CCMC Cheat Sheet 2026

The 30 highest-yield CCMC facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Under the Americans with Disabilities Act (ADA), what is an employer required to provide to a qualified employee with a disability? → Reasonable accommodation unless it causes undue hardship
2. Which federal law requires health plans to establish an internal and external appeals process for denied claims? → The Affordable Care Act (ACA)
3. Case Management is what type process? → Collaborative
4. Which federal agency enforces workplace safety regulations and standards designed to prevent occupational injuries and illnesses? → Occupational Safety and Health Administration (OSHA)
5. When a payer denies a claim for lack of medical necessity, the case manager's FIRST step should be to: → Review the denial reason and gather supporting clinical documentation
6. In the context of utilization management, 'bundled payment' reimbursement creates an incentive for providers to: → Use resources efficiently and avoid unnecessary services within the episode of care
7. In workers' compensation case management, what is the PRIMARY goal when coordinating care for an injured worker? → Facilitating recovery and safe return to work as early as clinically appropriate
8. Social Security Disability Insurance (SSDI) requires that an applicant's disability must be expected to last at least how long or result in death? → 12 months
9. A case manager identifies that a client qualifies for the Supplemental Nutrition Assistance Program (SNAP). Which federal department administers SNAP? → Department of Agriculture (USDA)
10. What computer-based system is designed for collecting, storing, manipulating, and making clinical information important to the health care delivery process? → Clinical information system
11. The first thing for the case manager to do when a client is not compliant with the plan of care is to: → Discuss barriers to compliance with the member.
12. Which type of rehabilitation service focuses on improving a patient’s ability to perform activities of daily living (ADLs)? → Occupational therapy
13. Concurrent utilization review is performed: → During the course of treatment or hospitalization
14. Which metric is MOST commonly used to evaluate utilization management effectiveness in an inpatient setting? → Average length of stay (ALOS) compared to geometric mean length of stay (GMLOS)
15. Which of the following is an example of underutilization in healthcare? → Failure to provide a clinically recommended preventive screening
16. Retrospective utilization review is MOST useful for: → Identifying patterns of over- or under-utilization after care is delivered
17. What is the primary purpose of utilization management in case management? → To ensure appropriate use of healthcare resources while maintaining quality
18. A 'peer-to-peer review' in utilization management involves: → A treating physician speaking directly with a medical reviewer to discuss a denial
19. Which of the following is a common reimbursement model used in healthcare? → All of the above
20. An elderly client living alone needs transportation to medical appointments. Which community program MOST directly addresses this need at low or no cost? → Medicaid non-emergency medical transportation (NEMT)
21. Which of the following made by a nurse on information technology needs further correction? → "It enables us to disclose information to anybody."
22. Which utilization management strategy is MOST effective at reducing preventable hospital readmissions? → Robust discharge planning with post-acute care coordination and patient education
23. Which community support model pairs a professional case manager with a peer support specialist who has lived experience with the same condition as the client? → Assertive Community Treatment (ACT)
24. Which federal housing program provides vouchers that allow low-income individuals and families to rent privately owned housing? → Section 8 Housing Choice Voucher Program
25. Which case management function involves identifying formal and informal community supports and linking clients to those resources? → Resource identification and referral
26. Which of the following is a primary goal of implementing a case management information system for quality and outcomes evaluation? → To facilitate data collection, analysis, and reporting for performance improvement.
27. Which type of disability benefit replaces a portion of income for employees unable to work due to a non-work-related illness or injury? → Short-term disability (STD) insurance
28. A case manager is helping an uninsured patient access prescription medications at low or no cost. Which resource is MOST appropriate to recommend? → Pharmaceutical manufacturer patient assistance programs
29. Which of the following is a primary goal of rehabilitation in case management? → To restore the patient’s functional independence
30. Which of the following is a key component of a comprehensive rehabilitation plan? → Multidisciplinary team approach