Practice Questions

Question 1

Disability case managers are most often employed by:
A. the Social Security Administration
B. workers compensation insurers
C. skilled nursing facilities
D. assisted living facilities

Answer 1

B. Disability case managers manage occupational diseases to return disabled employees to productive employment

Question 2

The federal agency charged with improving the safety and quality of the United States health care system is:
A. Institute of Medicine (IOM)
B. Health and Human services (HHS)
C. The Joint Commission
D. the Agency for health care and research quality (AHRQ)

Answer 2

D. AHRQ is charged with this mission. It is an agency within HHS.

Question 3

Colorectal cancer screening is recommended for:
A. women of average risk at 45
B. men and women of average risk at 45
C. men and women of average risk at 55
D. men and women of average risk at 65

Answer 3

B. Men and women of average risk are recommended for colorectal screening beginning at 45.

Question 4

Case recording and good documentation are not meant to:
A. justify expenses
B. defend the CCM against negligence
C. assist the family and friends in knowing the activities the client
D. validate interventions

Answer 4

C. Although good documentation may serve to guide the family in decision making, the client may not want family or friends to know their activities due to privacy matters.

Question 5

The functional independence measure (FIM) is a tool used by healthcare professionals. If the patient had a score of 7 on a scale, the evaluator would document that the patient:
A. Needed no assistance and was completely independent.
B. Needed minimal assistance with activities of daily living.
C. Needed total assistance with most activities.
D. Needed assistance with ambulation.

Answer 5

A. The FIM assesses levels of disability. This tool is composed of eighteen items and seven scales. A 7 on the scale indicates total independence, and a 1 is total assistance with care needs.

Question 6

Part D of Medicare is also known as the:
A. Medicare supplement plan.
B. Medicare Hospital and long term care coverage.
C. Medicare Prescription drug plan.
D. Medicare prescription drug advantage.

Answer 6

C. Part D is the Medicare Prescription Drug Plan.

Question 7

The CM has a hospitalized patient who practices Hinduism and is refusing a common medical intervention. The CCM realizes this refusal may be related to any of the following Hindu beliefs except:
A. A period suffering being caused by a past life experience.
B. Being prohibited from using Western medicine.
C. The experience of pain promoting spiritual growth.
D. The need for proper food prior to the treatment.

Answer 7

B. While many practitioners of Hinduism use Ayurveda - Traditional Indian beliefs and methods of medicine - Hinduism does not necessarily prohibit the application of Western Medicine.

Question 8

Your new client at a Community Health Center has uncontrolled type 1 diabetes and neuropathy. He states that he can’t get “disability” because he never has worked. You know, he may be able to get SSI benefits because:
A. He is over age 50, so he qualifies for SSI.
B. His parents worked, so he can collect on their benefits.
C. SSI is for disabled people who may have never worked.
D. SSI is administered by the state and covers disabled people.

Answer 8

C. SSI is for low-income people who qualify by disability, even if they have never worked.

Question 9

Understanding the family dynamics when accepting a new patient is critical. In analyzing family dynamics, the CCM should seek to understand all of the following except:
A. Knowing the patient’s role in the family dynamics.
B. Knowing which family member is the main caregiver.
C. Modifications of family responsibilities due to the diagnosis.
D. Disease management services.

Answer 9

D. Disease management is not part of family dynamics.

Question 10

When determining the patient’s role in family dynamics, the CCM should consider all of the following information except:
A. What type of career did the patient have, and were they the primary breadwinner?
B. Did the patient ever care for anyone in the family?
C. What medications does the patient take?
D. Did the patient marry and have children?

Answer 10

C. Medications are an important factor when determining a health history, not a patient’s role in their family.

Question 11

To meet SSI income requirements, you can only have ____ in assets as an individual.
A. $1,500
B. $2,000
C. $2,500
D. $3,000

Answer 11

B. An individual must have no more than $2,000 in assets to qualify for SSI, which is needs based.
(Please note this monetary figure is based on a study guide published in 2020).

Question 12

As a case management director at a large urban Community Health Center, you are asked to prepare a presentation summarizing disparities in health care for the vulnerable populations that you serve. One data service. That you utilize to obtain information is the:
A. ORYX report.
B. CMS patient quality and disparities index.
C. National healthcare quality and disparities report.
D. CMS health and safety report.

Answer 12

C. The National healthcare quality and disparities report is the best source for this information.

Question 13

The vaccine that is not recommended for people born before 1957 is the:
A. Herpes zoster.
B. Influenza (flu shot).
C. Pneumococcal (pneumonia).
D. Measles, mumps, and rubella (MMR).

Answer 13

D. The MMR vaccine is not recommended for people born before 1957.

Question 14

Which of the following health care providers can prescribe medication?
A. Psychologists
B. Nurse Practitioners
C. Registered Nurses
D. Licensed Professional Counselors

Answer 14

B. A nurse practitioner can prescribe medication. Psychologists, registered nurses, and licensed professional counselors cannot.

Question 15

The four components of communication do not include:
A. The message.
B. The sender.
C. The format.
D. The context.

Answer 15

C. The format is not one of the four components of communication.
The four components include: Sender, Receiver, Message, and Context.

