CCM Multiple Choice Questions and Answers Updated 2026

CCM Multiple Choice Questions and
Answers Updated 2026
AllMofMtheMfollowingMareMtrueMregardingMcoordinationMofMbenefitsM(COB)Mexcept:

MA)MCOBMpreventsMdoubleMpaymentMforMservicesMwhenMaMsubscriberMhasMhealthMinsu
ranceMcoverageMfromMtwoMorMmoreMsources.

MB)MCOBMisMvoluntary.

MC)MCOBMdeterminesMwhichMinsurerMpaysMfirstMwhenMtheMinsuredMisMcoveredMunderM
moreMthanMoneMhealthMinsuranceMpolicy.

MD)MCOBMcoordinatesMworkers'McompensationMwithMhealthMinsuranceMcoverage.M-
MAnswerMAnswer:MD)MCOBMcoordinatesMworkers'McompensationMwithMhealthMinsuranceM
coverage.



Rationale:MCOBMdoesMnotMcoordinateMbenefitsMwithMworkersMcompensation.MCOBMisMa
MvoluntaryMprogramMthatMpreventsMdoubleMpaymentMforMservicesMwhenMtheMsubscriber
MhasMhealthMinsuranceMfromMmoreMthanMoneMsource.MCOBMhasMrulesMtoMdetermineM
whichMinsurerMpaysMfirst.



UtilizationMmanagementMreviewsMservicesMtoMensureMthat:

A)MeachMlineMitemMonMaMsubmittedMclaimMisManMappropriateMcharge

MB)MtheyMareMmedicallyMnecessary,MprovidedMinMtheMmostMappropriateMcareMsetting,M
andMatMorMaboveMqualityMstandards.

C)MappropriateMdischargeMplanningMisMperformed.

D)MtheyMareMorderedMbyMaMphysician,MprovidedMinMtheMmostMappropriateMcareMsettin
g,MandMexceedMqualityMstandards.M-
MAnswerMAnswer:MB)MtheyMareMmedicallyMnecessary,MprovidedMinMtheMmostMappropriat
eMcareMsetting,MandMatMorMaboveMqualityMstandards.



Resource:MCCMCMGlossaryMofMTerms



Rationale:MUtilizationMManagement:MReviewMofMservicesMtoMensureMthatMtheyMareMmedi
callyMnecessary,MprovidedMinMtheMmostMappropriateMcareMsetting,MandMatMorMaboveMq
ualityMstandards.



TheMcaseMmanagersMroleMwhenMworkingMwithMclientsMwithMsubstanceMabuseMisMto:

A)MMotivateMtheMclientMtoMchange.

, B)MSupportMtheMtreatmentMplanMandMassistMinMfindingMresources.M

C)MCounselMtheMclient.

D)MMonitorMforMsubstanceMuse.M-
MAnswerMAnswer:MB)MSupportMtheMtreatmentMplanMandMassistMinMfindingMresources.



ToMmeetMtheMcriteriaMofMmedicalMnecessityMallMofMtheMfollowingMshouldMbeMpresentM
except:

A)MItMisMreasonable

B)MItMisMbasedMonMevidence-basedMstandardsMofMcare

C)MItMisMappropriate

D)MItMisMcustodialM-MAnswerMAnswer:MD)MItMisMcustodial



TheMAmbulatoryMPaymentMClassificationMSystemM(APC)MisMusedMtoMdetermineMpayment
MratesMforMwhichMoneMofMtheMfollowingMunderMMedicare?

A)MAmbulatoryMsurgery

B)MOutpatientMrehabilitationMandMambulatoryMsurgery

C)MER,Mhospital-basedMclinic,Mobservation,MandMambulatoryMsurgery

D)MPhysicianMofficeMvisitsM-MAnswerMAnswer:MC)MER,Mhospital-
basedMclinic,MobservationMandMambulatoryMsurgery



Rationale:MTheMAmbulatoryMPaymentMClassificationMSystemM(APC)MisMMedicare'sMprospect
iveMpaymentMsystemMforMtheMhospital-
basedMclinic,MER,Mobservation,MandMambulatoryMsurgeryMencounter.



WhichMwouldMbeMmostMappropriateMforMaM48-year-
oldMnurseMwhoMhasMaMbrokenMlegMasMtheMresultMofMaMwork-relatedMinjury?M

A)MWorkMhardening

B)MWorkMadjustment

C)MTransitionalMWorkMDuty

D)MTemporaryMTotalMDisabilityM-MAnswerMAnswer:MC)MTransitionalMWorkMDuty



Rationale:MTransitionalMworkMdutyM(TWD)MallowManMinjuredMemployeeMtoMreturnMtoMw
ork.MTheMemployerMwillMcreateMaMtemporaryMpositionMwhichMconformsMtoMtheMrestricti
onsMputMinMplaceMbyMtheMemployee'sMtreatingMphysician.