CCM General 4 — Questions and Answers
Question 1: Which federal program provides health coverage primarily to individuals aged 65 and older and certain individuals with disabilities?
- Medicaid
- CHIP
- Medicare (Correct answer)
- TRICARE
Correct answer: Medicare
Medicare is a federal health insurance program for people 65 and older and for individuals with certain disabilities or end-stage renal disease.
Question 2: A case manager is working with a client who has limited English proficiency. The MOST appropriate action to ensure informed consent is to:
- Ask the client's adult child to interpret
- Use a qualified medical interpreter (Correct answer)
- Simplify the explanation and proceed without formal interpretation
- Delay the consent until the client learns English
Correct answer: Use a qualified medical interpreter
Using a qualified medical interpreter ensures accurate communication, protects patient rights, and meets legal and ethical standards.
Question 3: Which of the following is an example of a PROCESS measure in case management quality improvement?
- Thirty-day hospital readmission rate
- Percentage of clients who received a follow-up call within 48 hours of discharge (Correct answer)
- Client mortality rate
- Average cost per case
Correct answer: Percentage of clients who received a follow-up call within 48 hours of discharge
Process measures evaluate whether specific care steps were performed, such as timely follow-up calls, rather than the outcomes of care.
Question 4: The Americans with Disabilities Act (ADA) requires employers with 15 or more employees to provide:
- Free health insurance to all disabled workers
- Reasonable accommodations for qualified individuals with disabilities (Correct answer)
- Priority parking for all employees
- Unlimited leave for chronic conditions
Correct answer: Reasonable accommodations for qualified individuals with disabilities
The ADA mandates reasonable accommodations that allow qualified individuals with disabilities to perform the essential functions of their job.
Question 5: A client is being discharged from an acute care hospital to a skilled nursing facility (SNF). Medicare Part A will cover the SNF stay only if the client had a qualifying:
- Emergency room visit of at least 24 hours
- Inpatient hospital stay of at least 3 consecutive days (Correct answer)
- Physician referral from a primary care doctor
- Prior authorization from Medicare
Correct answer: Inpatient hospital stay of at least 3 consecutive days
Medicare Part A SNF coverage requires a prior qualifying inpatient hospital stay of at least three consecutive days, not counting the discharge day.
Question 6: Which case management model focuses on the case manager serving as the primary coordinator who directly provides services rather than brokering them to others?
- Broker model
- Clinical model (Correct answer)
- Strengths-based model
- Collaborative model
Correct answer: Clinical model
The clinical model has the case manager directly delivering hands-on services and interventions rather than solely linking clients to other providers.
Question 7: When setting priorities in a care plan, which client need should a case manager address FIRST?
- Financial planning for long-term care costs
- Immediate safety and life-threatening medical issues (Correct answer)
- Vocational rehabilitation goals
- Social activities and community reintegration
Correct answer: Immediate safety and life-threatening medical issues
Maslow's hierarchy and clinical urgency both direct case managers to address immediate safety and life-threatening needs before higher-order concerns.
CCM General 4
Which federal program provides health coverage primarily to individuals aged 65 and older and certain individuals with disabilities?