Question 16

The CCM has different Spiritual beliefs and their patient. An effective intervention for the patient would be to:
A. Keep the CCM’s beliefs separate from their patient care duties and ensure that the patient’s beliefs are the only ones to impact their medical care.
B. Encourage more pastoral visits for the patient.
C. Provide the patient with education on the CCM’s spiritual beliefs.
D. Encourage more physician visits.

Answer 16

A. The patient’s spiritual beliefs are the only beliefs with any bearing on their health care needs or the interaction between the CCM and the patient.

Question 17

An example of inappropriate documentation is:
A. The patient ate 100% of their meal at 8:00am.
B. The patient’s outfit is not attractive: therefore, the patient didn’t attend the outing.
C. The patient did not attend the outing due to reported feelings of depression.
D. The patient stated, “I feel depressed and do not want to go to the outing.”

Answer 17

B. This statement sounds biased and may be the opinion of the recorder. Quotation marks are appropriate when documenting facts.

Question 18

The functional independence measure (FIM) is a tool that evaluates tasks to determine level of disability. This measure does not evaluate:
A. How the patient transfers.
B. How the patient communicates.
C. The social cognition of the patient.
D. How well the patient sleeps.

Answer 18

D. Sleeping is measured by a sleep study, not the FIM.

Question 19

Social Security disability insurance (SSDI) is funded by:
A. The US Treasury Department.
B. A private disability reinsurer.
C. Employers.
D. Taxpayers.

Answer 19

D. SSDI is funded by payroll taxes.

Question 20

A workers’ compensation case manager is charged with creating a “physician report card” that will measure physician performance. One valuable one variable of this report card should be:
A. The number of clients who obtain Social Security Disability Insurance.
B. Aggregate days of disability of all clients treated.
C. The usability of narrative reports.
D. Mean days of disability per diagnosis.

Answer 20

D. The average days of disability per diagnosis would compare “apples to apples,” rather than “apples to oranges” (i.e., comparing days out of work due to carpal tunnel surgery to days out due to total knee arthroplasty).

Question 21

According to the American Cancer Society, women should have a mammogram:
A. every other year after 40.
B. Every year after 40.
C. Every year between 45 and 54.
D. Every year after fifty.

Answer 21

C. Women should have a mammogram every year between 45 and 54.

Question 22

Which statement about documentation is incorrect?
A. Documentation with the family must be included.
B. Communication with the insurer must not be included.
C. Documentation should be done shortly after the encounter, if possible.
D. Rationale to modify the care plan should be documented.

Answer 22

B. Communication with the insurer must be included when the CCM is completing documentation.

Question 23

Interpersonal communication is paramount for the CCM. Interpersonal communication does not include
A. Active listening.
B. Nodding.
C. Formulating necessary changes.
D. Taking notes.

Answer 23

C. Although the patient may need to make some changes in order to be healthier, this is not component of interpersonal communication.

Question 24

A family member of the patient calls the CCM to report a concern, but the CCM cannot hear them due to the construction noise in the background. The construction noise is an example of this communication barrier:
A. Physiological noise.
B. Structural barrier.
C. Physical interference.
D. Perceptual barrier.

Answer 24

C. Background noise is an example of physical interference in interpersonal communication.

Question 25

All of the following statements about inpatient rehabilitation facility, dash patient assessment instrument (IRF-PAI) are true except:
A. It is used for Medicare Part C patients.
B. It is used for Medicare Part, a fee-for-service patients.
C. It is used to determine payment.
D. It is used solely for Medicaid patients.

Answer 25

D. The IRF-PAI is not solely for Medicaid patients.

Question 26

Social Security Disability Insurance (SSDI) is for people who have sufficient work quarters and:
A. Have a disability that prevents basic, substantially gainful work activities for at least one year.
B. Have a disability and are over age 50 and can no longer work.
C. Have a disability that is on the SSDI listing of impairments.
D. Having disability that prevents basic, substantially gainful work activities for at least three years.

Answer 26

A. The disability must prevent basic work activities or limit earnings to a very low amount established by the SSA, and the disability must be expected to last for at least one year.

Question 27

A non-disabled person qualifies for Medicare at age:
A. 67.
B. 66.
C. 65.
D. 64.

Answer 27

C. Non-disabled people qualify for Medicare at age 65, as long as they have worked enough quarters under Social Security.

Question 28

Health risks and outcomes for clients can be evaluated by using:
A. A health assessment screening tool.
B. A scan of past medical records.
C. Evidence based guidelines.
D. Local hospital data.

Answer 28

A. A health assessment screening tool can evaluate risks and outcomes and can be descriptive, predictive, or evaluative.

Question 29

The Wellness goal that is CCM does not discuss with a patient unless recommended by a physician is:
A. A routine foot exam for patients with diabetes.
B. An annual flu vaccine.
C. An annual audiology exam.
D. An Annual Medicare Wellness exam.

Answer 29

C. Annual audiology exams are not typically discussed unless requested by the patient’s physician.

Question 30

A CCM observes a caregiver verbally abusing their patient. An inappropriate intervention by the CCM would be to:
A. Determine the reason the caregiver gets upset and help find appropriate support.
B. Report the abuse to Elder Protective Services.
C. Call the police if immediate danger is suspected.
D. Ensure the safety of the patient and tell the caregiver that their anger is justified.

Answer 30

D. Although ensuring the safety of the patient is important, telling the caregiver their actions are justified leads to continuation of inappropriate behavior.

Question 31

Medicare Part B provides coverage for:
A. Occupational therapy.
B. Outpatient hospital care.
C. At home Hospice care.
D. Prescription drugs.

Answer 31

B. Medicare Part B provides coverage for outpatient services such as doctor’s visits, screenings, and ambulance services.

Question 32

A patient of East Indian origin. Who is over 65 may receive _____ while hospitalized.
A. Personal attention from nurses.
B. Pastoral visits.
C. Family involvement in health care decisions
D. Privacy and confidentiality.

Answer 32

C. Family involvement in health care decisions is often very important to patients of East Indian origin who are over 65. The CCM should always ask permission from the patient before discussing protected health information (PHI) with anyone, regardless of cultural traditions.

Question 33

The CCM works in a hospital setting. Potential documentation for a patient may include all of the following except:
A. Informed consent.
B. Discharge planning.
C. Advance directives.
D. Outcome of physical therapy completion.

Answer 33

D. Physical therapy would be documented by the physical therapist, not the CCM.

Question 34

And own-occupation policy is not:
A. A type of disability insurance.
B. The strictest type of disability policy.
C. The most lenient type of disability policy
D. A high-cost policy.

Answer 34

B. Own-occupation disability policies are more lenient and expensive than some other policies. Disability may be claimed as long as duties cannot be performed while doing the most recent job.

Question 35

A person who has been deemed eligible for SSDI will receive Medicare benefits:
A. Immediately.
B. After one year.
C. After two years.
D. After three months.

Answer 35

C. SSDI recipients must wait 2 years to receive Medicare. Generally, they receive Medicaid benefits in the interim.

Question 36

Compared with urban residents, rural residents are:
A. Healthier and weigh less.
B. Poorer, older, and sicker.
C. More prone to diabetes.
D. Happier and more self-directed.

Answer 36

B. The Agency for Healthcare Research and Quality has identified that rural inhabitants are generally older, poorer, sicker, and more likely to be overweight.

Question 37

The CCM has a new patient whose cultural practices conflict with his physician’s treatment recommendations. The CCM realizes these practices may cause a health risk. To the patient. After the patient is educated by the CCM, the final decision on the appropriate treatment plan will be made by:
A. the physician
B. the patient
C. the CCM
D. the family

Answer 37

B. The patient makes the final decision regarding the recommended treatment plan.

Question 38

The patient should expect that their treatment conforms to:
A. standards of Care
B. standards of Practice
C. clinical pathway
D. practice guidelines

Answer 38

A. Standards of care are statements that define care in the medical community. The patient will be aware of the outcome expected and of care to be received based on scientific knowledge and clinical expertise.

Question 39

When coordinating a transition of a client to another care provider, the case manager should always be aware that:
A. The client may not accept the transition.
B. The client is at increased risk for an adverse outcome.
C. The client is now the responsibility of the receiving provider.
D. The clients family must agree to the transition plan.

Answer 39

B. The case manager must be aware of the risk of transitioning care (i.e., medication errors or failure to follow through on a recommended treatment plan).

Question 40

The state-federal program that provides health insurance for children is known as:
A. CIP.
B. CMMS.
C. NCLB.
D. CHIP.

Answer 40

D. CHIP is the Children’s Health insurance program.

Question 41

A measure of a transition of care might include:
A. Hospitalized COPD patients who were provided with complete discharge instructions.
B. Patients who were discharged on time.
C. Supplies that were given to indigent patients.
D. Hospitalized diabetic patients who were satisfied with hospital services.

Answer 41

A. This measure is clearly quantifiable and specific as it focuses on a targeted population. (Discharged COPD patients).

Question 42

A provider being paid a capitated rate:
A. Receives a predetermined global fee annually for participation in a plan.
B. Is always a provider in a managed care organization MCO.
C. Receives a fee that is determined by CMS.
D. Receives a predetermined fee for each patient in a plan.

Answer 42

D. A capitated rate is calculated “per head,” or per patient.

Question 43

A CCM disagrees with their patient’s cultural beliefs regarding health care choices. It is the CCM’s responsibility to:
A. Educate the patient regarding their health needs and support the patient’s beliefs, even if the CM disagrees.
B. Educate and persuade the patient to comply with the correct intervention.
C. Have a conference with the IDT and explore ways to persuade the patient to make the correct decision.
D. Educate the family about the correct decision and see if they can persuade the patient.

Answer 43

A. the CCM must educate and support the patient’s cultural beliefs.

Question 44

The set of principles that states what is expected of a provider are:
A. Standards of care.
B. Standards of practice.
C. Clinical pathway.
D. Practice guidelines.

Answer 44

B. Standards of practice are statements that describe the acceptable level of provider performance based on clinical research and are typically formulated by practitioner organizations.

Question 45

A long term disability policy that strictly defines disability and is less expensive than some other policies as known as:
A. Own-occupation
B. Any-occupation.
C. Only-occupation.
D. Long-term occupation

Answer 45

B. With an any-occupation long-term disability policy, the premiums are less expensive because the patient must not be able to perform any work tasks to qualify for claims.

Question 46

Since the advent of the opioid crisis, many states have operationalized:
A. Mandatory jail terms for abusive prescribers.
B. Prescription drug monitoring programs.
C. 48 hour holds on narcotic medications.
D. Limitations on narcotic medication refills.

Answer 46

B. As of July 2018, 49 states have prescription drug monitoring programs (PDMP).

Question 47

Off label medication is:
A. Made by a non-us pharmaceutical company and is not FDA approved.
B. Purchased by illegal means.
C. Prescribed for someone else.
D. Prescribed for a purpose not specified by the FDA.

Answer 47

D. Off label medication is medication that is being prescribed for a use not defined in the FDA insert.

Question 48

A significant contributor to rising health care costs is:
A. Higher charges by specialists.
B. Sicker patients.
C. Readmissions.
D. Medicare fraud

Answer 48

C. Readmissions of recently discharged patients are major cost drivers of health care costs. Per the AHQR.

Question 49

The CM’s new patient is a practicing Jehovah’s Witness. The CCM understands that an important component of this religion that may affect the patient’s medical decision is the belief that:
A. Mental illness does not require medication.
B. Preventive medical treatment is not important.
C. Blood transfusions are not allowed.
D. Medications are stopped once the symptoms of illness have ceased.

Answer 49

C. According to the teachings of Jehovah’s Witnesses, the Bible prohibits blood transfusions.

Question 50

Standards of care are not:
A. Strict and meant to be followed.
B. Designed to be flexible.
C. Medically necessary.
D. Based on current outcomes data.

Answer 50

B. Standards of care are strict criteria designed for the management of a clinical condition and are not flexible.

Question 51

Trust is built with the patient through:
A. Canceling and rescheduling appointments.
B. Speaking over the patient to demonstrate knowledge.
C. Doing what you say you will do.
D. Doing what the patient wants.

Answer 51

C. Doing what you say you will do builds trust with the patient.

Question 52

The CCM is interviewing a new patient who frequently deviates from the questions. A good way for the CCM to redirect the interview is to:
A. Use guided questions.
B. Speak more quickly.
C. Omit less important assessment questions.
D. Inform the patient that only pertinent information is needed.

Answer 52

A. Guided questions to help redirect the interview or to obtain more specific information.

Question 53

What is not true of home health rehabilitation?
A. The patient should not leave home, except for medical or short non-medical trips.
B. Visits are typically four to five times per week.
C. Physical therapy is provided in the patient’s home for an hour per session.
D. The patient no longer needs hospitalization but does need intensive therapy.

Answer 53

B. Home health rehabilitation visits are typically two to three times per week.

Question 54

An effective way for the CCM to close the interview would be to:
A. request to meet with the family.
B. Request a face to face visit.
C. Explain the care plan.
D. Ask to call the primary care physician.

Answer 54

C. Explaining the care plan and providing a summary are effective ways for the CCM to close the interview.

Question 55

A CCM’s new patient has recently been diagnosed with insulin dependent diabetes. The factor that will help the family adapt to the diagnosis is:
A. Denying the condition of the patient.
B. Relying on one family member for all duties.
C. Researching and accepting help.
D. Focusing on the patient and not the other family members.

Answer 55

C. The adaptation will be more successful if help is accepted.

Question 56

An example of soft savings in a case management practice would be:
A. A negotiated lower rate for DME.
B. Hiring a medical assistant to provide case management.
C. Precertification.
D. Avoid emergency department (ED) visits.

Answer 56

D. The potential savings by avoiding a probable ED visit is a soft savings.

Question 57

The program that provides block grants to states to provide financial assistance and support to families is the:
A. Transitional Assistance to New Families.
B. Social Security Administration.
C. Temporary Assistance for Needy Families.
D. US Public Welfare Division.

Answer 57

C. Temporary Assistance for Needy Families, administered by US Health and Human Services, provides funding to help support low-income families.

Question 58

A CCM is working in a hospital with a patient who is Jewish. The CCM understands that part of this religion may include:
A. Following certain dietary guidelines.
B. Limiting physical activity on certain days of the week.
C. Avoiding eye contact and interpersonal interactions.
D. Believing illness is caused by a disturbance in chi (energy).

Answer 58

A. Many people who practice Judaism follow a kosher diet. The CCM should discuss the patient’s dietary needs with him or her and arrange for a kosher diet if necessary.

Question 59

Practice guidelines are not:
A. Strict and meant to be followed.
B. Designed to be flexible.
C. Clinical recommendations.
D. Meant to replace the provider judgements

Answer 59

A. Practice guidelines are recommendations for screenings, diagnostics, and actions to improve the health of a patient.

Question 60

There are many barriers to effective communication. Barriers referred to as prejudice of the listener include:
A. Barrier to processing information.
B. Perceptual filters.
C. Physical interference.
D. Semantic noise.

Answer 60

B. Perceptual filters describe prejudices of the listener that have been established through their unique experiences, culture, and values.

Question 61

A medical home is a philosophy and model of primary care, that is:
A. Patient centered.
B. Hospital affiliated.
C. A telehealth system.
D. Part of a preferred provider network.

Answer 61

A. The medical home is a partnership between primary care doctors and patients and their families that respects the patient’s needs and preferences.

Question 62

Susan works for a large healthcare insurance company as a case manager. She works with network physicians to provide optimal quality care for the plan members. This type of case management is also known as:
A. Payer based case management.
B. Third party case management.
C. Workers compensation case management.
D. Primary care case management.

