Certified Case Manager 2024 Exam Questions and Correct Answers

Ancillary Providers Ans--A subset of care providers including non-physician providers such as rehabilitation, transportation, dialysis, etc. Attending Physician Ans--The physician primarily responsible for the inpatient health care of an individual. AWP Ans--Two definitions: "Average wholesale price" is a calculation used to determine reimbursements for pharmacies. "Any willing provider" are contractors under HMO (Health Maintenance Organization) contracts who meet their provider conditions. Bed Days Ans--The term used to designate length of hospital stays. Bed Days per Thousand Ans--A hospital management calculation which factors beds used and days available per 1,000 members. Bundling Ans--The simultaneous billing or contracting of more than one service Capitation Ans--The practice of providers supplying health services to a group for a fixed and prepaid price. Carve-out Ans--Services that are administered and contracted outside of the primary medical group such as pharmacy, optical, dental, and mental health. Co-insurance Ans--In addition to the monthly premium received by an insurer, the coinsurance is paid by the insured and covers 10-20% of the health care expense