CCM Certified Case Manager (CCM) MCQ 3

Question 1

A case manager working with a Medicare patient notices the patient cannot afford prescribed medications. The FIRST step should be to:

Accepted Answer

Assess eligibility for Medicare Extra Help (Low Income Subsidy) and pharmaceutical assistance programs

Answer

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:

Accepted Answer

Provide evidence-based guidelines for clinical decision-making in utilization review

Answer

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?

Accepted Answer

Facilitating communication, advocating for the patient, and coordinating the care plan across disciplines

Answer

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:

Accepted Answer

The patient has less than 12 months to live if disease follows its expected course

Answer

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?

Accepted Answer

Medicaid HCBS waivers

Answer

Medicaid Home and Community-Based Services (HCBS) waivers fund case management and support services for individuals with developmental disabilities.

CCM - Certified Case Manager Exam Practice Test

CCM - Certified Case Manager Exam Practice Test

CCM Certified Case Manager (CCM) MCQ 3