Answer 62

A. Health insurance based case management is called payer based case management.

Question 63

A cultural group whose beliefs include faith that certain foods may help heal illnesses is:
A. Followers of Judaism.
B. practitioners of traditional Chinese medicine.
C. Practicing Jehovah’s Witnesses.
D. Christian scientists.

Answer 63

B. Followers of Judaism, Jehovah’s Witness and Christian scientists may have dietary restrictions, but it is not a common belief among these groups that the diet heals practitioners of traditional Chinese medicine are more likely to embrace the idea that certain foods can alleviate or cure illnesses.

Question 64

Which item listed below is not typically a goal of the motivational interview process?
A. Evaluating the patient’s care needs.
B. Reinforcing the patient’s statements regarding change.
C. Discovering what concerns the patient about changing their behavior.
D. Addressing the patient’s care needs as a partnership.

Answer 64

A. The evaluation stage is not a goal of motivational interviewing.

Question 65

A review of services to determine medical necessity is known as:
A. Pre-admission certification.
B. Utilization management.
C. Prequalification.
D. Quality assurance.

Answer 65

B. Utilization management reviews services for medical necessity, appropriateness, and adherence to quality standards.

Question 66

An important benchmark in workers compensation case management is:
A. Reducing injuries
B. Improving return-to-work times.
C. Managing caseloads.
D. Improving UR performance.

Answer 66

B. Improving return-to-work times and decreasing days out of work is a critical benchmark in workers compensation.

Question 67

TRICARE allows military personnel to receive care:
A. At the VA hospital system.
B. At the VA hospital system or through private facilities.
C. At predetermined facilities.
D. When they are on active duty.

Answer 67

B. Tricare allows military personnel, both active and retired, to receive care at both military and private facilities.

Question 68

An Islamic belief that could conflict with medical recommendations regarding diabetes care may include:
A. Following a halal diet.
B. Fasting during Ramadan.
C. Prohibitions against injections.
D. Praying five times daily.

Answer 68

B. Practicing Muslims traditionally fast during the month of Ramadan. Patients who are Muslim and have diabetes should speak with their health care provider before Ramadan starts to ensure that they are meeting their medical needs.

Question 69

Algorithms that incorporate protocols for common diseases and procedures are called:
A. Evidence-based guidelines.
B. Clinical pathways.
C. Standards of practice
D. Practice guidelines.

Answer 69

B. Clinical pathways used evidence-based guidelines to incorporate common diseases and procedures into an algorithm format.

Question 70

Older Chinese patients are likely to believe all of the following in relation to health care except:
A. Avoiding eye contact with the doctor is a sign of respect.
B. Illness may be caused by a disturbance in their chi (energy).
C. The head of the household is frequently involved in health care decisions.
D. Nodding in response to an authority figure is a sign of disrespect.

Answer 70

D. Nodding is a customary way to greet someone and is a sign of respect in Chinese culture.

Question 71

Your client, who was recently discharged from a skilled nursing facility, has had increasing issues with aspirating while eating. You would like the client’s ability to swallow evaluated and recommend a referral to:
A. A speech pathologist.
B. A radiologist.
C. A dietitian.
D. A respiratory therapist.

Answer 71

A. A speech pathologist is trained to evaluate swallowing as well as speech, fluency, and the effects of cognition on speech.

Question 72

During a functional job analysis:
A. information is collected to define the patient’s job duties.
B. Interviews are performed with coworkers and supervisors.
C. Job scheduling is not a concern.
D. A physical or occupational therapist may perform the analysis.

Answer 72

C. The job schedule is not a factor with the functional job analysis.

Question 73

A primary benefit of having a spiritual practice is:
A. A more successful career.
B. More social engagements.
C. A longer life.
D. Meeting familial expectations.

Answer 73

C. On average, people who are spiritual live a longer life.

Question 74

Important psychosocial resources for the CCM’s patient would include:
A. Transportation to medical appointments
B. Support groups.
C. Wellness exams.
D. Community events.

Answer 74

B. Support groups can be an important psychosocial resource.

Question 75

A network of providers and hospitals who agreed to provide services to members for a lower reimbursement rate and with more freedom to select providers without a referral is known as a:
A. Health management organization (HMO).
B. Preferred provider organization (PPO).
C. Hospital-centered network.
D. Provider hospital network.

Answer 75

B. A preferred provider organization (PPO) is a network of providers that agrees to provide services for a lower reimbursement rate and offers users more freedom to select providers.

Question 76

The longer an injured worker is out of work:
A. The more case management is needed.
B. The more likely she is to return to work in a new career.
C. The less likely she will ever return to work.
D. The less the claim costs over time.

Answer 76

C. Studies have demonstrated that, statistically, the chances of return to work decrease dramatically as time out of work continues.

Question 77

The nonprofit group that collects data to evaluate the safety and quality performance of hospitals and provides that information to consumers is:
A. The American Medical Association.
B. The Leapfrog group.
C. The Abacus group.
D. Health and Human Services.

Answer 77

B. The Leapfrog Group is a national nonprofit that conducts outcome surveys and provides a hospital report card for consumers.

