CCM Certified Case Manager (CCM) MCQ 3 — Questions and Answers
Question 1: A case manager working with a Medicare patient notices the patient cannot afford prescribed medications. The FIRST step should be to:
- Suggest the patient skip non-essential doses to extend supply
- Assess eligibility for Medicare Extra Help (Low Income Subsidy) and pharmaceutical assistance programs (Correct answer)
- Recommend switching to over-the-counter alternatives
- Document the issue and take no further action
Correct answer: Assess eligibility for Medicare Extra Help (Low Income Subsidy) and pharmaceutical assistance programs
Medicare Extra Help and manufacturer patient assistance programs are primary resources to address medication affordability for eligible beneficiaries.
Question 2: The InterQual or Milliman criteria are used in case management primarily to:
- Determine patient satisfaction scores
- Provide evidence-based guidelines for clinical decision-making in utilization review (Correct answer)
- Calculate healthcare provider reimbursement rates
- Assign ICD-10 diagnosis codes
Correct answer: Provide evidence-based guidelines for clinical decision-making in utilization review
InterQual and Milliman Care Guidelines are evidence-based clinical criteria used to evaluate the appropriateness of services and level of care.
Question 3: Which of the following BEST describes a case manager's role in a multidisciplinary care team meeting?
- Directing all clinical decisions for the team
- Facilitating communication, advocating for the patient, and coordinating the care plan across disciplines (Correct answer)
- Replacing the attending physician in clinical decision-making
- Documenting meeting minutes only
Correct answer: Facilitating communication, advocating for the patient, and coordinating the care plan across disciplines
Case managers serve as coordinators and patient advocates within the interdisciplinary team, facilitating collaboration rather than directing clinical care.
Question 4: A patient with end-stage renal disease (ESRD) asks the case manager about hospice eligibility. The case manager should explain that hospice is appropriate when:
- The patient has less than 12 months to live if disease follows its expected course (Correct answer)
- The patient has stopped all dialysis treatments for at least one year
- The patient is cognitively impaired and cannot make decisions
- The patient's family requests it regardless of prognosis
Correct answer: The patient has less than 12 months to live if disease follows its expected course
Hospice eligibility requires a physician-certified prognosis of 6 months or less to live if the illness runs its normal course.
Question 5: Which funding source provides case management services for individuals with developmental disabilities through home and community-based waivers?
- Medicare Part A
- Medicaid HCBS waivers (Correct answer)
- TRICARE
- CHIP
Correct answer: Medicaid HCBS waivers
Medicaid Home and Community-Based Services (HCBS) waivers fund case management and support services for individuals with developmental disabilities.
Question 6: A patient is being discharged after a stroke. A case manager should prioritize which assessment to prevent a 30-day readmission?
- Credit score and financial history
- Functional status, caregiver support, and medication adherence capacity (Correct answer)
- Employer verification and return-to-work timeline
- Laboratory result trending only
Correct answer: Functional status, caregiver support, and medication adherence capacity
Post-stroke readmission prevention depends on assessing functional deficits, available caregiver support, and the patient's ability to manage medications at home.
Question 7: Which model of case management integrates behavioral health and medical services to address the whole person?
- Disease management model
- Integrated or co-located care model (Correct answer)
- Brokerage model
- Single-payer model
Correct answer: Integrated or co-located care model
Integrated care models co-locate or coordinate behavioral health and primary care services to address both physical and mental health needs simultaneously.
CCM Certified Case Manager (CCM) MCQ 3
A case manager working with a Medicare patient notices the patient cannot afford prescribed medications.
The FIRST step should be to: