CCM EXAM CONCEPTS
STUDY QUESTIONS AND
CORRECT ANSWERS
GRADED A+ 2025-2026
Five Ethical Principles - ANS-autonomy, beneficence, nonmaleficence, justice, and
veracity
Autonomy - ANS-Empower.A form of personal liberty of action in which the patient
holds the right and freedom to select and initiate his or her own treatment and course
of action and to take control of his or her health (i.e. fostering the patient's
independence and self-determination.)
Beneficence - ANS-Do good. The obligation and duty to promote good, to further and
support a patient's legitimate interests and decisions, and to actively prevent or
remove harm (i.e. to share with the patient the risks associated with a particular
treatment option.)
Nonmaleficence - ANS-prevent harm or wrongful acts. Refraining from doing harm to
others (i.e. emphasizing quality care outcomes), or if harm is inevitable, insuring that
as little harm occurs as possible
Justice - ANS-Be fair. Maintaining what is right and fair, and making decisions that are
good for the patient; balancing what is just for one's patient, versus what is just for
the larger society
Veracity - ANS-Truthfulness. The act of telling the truth; the truthfulness of one's
behavior. It is the obligation of the case manager to conform, in his/her dealings with
patients and families, to fact or truth, to accuracy and precision.
, Benchmarking - ANS-the comparison of an organization's practices and performance
with the practices and performance of other organizations in order to identify best
practices and standards to improve quality.
Root cause analysis (RCA): - ANS-a method of problem solving which identifies and
addresses the root of a problem or issue so that the problem or issue is not recurrent.
Prospective review: - ANS-review for need for case management prior to start of
services (i.e., preadmission review). 3-5% of cases reviewed prospectively are in need
for case management. A prospective review helps to determine necessity and
estimated length of stay.
Concurrent review: - ANS-review while services are being rendered; reviews the success
or failure of treatments and provides data for reducing length of stay or exploring
alternate care plans. It also documents the required processes for discharge success.
Retrospective review - ANS-reviews case outcomes after the patient's discharge; it
tracks the appropriateness of care and consumption of resources, and allows the case
manager to take away information which will assist with planning future, similar cases.
Risk management - ANS-the "clinical and administrative activities undertaken to
identify, evaluate, and reduce the risk of injury to patients, staff, and visitors and the
risk of loss to the organization itself." (Joint Commission). Risk management can be
proactive (avoiding/preventing risk) or reactive (minimizing loss or damage after an
adverse/bad event).
Case management - ANS-is a collaborative process that assesses, plans, implements,
coordinates, monitors, and evaluates the options and services required to meet the
client's health and human service needs. It is characterized by advocacy,
communication, and resource management and promotes quality and cost-effective
interventions and outcomes.
Managed care - ANS-is a health care system with administrative control over primary
health care services in a medical group practice. The intention is to eliminate
redundant facilities and services and to reduce costs. The term is used to describe
many types of medical care plans including, HMO, PPO, IPA, etc.
STUDY QUESTIONS AND
CORRECT ANSWERS
GRADED A+ 2025-2026
Five Ethical Principles - ANS-autonomy, beneficence, nonmaleficence, justice, and
veracity
Autonomy - ANS-Empower.A form of personal liberty of action in which the patient
holds the right and freedom to select and initiate his or her own treatment and course
of action and to take control of his or her health (i.e. fostering the patient's
independence and self-determination.)
Beneficence - ANS-Do good. The obligation and duty to promote good, to further and
support a patient's legitimate interests and decisions, and to actively prevent or
remove harm (i.e. to share with the patient the risks associated with a particular
treatment option.)
Nonmaleficence - ANS-prevent harm or wrongful acts. Refraining from doing harm to
others (i.e. emphasizing quality care outcomes), or if harm is inevitable, insuring that
as little harm occurs as possible
Justice - ANS-Be fair. Maintaining what is right and fair, and making decisions that are
good for the patient; balancing what is just for one's patient, versus what is just for
the larger society
Veracity - ANS-Truthfulness. The act of telling the truth; the truthfulness of one's
behavior. It is the obligation of the case manager to conform, in his/her dealings with
patients and families, to fact or truth, to accuracy and precision.
, Benchmarking - ANS-the comparison of an organization's practices and performance
with the practices and performance of other organizations in order to identify best
practices and standards to improve quality.
Root cause analysis (RCA): - ANS-a method of problem solving which identifies and
addresses the root of a problem or issue so that the problem or issue is not recurrent.
Prospective review: - ANS-review for need for case management prior to start of
services (i.e., preadmission review). 3-5% of cases reviewed prospectively are in need
for case management. A prospective review helps to determine necessity and
estimated length of stay.
Concurrent review: - ANS-review while services are being rendered; reviews the success
or failure of treatments and provides data for reducing length of stay or exploring
alternate care plans. It also documents the required processes for discharge success.
Retrospective review - ANS-reviews case outcomes after the patient's discharge; it
tracks the appropriateness of care and consumption of resources, and allows the case
manager to take away information which will assist with planning future, similar cases.
Risk management - ANS-the "clinical and administrative activities undertaken to
identify, evaluate, and reduce the risk of injury to patients, staff, and visitors and the
risk of loss to the organization itself." (Joint Commission). Risk management can be
proactive (avoiding/preventing risk) or reactive (minimizing loss or damage after an
adverse/bad event).
Case management - ANS-is a collaborative process that assesses, plans, implements,
coordinates, monitors, and evaluates the options and services required to meet the
client's health and human service needs. It is characterized by advocacy,
communication, and resource management and promotes quality and cost-effective
interventions and outcomes.
Managed care - ANS-is a health care system with administrative control over primary
health care services in a medical group practice. The intention is to eliminate
redundant facilities and services and to reduce costs. The term is used to describe
many types of medical care plans including, HMO, PPO, IPA, etc.