Question 78

The implementation phase of a case management plan is also called:
A. An action plan.
B. Objective attainment.
C. Care coordination.
D. Plan completion.

Answer 78

C. Care coordination is the implementation phase of a case management plan, as defined by the case management body of knowledge (CMBOK).

Question 79

Evidence-based practice refers to:
A. Using medical interventions that are proven through research to be effective.
B. Recommendations for health and wellness goals.
C. Rigid criteria to meet medical necessity requirements.
D. Systemically developing statements that serve providers in determining care.

Answer 79

A. Evidence-based practice refers to the use of medical interventions proven by research to be effective.

Question 80

Patient autonomy does not:
A. Focus on defending individuals who cannot represent themselves.
B. Refer to patients having control over their own health care decisions.
C. Describe a patient’s freedom to make choices.
D. Foster patient independence.

Answer 80

A. Autonomy describes personal freedom of the patient to make their own choices in health care decisions.

Question 81

A rehabilitation CCM is seeing a new patient who was injured while driving his taxi He cannot drive currently, but can work in the office for the Taxi Company until he has healed from his injury. The CCM knows this situation is called:
A. Transitional work duty (TWD).
B. Work adjustment.
C. Work conditioning
D. Job development.

Answer 81

A. Transitional work duty (TWD) allows an injured worker to perform a work task at a lower capacity than prior to injury.

Question 82

The cost of health insurance each month is known as the Colon
A. Coinsurance.
B. Copay.
C. Premium.
D. Deductible.

Answer 82

C. The premium is the monthly cost of insurance.

Question 83

A CCM makes a house call to a 50-year-old client with diabetes who has just returned home from a hospital stay. During the visit, the case manager observes his client’s elderly mother lying on a urine-soaked bed. The client admits that no one was caring for his mother while he was in the hospital and states that a family member is going to come and help as a result. The CCM should:
A. Take care of the client’s mother while at the home.
B. Find out if the mother is eligible for in-home services.
C. Report the situation to his supervisor.
D. Report the situation to the appropriate state agency

Answer 83

D. Case managers are mandatory reporters in most statutes, and elder neglect/abuse must be reported to the appropriate agency in the jurisdiction for further investigation.

Question 84

The regulatory body that performs accreditation of health systems and establishes national standards for quality measures is:
A. Health and Human services.
B. The Leapfrog group.
C. The Joint Commission.
D. The Hospital Quality Commission.

Answer 84

C. The Joint Commission is charged with this responsibility.

Question 85

The best way for the CCM to begin an interview is by:
A. Asking family members to attend.
B. Asking open-ended questions.
C. Asking that the patient be alone in a safe location.
D. Asking for medication and health history lists.

Answer 85

B. The CCM should always use open-ended questions when initiating an interview.

Question 86

Preparing for the patient interview is an important step for the CCM. This phase includes all of the following except:
A. Scheduling the interview when there will be no interruptions.
B. Informing the patient about information that will be needed.
C. Informing the patient of the interview’s approximate duration.
D. Creating goals for the patient’s health needs.

Answer 86

D. Creating goals for the patient’s health needs comes at the end of the interview and is a collaborative process between the CCM and patient.

Question 87

Michael works in a community health clinic that focuses on vulnerable populations with insulin-dependent diabetes. He provides education, monitoring, and supplies for eligible clients. This type of case management is called:
A. Community health case management.
B. Public health case management.
C. Diagnosis management.
D. Disease management.

Answer 87

D. This case manager performs disease management. The other answers are contrived definitions.

Question 88

In patient care, beneficence is not:
A. An obligation to do good for the patient.
B. Providing informed consent.
C. Defined as the act of telling the truth.
D. Removing the patient from harm’s way.

Answer 88

C. The term veracity describes the act of telling the truth.

Question 89

Ergonomic products, address:
A. Renumeration and benefits.
B. Environment and productivity.
C. Legal and moral issues.
D. Organization and cooperation.

Answer 89

B. Ergonomics refers to the understanding of human interactions and systems. Ergonomists design and evaluate products that address issues related to environment, productivity, and operator fatigue.

Question 90

Cultural competence in Healthcare is best described as:
A. Providing health care professionals that speak the patient’s native language.
B. The integration of multicultural providers within a network.
C. The integration of a variety of factors such as race, ethnicity, language, and socioeconomic status into care delivery.
D. The ability to empathize with patients from a variety of cultures.

Answer 90

C. Language skills, representation, and cultural sensitivity are components of cultural competence, but the definition of cultural competence includes multiple factors like race, ethnicity, language, and socioeconomic status.

Question 91

As a case manager in an inpatient detoxification facility, you are working to prepare a client for transfer to a residential treatment center. This activity is also known as:
A. Discharge planning.
B. Transitional discharge.
C. Transition of care.
D. Transfer care.

Answer 91

C. This is a transition of care, as defined by the Case Management Body of Knowledge (CMBOK).

Question 92

_______ serve designated high need areas or populations.
A. Free clinics
B. Community-based centers
C. Medical homes
D. Community health centers

Answer 92

D. Community health centers were created to treat underserved populations.

Question 93

One of the most important outcome measures used by CMS to evaluate hospitals is:
A. Cost of hospital stay.
B. Mortality.
C. Efficient use of medical imaging
D. Use of case management at discharge.

