CCM CERTIFICATION WITH COMPLETE
SOLUTIONS 100% 2023/2024
continuing care retirement communities
provide the aging population with a plethora of services, from independent-living facilities to assisted-
living facilities to skilled-nursing facilities (often all on the same campus). This structure allows
residents to transition between facilities or move to a different tier as their health declines.
assisted-living facilities (ALFs)
are a form of long-term care that is available to seniors, also known as an alternative level of care.
This enables seniors to remain independent, providing services only as they are needed. It is a level of
care that bridges the gap between residing in one's own home and living in a nursing facility. They are
favorable because they are less expensive than nursing homes.
room, board, and amenities in ALFs
In some states these may be covered by a Medical Waiver program. For most individuals, they are not
covered, funded, or regulate by Medicare of Medicaid.
Who predominantly operate ALFs?
for-profit companies
What is the cost to reside in a assisted living facility?
It is related to the amount of care needed by the individual. In 2015, the median annual cost to rent a
one-bedroom apartment in an assisted-living facility was estimated at $43,200.
In ALFs what do case managers serve as?
a liaison between the facility staff, the patient, and the family throughout the patient's residency,
whether it is a short-term or long-term stay
What are ALFs used for?
Not only as a permanent solution for aging adults as their functional dependence increases, but they
also serve as a resource for temporary respite care. This can be beneficial for caregivers who still have
full-time jobs or are planning to take a vacation.
What are the types of ALFs?
- group homes
- adult foster care
- residential treatment facilities
group homes
Come in the form of single-room residences, board and care homes, apartments, or even domiciliary
care. These for-profit businesses are available for children (19 or younger) or adults. In some
instances, group homes are licensed by states, offering individuals an alternative living environment.
This may also be set up for a variety of purpose, such as to care for people with disabilities, those who
suffer from chronic mental illness, or elderly dementia patients.
staffing at group homes
,Varies depending on the type of home. While some are staffed twenty-four hours per day, others may
have "house parents" on the premises who actually take on a parenting role
adult foster care
Offers support for the activities of daily life and provide room and board. Managed by sponsoring
families or paid caregivers living onsite, they give aging residents the opportunity to live in an
environment that mimics a home-based setting. In some states, they can be used as an alternative to
long-term care or institutionalized living.
resident treatment facilities
Provide access to fully integrated, long-term, intensive treatment for individuals suffering from
mental illness, substance abuse, or other behavioral-health issues. This structured environment not
only gives patients access to qualified staff but also to peers who can help effectively support ongoing
treatment. Individuals who require such assistance may reside in a facility for up to one year. These
facilities provide participants with access to services that are more intensive than is commonly
provided in an outpatient setting.
case managers in residential settings
Serve as an advocate when the patient is unable to advocate for themselves. They support activities
such as care coordination between various members of the interdisciplinary team and activities
associated with discharge planning, so that the patient is able to make a safe transition back into the
community and into outpatient services. Even after discharge, the case manager will need to maintain
ongoing contact with the member and/or family.
What is the case-management process and tools?
- assessment
- planning
- implementation
- coordination
- monitoring
- evaluation
- outcomes
case closure
Once it has been determined that the patient has achieved his/her best level of function, the case
manager will make the decision to close the case.
What are some of the additional factors that must be considered for case closure?
- risk for readmission
- services in place or sufficiently deliverer to meet the needs of the patient
- the patient's ability to adequately administer self-care
- the patient's ability to adhere to care
- the patient's support system
- the patient's action plan inn place for an urgent or emergent even
- the patient's demonstrated understanding of how to seek healthcare support through the
appropriate channels
On occasion, when can case managers close cases?
- the patient dies
- benefits or eligibility for services are terminated
, - the patient or caregiver declines case-management services
- services are no longer available
diagnosis-related groups
Are used to categorize patients based on their diagnoses, types of treatment (including surgical
procedures) and the presence or absence of comorbidities or complications. Clinicians and
organizations such as hospitals and managed care organizations use them to help with determining
what constitutes an acceptable duration or length of stay based on their diagnosis. Hospitals stays are
also assigned one.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Functions as the standard system of classification of mental disorders. Compromising three major
components - the diagnostic, classification, the diagnostic criteria sets, and the descriptive text - it is
used by mental-health professionals and other healthcare professionals, including case managers, to
classify mental illness. It contains diagnoses that include a diagnostic code typically used by individual
providers, institutions, and agencies for data-collection and billing purposes.
international classification of disease (ICD)
Under the tenth revision of this, codes are assigned to help classify individuals into manageable
categories that have clinical meaning. It is a standard diagnostic tool that is leveraged to track
epidemiology, support health management, and guide clinical activities. Healthcare professionals and
organizations alike find it to be beneficial as it allows for the ability to closely track both the incidence
and prevalence of diseases, along with other health problems that may impact various populations.
Where is the ICD-10 used?
More than a hundred countries and operated as a means for identifying health trends and statistics all
over the world, and it allows for countries to compare and exchange health information using a
common language.
What does the ICD-10 allow?
for providers to gain a deeper level of detail about a patient's condition. It is updated periodically to
reflect advanced in health and medical science. The 11th revision will be finalized and/or released in
2018.
current procedural terminology
Commonly referred to as CPT, is a medical code that is utilized along with ICD numerical diagnostic
coding as a component of the billing process. These codes are used to identify medical, surgical, and
diagnostic procedures and services for entities such as physicians, health-insurance companies, and
accreditation organizations.
case managers in cost containment
they act as advocates to get the best treatment for their patients, and must also find the treatment
option that is most financially feasible for the patient and, in some instances, the insurance
organization
cost containment
is an effort to ensure that the medical coverage provided through insurance is a comprehensive yet
inexpensive as possible
SOLUTIONS 100% 2023/2024
continuing care retirement communities
provide the aging population with a plethora of services, from independent-living facilities to assisted-
living facilities to skilled-nursing facilities (often all on the same campus). This structure allows
residents to transition between facilities or move to a different tier as their health declines.
assisted-living facilities (ALFs)
are a form of long-term care that is available to seniors, also known as an alternative level of care.
