CERTIFIED CASE MANAGER exam questions
with solved solutions
Who is eligible for WIC? - ANSWER>>Women, infants, children
What does WIC provide? - ANSWER>>Vouchers for food, infant cereal, baby
food,veggies, etc
Utilization Review - ANSWER>>Evaluates appropriateness of an admission to a
health care facility or extension of stay; also measures efficiency
What is the CAGE acronym stand for and when is it used? - ANSWER>>Screens for
alcoholism
1. Have you felt the need to CUT down on drinking?
2. Have ppl ANNOYED you by criticizing your drinking?
3. Have you felt GUILTY about drinking?
4. Have you felt the need for a drink in the AM (EYE Opener)
Who does hospice serve? - ANSWER>>Both patient and family
What is the Medicare criteria for hospice and which Part covers it? What will
Medicare NOT cover? - ANSWER>><6 month life expectancy
-Part A
-Not cover treatment to cure illness, room and board
$0 OOP cost for hospice
What is the O2 sat level for Medicare to approve home O2? - ANSWER>>88% or
less to approve home O2 at rest/awake
88% or less x5 min while asleep
custodial care - ANSWER>>Bathing, eating, dressing
,Family typically covers it
SSDI (Social Security Disability Income) - ANSWER>>Means of income for an
individual who are restricted in their ability to work due to a disability (usually
physical); total disability (not short term);available to workers who have
accumulated a sufficient number of work credits
-must be younger than 65
-5 month waiting period
-SSDI is funded by the Social Security taxes paid by workers, employers and self-
employed people
POS (Point of Service) - ANSWER>>Allows individual to choose provider
Higher cost in premiums, deductibles and coinsurance
Primary HIV infection prevention - ANSWER>>reduction of transmission and
acquisition of HIV
secondary HIV infection prevention - ANSWER>>prevent a person with HIV from
becoming ill or dying
What does the Rancho Los Amigos scale measure? - ANSWER>>Assess individuals
after a closed head injury, such as traumatic brain injury (TBI), based on cognitive
and behavioural presentations as they emerge from COMA
I = no response to all stimuli
III = localized response (specific not inconsistent)
V = confused/inappropriate
VIII = purposeful, appropriate, A&O x4
Delerium - ANSWER>>- Disturbance of conciousness; reduced ability to focus,
sustain or shift attention; change in cognition
- Develops over hours or days and fluctuates during the course of the day
,Dementia - ANSWER>>Overall decline in intellectual function, including language
difficulty, simple calculations, planning, judgement, motor skills
privileged communication - ANSWER>>legal term for a right that belongs to a
client
Medicare requirement prior to SNF admission - ANSWER>>3 day hospital stay is
required
Wellness coach per-requisites - ANSWER>>- Can open own business w/minimal
training
- For health care employers: generally a Bachelor's degree is required
Examples of community based programs - ANSWER>>Church grief support, ESL
tutoring, social organizations
mental capacity - ANSWER>>A person's "ability" or "capacity"
Describes a cluster of mental skills people use in their everyday lives
Case management vs Disease Management - ANSWER>>CM = oversees an
individual patient
DM = groups of pts with high cost diagnosis
Demand Management - ANSWER>>Self care CM through patient education to
determine problems and seek treatment when appropriate
Ergonomics - ANSWER>>Study of interaction of people and things; designing and
organizing them for efficient, safe use
Clinical Pathways - ANSWER>>aka Critical paths, care paths, critical pathways
They are plans used to manage patient care through GOALS that define WHAT is
needed and in a timely manner (eg. STEMI care path)
, due diligence - ANSWER>>Effort made by someone to avoid harming himself or
someone else
**What is the main difference between clinical vs ethical committees? -
ANSWER>>Types of experts
Clinical = experts in clinical issues
Organizational= utilization management, code of professional conduct, corporate
compliance
How often should CM send a cost benefit analysis of their case load to their
employer? - ANSWER>>Quarterly
What is Worker's Comp and how is it paid?