Answer 93

B. Mortality is one of the most important measures evaluated by CMS.

Question 94

To improve an outcome, the ______ must be improved.
A. Process
B. Measures
C. Population
D. Case management

Answer 94

A. Process measures are the steps in a process that translate to a negative or positive outcome.

Question 95

A crucial part of case management that contributes to patient autonomy, beneficence, and justice is known as:
A. Veracity.
B. Advocacy.
C. Conduct.
D. Competency.

Answer 95

B. Patient advocacy is a main factor in case management that fosters patient autonomy, justice, and beneficence.

Question 96

When a CCM exceeds legal duties and adheres to a professional standard, it is referred to as meeting:
A. acceptable standards.
B. Societal standards.
C. Ethical standards.
D. Appropriate standards.

Answer 96

C. Adhering to ethical standards means exceeding legal duties and following an even higher standard.

Question 97

The most important aspect of the patient that may affect their health care choices is their:
A. Age.
B. Gender.
C. Spiritual beliefs.
D. Diet.

Answer 97

C. Patients’ spiritual beliefs could directly impact their choices regarding medical care.

Question 98

Patients who are ill in practice, a spiritual discipline may improve their well-being through all of the following except:
A. Improvement of coping skills.
B. Decreasing of suicidal thoughts.
C. Improvement of physical symptoms.
D. Medical education.

Answer 98

D. Spirituality does not impact medical education.

Question 99

Assistive devices do not include:
A. Tangible items that help disabled persons.
B. Closed captioning and hearing aids.
C. Mobility devices such as a cane or a screen reader.
D. Pacemakers or corneal implants.

Answer 99

D. Assistive devices are external.

Question 100

Your new client is a young man who admits to having depression and some transient suicidal ideation. As you perform your initial case management assessment, you focus on other risk factors for suicide, including:
A. Prior suicide attempts and substance abuse.
B. Socioeconomic status and neighborhood.
C. Family history of depression.
D. other medical and mental health conditions.

Answer 100

A. The substance abuse and Mental Health Services Administration (SAMHSA) identifies prior suicide attempts and substance abuse as risk factors, along with access to lethal weapons.

Question 101

Data collected from a number of healthcare domains and used for analysis is known as:
A. Data analysis.
B. Outcomes measures.
C. Healthcare Analytics.
D. Quality analytics.

Answer 101

C. Healthcare analytics is the term for healthcare analysis activities derived from data collection from four areas.

Question 102

An example of semantic noise is:
A. The receiver being too hungry to listen.
B. Terminology the receiver cannot understand.
C. A startling interrupts the message.
D. Anxiety preventing the receiver from focusing.

Answer 102

B. Medical terminology that the receiver cannot understand is an example of semantic noise. The CCM must realize that semantic noise impacts the patient’s ability to engage.

Question 103

The following all represent vulnerable populations except:
A. The homeless.
B. The uninsured and underinsured.
C. Recent immigrants.
D. Women.

Answer 103

D. Being a woman does not necessarily equate with being a part of a vulnerable population.

Question 104

The potential barriers preventing the patient from processing information include all of the following except:
A. An educational deficit.
B. Cognitive ability.
C. An overload of information.
D. The patient’s values.

Answer 104

D. The patient can still process information even if their value system is different from the CCMs.

Question 105

The CCM is also a social worker. When confronted with an ethical dilemma, he knows that he must abide by both his:
A. Code of Case Management and Code of Conduct.
B. Code of Professional Conduct and Code of Case Management.
C. Code of Professional Conduct and Code of Ethics.
D. Code of Conduct and Code of CCM.

Answer 105

C. He must abide by the CCMC’s Code of Professional Conduct as a CCM, and the Code of Ethics as a Social worker.

Question 106

Ergonomics improves environmental design by applying all of the following except:
A. Theory.
B. Data.
C. Methods.
D. Structure.

Answer 106

D. Principles, along with theory, data, and methods are applied in ergonomics to improve environmental design.

Question 107

To qualify for Home Health Services, the client must be:
A. Financially needy.
B. Homebound.
C. Non-ambulatory.
D. Over age 55.

Answer 107

B. The client must be homebound or have significant difficulty leaving me home to qualify for home health services.

Question 108

_______ is an Insurance that provides wage replacement and medical care to injured employees.
A. Long-term disability
B. Temporary total disability
C. Workers compensation
D. Workers Indemnity Fund

Answer 108

C. Workers compensation provides these benefits in exchange for the surrender of the ability to sue the employer through the tort system.

Question 109

A process that analyzes data and forecasts probable outcomes is known as:
A. Health care analytics.
B. Data analysis.
C. Outcomes modeling.
D. Predictive modeling.

Answer 109

D. Predictive modeling uses statistics to predict or forecast outcomes.

Question 110

A residential treatment facility:
A. Is an intermediate care facility for the developmentally disabled.
B. Is for end of life care for patients with chronic illnesses.
C. Is for patients with substance abuse and behavioral illness.
D. Is for elderly patients who need assistance with ADLs.

Answer 110

C. A residential treatment facility is an inpatient facility for treatment of substance abuse and other mental and behavioral disorders.

Question 111

URAC is the acronym for:
A. Utilization Review Access Corporation.
B. Utilization Recovery and credibility.
C. Utilization Review Accreditation Commission.
D. Utilization Review and Care.

