CCM General 3 — Questions and Answers
Question 1: When performing a comprehensive needs assessment, which domain is MOST critical for a case manager to evaluate in a client newly diagnosed with a chronic illness?
- Insurance premium costs
- Psychosocial and support system factors (Correct answer)
- Hospital billing codes
- Physician's academic credentials
Correct answer: Psychosocial and support system factors
Psychosocial factors including social support, mental health, and coping capacity are central to successful chronic disease management.
Question 2: Which payment model reimburses a fixed amount per patient per month regardless of services utilized?
- Fee-for-service
- Capitation (Correct answer)
- Per diem
- Prospective payment system
Correct answer: Capitation
Capitation pays a fixed monthly amount per enrolled member, incentivizing preventive care and efficient resource use.
Question 3: A case manager identifies that a client's home environment poses fall risks. The BEST next step is to:
- Recommend immediate nursing home placement
- Refer for a home safety evaluation by an occupational therapist (Correct answer)
- Document the finding and wait for the next visit
- Notify the insurer to deny further home care
Correct answer: Refer for a home safety evaluation by an occupational therapist
An occupational therapist home safety evaluation identifies specific hazards and recommends targeted modifications to reduce fall risk.
Question 4: Which concept describes the ability of a healthcare system to provide care that does not vary in quality because of personal characteristics such as gender, ethnicity, or socioeconomic status?
- Health equity (Correct answer)
- Continuity of care
- Evidence-based practice
- Value-based purchasing
Correct answer: Health equity
Health equity means every person has a fair opportunity to attain their highest level of health regardless of social determinants.
Question 5: A Milliman Care Guideline (MCG) is BEST described as:
- A federal regulation governing hospital admissions
- An evidence-based clinical criteria tool used in utilization management (Correct answer)
- A reimbursement schedule set by Medicare
- A state licensure requirement for case managers
Correct answer: An evidence-based clinical criteria tool used in utilization management
MCG guidelines are evidence-based criteria used to determine appropriate level of care and length of stay during utilization review.
Question 6: In motivational interviewing, the technique of 'rolling with resistance' means the case manager should:
- Confront the client directly about their denial
- Avoid arguing and reflect the client's ambivalence back to them (Correct answer)
- Terminate the session when the client is uncooperative
- Escalate to the supervisor immediately
Correct answer: Avoid arguing and reflect the client's ambivalence back to them
Rolling with resistance involves acknowledging the client's perspective without argument, reducing defensiveness and maintaining therapeutic rapport.
Question 7: Which of the following BEST describes a 'catastrophic case' in case management?
- Any case requiring more than three office visits
- A case involving high costs, complex needs, and long-term care requirements (Correct answer)
- A case where the client refuses all services
- A case assigned to a specialist case manager only
Correct answer: A case involving high costs, complex needs, and long-term care requirements
Catastrophic cases involve severe conditions such as traumatic brain injury or spinal cord injury with high resource utilization and long-term complex needs.
CCM General 3
When performing a comprehensive needs assessment, which domain is MOST critical for a case manager to evaluate in a client newly diagnosed with a chronic illness?