CCM General 2 — Questions and Answers
Question 1: Which ethical principle requires a case manager to act in the best interest of the client, even when it conflicts with institutional policies?
- Autonomy
- Beneficence (Correct answer)
- Nonmaleficence
- Fidelity
Correct answer: Beneficence
Beneficence obligates case managers to promote client welfare and act in the client's best interest above all.
Question 2: A case manager is coordinating discharge for a patient with complex needs. Which tool is MOST useful for ensuring all team members share the same care goals?
- Utilization review form
- Interdisciplinary care conference (Correct answer)
- Insurance pre-authorization
- Functional capacity evaluation
Correct answer: Interdisciplinary care conference
An interdisciplinary care conference aligns all team members around shared goals and promotes coordinated discharge planning.
Question 3: Under HIPAA, which of the following is a permitted disclosure of protected health information (PHI) WITHOUT patient authorization?
- Marketing a health product
- Sharing with an employer for hiring decisions
- Treatment coordination among providers (Correct answer)
- Selling data to a research firm
Correct answer: Treatment coordination among providers
HIPAA permits PHI disclosure for treatment, payment, and healthcare operations without explicit patient authorization.
Question 4: A client with a new spinal cord injury is refusing rehabilitation services. The case manager's first action should be to:
- Document the refusal and close the case
- Notify the insurer immediately
- Explore the client's concerns and reasons for refusal (Correct answer)
- Contact family members for consent
Correct answer: Explore the client's concerns and reasons for refusal
Exploring the client's concerns respects autonomy while identifying barriers that may be addressable through education or support.
Question 5: The PRIMARY goal of utilization management in case management is to:
- Reduce the case manager's caseload
- Ensure appropriate use of healthcare resources (Correct answer)
- Increase hospital admission rates
- Eliminate all elective procedures
Correct answer: Ensure appropriate use of healthcare resources
Utilization management ensures clients receive necessary, appropriate, and cost-effective care at the right level of service.
Question 6: Which accreditation body sets standards specifically for case management programs in managed care organizations?
- The Joint Commission (TJC)
- URAC (Correct answer)
- CARF International
- National Committee for Quality Assurance (NCQA)
Correct answer: URAC
URAC (formerly the Utilization Review Accreditation Commission) accredits health utilization management and case management programs.
Question 7: A case manager notices a client's treatment plan has not been updated in six months despite significant functional decline. This situation represents a failure of:
- Beneficence
- Fidelity
- Ongoing monitoring and reassessment (Correct answer)
- Cultural competency
Correct answer: Ongoing monitoring and reassessment
Ongoing monitoring and reassessment is a core case management function that ensures the plan of care remains relevant to the client's current status.
CCM General 2
Which ethical principle requires a case manager to act in the best interest of the client, even when it conflicts with institutional policies?