CCM Trivia 4 — Questions and Answers
Question 1: Which transitional care model, developed by Mary Naylor, focuses on preventing hospital readmissions in elderly patients?
- BOOST Model
- Transitional Care Model (TCM) (Correct answer)
- Care Transitions Intervention (CTI)
- INTERACT Model
Correct answer: Transitional Care Model (TCM)
The Transitional Care Model (TCM), developed by Dr. Mary Naylor at the University of Pennsylvania, uses advanced practice nurses to coordinate care transitions for high-risk elderly patients.
Question 2: A case manager notices a client's cultural beliefs conflict with the recommended treatment plan. The BEST first action is to:
- Defer entirely to the physician's recommendation
- Explore the client's beliefs to identify culturally acceptable alternatives (Correct answer)
- Document the conflict and discharge the client
- Refer the client to a psychiatrist for evaluation
Correct answer: Explore the client's beliefs to identify culturally acceptable alternatives
Cultural competence requires the case manager to first understand the client's cultural perspective and then collaborate to find solutions that respect beliefs while meeting medical needs.
Question 3: What does 'subrogation' refer to in the context of workers' compensation or insurance?
- A legal process to deny a claim for lack of medical necessity
- The right of an insurer to recover costs from a liable third party (Correct answer)
- Substituting one service provider for another in a care plan
- Reducing coverage based on pre-existing conditions
Correct answer: The right of an insurer to recover costs from a liable third party
Subrogation allows an insurer that has paid a claim to pursue reimbursement from the party legally responsible for the loss or injury.
Question 4: Under HIPAA, a 'covered entity' includes all of the following EXCEPT:
- Health plans
- Healthcare clearinghouses
- Healthcare providers who transmit PHI electronically
- Employers who only self-administer a health plan internally (Correct answer)
Correct answer: Employers who only self-administer a health plan internally
Employers acting solely in their capacity as employers (not as health plan administrators transmitting PHI electronically) are not HIPAA covered entities.
Question 5: The Case Management Society of America (CMSA) was founded in which year?
- 1985
- 1990 (Correct answer)
- 1995
- 2000
Correct answer: 1990
CMSA was founded in 1990 and serves as the leading professional membership organization for case managers, setting standards of practice.
Question 6: Which type of disability insurance replaces a percentage of income when a worker cannot perform the duties of ANY occupation?
- Own-occupation disability
- Any-occupation disability (Correct answer)
- Partial disability coverage
- Social Security disability
Correct answer: Any-occupation disability
Any-occupation disability policies only pay benefits if the insured cannot perform the duties of any occupation for which they are reasonably suited by education, training, or experience.
Question 7: In a post-acute care setting, which outcome measurement tool is mandated for Medicare-certified home health agencies?
- FIM (Functional Independence Measure)
- OASIS (Outcome and Assessment Information Set) (Correct answer)
- MDS (Minimum Data Set)
- InterRAI HC
Correct answer: OASIS (Outcome and Assessment Information Set)
OASIS is the standardized data collection instrument required for all Medicare-certified home health agencies to measure patient outcomes and determine reimbursement.
CCM Trivia 4
Which transitional care model, developed by Mary Naylor, focuses on preventing hospital readmissions in elderly patients?