CCM Certified Case Manager (CCM) MCQ 4 — Questions and Answers
Question 1: A case manager notices a pattern of frequent emergency department visits by a patient with uncontrolled diabetes. The MOST appropriate intervention is to:
- Recommend the patient avoid the ED and call their physician instead
- Develop a proactive care plan with self-management education, regular follow-up, and access to primary care (Correct answer)
- Discharge the patient from case management due to non-compliance
- Notify the payer to deny further ED visits
Correct answer: Develop a proactive care plan with self-management education, regular follow-up, and access to primary care
Proactive care planning with self-management education and improved primary care access addresses the root cause of avoidable ED utilization.
Question 2: Under HIPAA, a case manager may share protected health information (PHI) with a patient's family member without explicit patient authorization when:
- The family member demands to know the diagnosis
- The patient is present and does not object, or the sharing is directly relevant to the family member's involvement in care (Correct answer)
- The case manager believes the family should know for the patient's safety
- The information is shared verbally and not in writing
Correct answer: The patient is present and does not object, or the sharing is directly relevant to the family member's involvement in care
HIPAA permits sharing PHI with involved family members when the patient is present and does not object, or when the patient has given prior permission.
Question 3: Which of the following is an example of secondary prevention in case management?
- Flu vaccination for healthy adults
- Early detection of hypertension through screening and initiating treatment (Correct answer)
- Rehabilitation after a stroke to regain function
- Public health education on smoking cessation
Correct answer: Early detection of hypertension through screening and initiating treatment
Secondary prevention involves early detection and treatment of disease before it progresses, such as identifying and managing hypertension.
Question 4: A patient with substance use disorder is being case-managed post-hospitalization. Which approach is most aligned with current best practice?
- Requiring complete abstinence before providing any further case management services
- Using a harm reduction framework with motivational interviewing and connection to peer support (Correct answer)
- Referring to inpatient detox only if the patient requests it
- Discharging from case management until the patient is 'ready to change'
Correct answer: Using a harm reduction framework with motivational interviewing and connection to peer support
Harm reduction with motivational interviewing is evidence-based and meets patients where they are, improving engagement and outcomes for substance use disorders.
Question 5: A case manager uses the Chronic Care Model (CCM). Which component of this model involves empowering patients to manage their own conditions?
- Community resources linkage
- Self-management support (Correct answer)
- Health system organization
- Clinical information systems
Correct answer: Self-management support
Self-management support is the component of the Chronic Care Model that equips patients with skills, tools, and confidence to manage their own health.
Question 6: Which measure is most directly used to evaluate the effectiveness of a case management program in reducing avoidable hospitalizations?
- Patient satisfaction scores
- 30-day all-cause readmission rate (Correct answer)
- Average length of initial hospital stay
- Number of referrals made per month
Correct answer: 30-day all-cause readmission rate
The 30-day all-cause readmission rate is a primary outcome metric for case management effectiveness in preventing avoidable hospitalizations.
Question 7: A case manager is working with a homeless patient being discharged from the hospital. The MOST immediate priority is:
- Scheduling a follow-up appointment in 3 months
- Securing safe housing or a shelter placement before discharge (Correct answer)
- Providing the patient with printed educational materials
- Initiating a disability application
Correct answer: Securing safe housing or a shelter placement before discharge
Safe housing must be secured before discharge because homelessness directly undermines medication adherence, follow-up, and clinical recovery.
CCM Certified Case Manager (CCM) MCQ 4
A case manager notices a pattern of frequent emergency department visits by a patient with uncontrolled diabetes.
The MOST appropriate intervention is to: