards require case managers to avoid conflicts of interest, including declining gifts from vendors regardless of value.
Question 4: A patient with congestive heart failure is being discharged home. Which community resource is MOST appropriate for daily symptom monitoring?
- Hospice services
- Telehealth remote patient monitoring program (Correct answer)
- Adult day health center
- Home health aide only
Correct answer: Telehealth remote patient monitoring program
Remote patient monitoring programs allow daily tracking of weight, blood pressure, and symptoms to detect CHF decompensation early.
Question 5: Utilization management in case management primarily aims to:
- Increase hospital length of stay to maximize reimbursement
- Ensure the appropriate level of care is used at the right time to optimize outcomes and resources (Correct answer)
- Deny services to reduce payer costs
- Expedite discharges regardless of patient readiness
Correct answer: Ensure the appropriate level of care is used at the right time to optimize outcomes and resources
Utilization management ensures care is medically necessary, delivered at the appropriate setting, and aligned with evidence-based criteria.
Question 6: A case manager identifies that a patient's insurance plan requires prior authorization for a recommended MRI. The MRI is urgently needed. The BEST action is to:
- Order the MRI and address authorization later
- Initiate a peer-to-peer review or expedited appeal with clinical documentation (Correct answer)
- Advise the patient to self-pay to avoid delays
- Cancel the MRI order and choose a non-approved alternative
Correct answer: Initiate a peer-to-peer review or expedited appeal with clinical documentation
Initiating an expedited peer-to-peer review with clinical justification is the appropriate step to secure timely authorization.
Question 7: Which tool is most commonly used by case managers to screen for social determinants of health (SDOH)?
- Glasgow Coma Scale
- PRAPARE or AHC-HRSN screening tool (Correct answer)
- CAGE questionnaire
- PHQ-2 depression screen
Correct answer: PRAPARE or AHC-HRSN screening tool
PRAPARE and AHC-HRSN are standardized SDOH screening tools designed to identify unmet social needs like housing and food insecurity.
CCM Certified Case Manager (CCM) MCQ 2
A case manager is coordinating care for a patient transitioning from an acute care hospital to a skilled nursing facility.
Which action BEST supports a safe transition?