If a person accepts Worker's Comp, what can they NOT expect? - ANSWER>>-
Provides coverage or injury or illness at work or that's work related
-premiums are paid by employer
-if worker is covered by and accepts coverage under worker's comp, they may
NOT claim benefits under a group insurance policy or bring suit against employer
for work related injuries
What does OASIS stand for and who receives reimbursement through OASIS? -
ANSWER>>Outcome and Assessment Information Set
Any home health agency MUST use this form to get reimbursement through
Medicare
What is the purpose for pharmacy benefit management (PBM)? - ANSWER>>They
are 3rd party administrators of Rx drug programs. They are responsible for
processing and paying Rx claims and develop formularies. They help contain Rx
cost through generic and lower tier Rx
What is HEDIS? - ANSWER>>Health Plan Employer Data and Info Set
-Performance measurement for managed care
with solved solutions
Who is eligible for WIC? - ANSWER>>Women, infants, children
What does WIC provide? - ANSWER>>Vouchers for food, infant cereal, baby
food,veggies, etc
Utilization Review - ANSWER>>Evaluates appropriateness of an admission to a
health care facility or extension of stay; also measures efficiency
What is the CAGE acronym stand for and when is it used? - ANSWER>>Screens for
alcoholism
1. Have you felt the need to CUT down on drinking?
2. Have ppl ANNOYED you by criticizing your drinking?
3. Have you felt GUILTY about drinking?
4. Have you felt the need for a drink in the AM (EYE Opener)
Who does hospice serve? - ANSWER>>Both patient and family
What is the Medicare criteria for hospice and which Part covers it? What will
Medicare NOT cover? - ANSWER>><6 month life expectancy
-Part A
-Not cover treatment to cure illness, room and board
$0 OOP cost for hospice
What is the O2 sat level for Medicare to approve home O2? - ANSWER>>88% or
less to approve home O2 at rest/awake
88% or less x5 min while asleep
custodial care - ANSWER>>Bathing, eating, dressing
,Family typically covers it
SSDI (Social Security Disability Income) - ANSWER>>Means of income for an
individual who are restricted in their ability to work due to a disability (usually
physical); total disability (not short term);available to workers who have
accumulated a sufficient number of work credits
-must be younger than 65
-5 month waiting period
-SSDI is funded by the Social Security taxes paid by workers, employers and self-
employed people
POS (Point of Service) - ANSWER>>Allows individual to choose provider
Higher cost in premiums, deductibles and coinsurance
Primary HIV infection prevention - ANSWER>>reduction of transmission and
acquisition of HIV
secondary HIV infection prevention - ANSWER>>prevent a person with HIV from
becoming ill or dying
What does the Rancho Los Amigos scale measure? - ANSWER>>Assess individuals
after a closed head injury, such as traumatic brain injury (TBI), based on cognitive
and behavioural presentations as they emerge from COMA
I = no response to all stimuli
III = localized response (specific not inconsistent)
V = confused/inappropriate
VIII = purposeful, appropriate, A&O x4
Delerium - ANSWER>>- Disturbance of conciousness; reduced ability to focus,
sustain or shift attention; change in cognition
- Develops over hours or days and fluctuates during the course of the day
,Dementia - ANSWER>>Overall decline in intellectual function, including language
difficulty, simple calculations, planning, judgement, motor skills
privileged communication - ANSWER>>legal term for a right that belongs to a
client
Medicare requirement prior to SNF admission - ANSWER>>3 day hospital stay is
required
Wellness coach per-requisites - ANSWER>>- Can open own business w/minimal
training
- For health care employers: generally a Bachelor's degree is required
Examples of community based programs - ANSWER>>Church grief support, ESL
tutoring, social organizations
mental capacity - ANSWER>>A person's "ability" or "capacity"
Describes a cluster of mental skills people use in their everyday lives
Case management vs Disease Management - ANSWER>>CM = oversees an
individual patient
DM = groups of pts with high cost diagnosis
Demand Management - ANSWER>>Self care CM through patient education to
determine problems and seek treatment when appropriate
Ergonomics - ANSWER>>Study of interaction of people and things; designing and
organizing them for efficient, safe use
Clinical Pathways - ANSWER>>aka Critical paths, care paths, critical pathways
They are plans used to manage patient care through GOALS that define WHAT is
needed and in a timely manner (eg. STEMI care path)
, due diligence - ANSWER>>Effort made by someone to avoid harming himself or
someone else
**What is the main difference between clinical vs ethical committees? -
ANSWER>>Types of experts
Clinical = experts in clinical issues
Organizational= utilization management, code of professional conduct, corporate
compliance
How often should CM send a cost benefit analysis of their case load to their
employer? - ANSWER>>Quarterly
What is Worker's Comp and how is it paid?
If a person accepts Worker's Comp, what can they NOT expect? - ANSWER>>-
Provides coverage or injury or illness at work or that's work related
-premiums are paid by employer
-if worker is covered by and accepts coverage under worker's comp, they may
NOT claim benefits under a group insurance policy or bring suit against employer
for work related injuries
What does OASIS stand for and who receives reimbursement through OASIS? -
ANSWER>>Outcome and Assessment Information Set
Any home health agency MUST use this form to get reimbursement through
Medicare
What is the purpose for pharmacy benefit management (PBM)? - ANSWER>>They
are 3rd party administrators of Rx drug programs. They are responsible for
processing and paying Rx claims and develop formularies. They help contain Rx
cost through generic and lower tier Rx
What is HEDIS? - ANSWER>>Health Plan Employer Data and Info Set
-Performance measurement for managed care