This enables seniors to remain independent, providing services only as they are needed. It is a level of
care that bridges the gap between residing in one's own home and living in a nursing facility. They are
favorable because they are less expensive than nursing homes.
room, board, and amenities in ALFs
In some states these may be covered by a Medical Waiver program. For most individuals, they are not
covered, funded, or regulate by Medicare of Medicaid.
Who predominantly operate ALFs?
for-profit companies
What is the cost to reside in a assisted living facility?
It is related to the amount of care needed by the individual. In 2015, the median annual cost to rent a
one-bedroom apartment in an assisted-living facility was estimated at $43,200.
In ALFs what do case managers serve as?
a liaison between the facility staff, the patient, and the family throughout the patient's residency,
whether it is a short-term or long-term stay
What are ALFs used for?
Not only as a permanent solution for aging adults as their functional dependence increases, but they
also serve as a resource for temporary respite care. This can be beneficial for caregivers who still have
full-time jobs or are planning to take a vacation.
What are the types of ALFs?
- group homes
- adult foster care
- residential treatment facilities
group homes
Come in the form of single-room residences, board and care homes, apartments, or even domiciliary
care. These for-profit businesses are available for children (19 or younger) or adults. In some
instances, group homes are licensed by states, offering individuals an alternative living environment.
This may also be set up for a variety of purpose, such as to care for people with disabilities, those who
suffer from chronic mental illness, or elderly dementia patients.
staffing at group homes
,Varies depending on the type of home. While some are staffed twenty-four hours per day, others may
have "house parents" on the premises who actually take on a parenting role
adult foster care
Offers support for the activities of daily life and provide room and board. Managed by sponsoring
families or paid caregivers living onsite, they give aging residents the opportunity to live in an
environment that mimics a home-based setting. In some states, they can be used as an alternative to
long-term care or institutionalized living.
resident treatment facilities
Provide access to fully integrated, long-term, intensive treatment for individuals suffering from
mental illness, substance abuse, or other behavioral-health issues. This structured environment not
only gives patients access to qualified staff but also to peers who can help effectively support ongoing
treatment. Individuals who require such assistance may reside in a facility for up to one year. These
facilities provide participants with access to services that are more intensive than is commonly
provided in an outpatient setting.
case managers in residential settings
Serve as an advocate when the patient is unable to advocate for themselves. They support activities
such as care coordination between various members of the interdisciplinary team and activities
associated with discharge planning, so that the patient is able to make a safe transition back into the
community and into outpatient services. Even after discharge, the case manager will need to maintain
ongoing contact with the member and/or family.
What is the case-management process and tools?
- assessment
- planning
- implementation
- coordination
- monitoring
- evaluation
- outcomes
case closure
Once it has been determined that the patient has achieved his/her best level of function, the case
manager will make the decision to close the case.
What are some of the additional factors that must be considered for case closure?
- risk for readmission
- services in place or sufficiently deliverer to meet the needs of the patient
- the patient's ability to adequately administer self-care
- the patient's ability to adhere to care
- the patient's support system
- the patient's action plan inn place for an urgent or emergent even
- the patient's demonstrated understanding of how to seek healthcare support through the
appropriate channels
On occasion, when can case managers close cases?
- the patient dies
- benefits or eligibility for services are terminated
, - the patient or caregiver declines case-management services
- services are no longer available
diagnosis-related groups
Are used to categorize patients based on their diagnoses, types of treatment (including surgical
procedures) and the presence or absence of comorbidities or complications. Clinicians and
organizations such as hospitals and managed care organizations use them to help with determining
what constitutes an acceptable duration or length of stay based on their diagnosis. Hospitals stays are
also assigned one.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Functions as the standard system of classification of mental disorders. Compromising three major
components - the diagnostic, classification, the diagnostic criteria sets, and the descriptive text - it is
used by mental-health professionals and other healthcare professionals, including case managers, to
classify mental illness. It contains diagnoses that include a diagnostic code typically used by individual
providers, institutions, and agencies for data-collection and billing purposes.
international classification of disease (ICD)
Under the tenth revision of this, codes are assigned to help classify individuals into manageable
categories that have clinical meaning. It is a standard diagnostic tool that is leveraged to track
epidemiology, support health management, and guide clinical activities. Healthcare professionals and
organizations alike find it to be beneficial as it allows for the ability to closely track both the incidence
and prevalence of diseases, along with other health problems that may impact various populations.
Where is the ICD-10 used?
More than a hundred countries and operated as a means for identifying health trends and statistics all
over the world, and it allows for countries to compare and exchange health information using a
common language.
What does the ICD-10 allow?
for providers to gain a deeper level of detail about a patient's condition. It is updated periodically to
reflect advanced in health and medical science. The 11th revision will be finalized and/or released in
2018.
current procedural terminology
Commonly referred to as CPT, is a medical code that is utilized along with ICD numerical diagnostic
coding as a component of the billing process. These codes are used to identify medical, surgical, and
diagnostic procedures and services for entities such as physicians, health-insurance companies, and
accreditation organizations.
case managers in cost containment
they act as advocates to get the best treatment for their patients, and must also find the treatment
option that is most financially feasible for the patient and, in some instances, the insurance
organization
cost containment
is an effort to ensure that the medical coverage provided through insurance is a comprehensive yet
inexpensive as possible