Answer 111

C. URAC, the Utilization Review Accreditation Commission, accredits a number of professional organizations.

Question 112

TRICARE offers a range of health care plans for:
A. Disabled veterans.
B. Retirees in need of Supplemental Plans.
C. Medicaid recipients.
D. Military personnel.

Answer 112

D. TRICARE, formerly CHAMPUS, provides a range of health care plans for active & retired military personnel.

Question 113

The principles of case management do not include:
A. Maintaining subjectivity with all patients.
B. Placing a patient’s interests above the CCM’s.
C. Obeying regulations.
D. Acting with respect and dignity when communicating with other professionals.

Answer 113

A. Maintaining objectivity with all patients is a principle of case management.

Question 114

The item listed below that is not typically a component of the health coaching process is:
A. Setting goals based on the patient’s preferences.
B. Building a relationship.
C. Motivational interviewing.
D. Obtaining MD orders.

Answer 114

D. The goal of the health coach is to achieve patient-related goals. Obtaining MD orders is not part of their role.

Question 115

The Mental Health Parity Act of 1996:
A. Excluded substance abuse treatment.
B. Had the impact on health insurance plans in practice that it had intended.
C. Mandated that mental health benefits be offered in insurance plans.
D. Did not mandate that annual insurance plan dollar limits for mental health treatment are equal to medical or surgical benefits.

Answer 115

A. Substance abuse and chemical dependency are not covered under this Act.

Question 116

In this sequence, which number is the mode? 4 4 4 4 7 7 10 10 40
A. 4.
B. 7.
C. 10.
D. 90.

Answer 116

A. Four is the most commonly listed number, so this is the mode.

Question 117

What is not true of a person with a chronic Illness or disability?
A. They may perform the same work after an illness or disability.
B. They may need a modified work schedule after an illness or injury.
C. They must apply for disability if job modifications cannot be made.
D. They may have their work environment modified after an illness or injury.

Answer 117

C. If job modifications cannot be made after an injury or illness, the worker may change jobs or apply for disability, but applying for disability is not required.

Question 118

Your client, a single woman, has had numerous hospitalizations for multiple sclerosis complications and a failed cauda equina surgery and is no longer able to safely ambulate or care for her colostomy. She is stable and ready for discharge. The appropriate level of care would be:
A. An intermediate care facility.
B. An assisted living facility.
C. A skilled nursing facility.
D. Palliative care.

Answer 118

C. This client should go to a skilled nursing facility, which provides 24 hour skilled care and rehabilitation. The other choices would not provide an adequate level of skilled care, given the diagnosis and current level of functioning.

Question 119

CMS states that professionals who transition their client to another provider or care setting should:
A. Identify the receiving case manager.
B. Ensure that the transition is within the same hospital.
C. Provide a summary of care record.
D. Provide ongoing case management for 30 days.

Answer 119

C. A summary of care should be provided at each transition/referral to reduce the chances of an adverse outcome.

Question 120

URAC requires case management programs to annually report:
A. 5 mandatory measures.
B. Adverse case outcomes.
C. Number of clients served.
D. Cost savings.

Answer 120

A. URAC requires accredited case management organizations to report on five mandatory measures.

Question 121

The defining feature of a managed care plan is that it:
A. Employs mechanisms to control utilization of medical services.
B. Allows treatment outside of the network after appeal.
C. Is a less expensive insurance plan.
D. Utilizes more case managers.

Answer 121

A. Managed care plans use various techniques to limit or control patient access to medical services. These techniques may include referrals, contracts with medical providers, and requiring approval for certain medical services.

Question 122

Important aspects of the introduction phase include all of the following except:
A. Informing the patient whom the CCM works for.
B. Explaining the purpose of the interview.
C. Collaborating on patient goals.
D. Inquiring about how the patient wishes to be addressed.

Answer 122

C. Collaborating on goals is important, but is not part of the introduction phase.

Question 123

All of the following are reasons for establishing a rapport with the patient except:
A. Facilitating effective communication.
B. Increasing the likelihood that the patient will disclose personal information.
C. Ensuring the patient will always do what the CCM wishes to improve their health.
D. Increasing patient engagement.

Answer 123

C. Despite a good report, the patient may not always do what the CCM wishes to improve their health.

Question 124

The acronym HCFA stands for:
A. Health Care for All.
B. Health Care Financing Administration.
C. Health Continuity for Americans.
D. Health Care Financial Administrator.

Answer 124

B. HCFA is the Health Care Financing Administration, a division of the US Department of Health and Human services.

Question 125

The Women’s Health and Cancer Rights Act of 1998 did not:
A. Require that reconstruction of the unaffected breast is covered to provide symmetry.
B. Require that lymphedema is covered.
C. State that breast prosthesis is covered.
D. Require reconstruction to be covered for the breast that was removed.

Answer 125

C. Mastectomy coverage does not include breast prosthesis.

Question 126

The Family Medical Leave Act (FMLA) does all of the following except:
A. Help workers who are expected to be out of work for an extended time.
B. Provide income for workers when they are out of work for an extended time.
C. Allow workers to keep their job after an illness or injury.
D. Allow employees to keep their health insurance while using FMLA.

Answer 126

B. FMLA does not provide income.

Question 127

A workers’ compensation insurance company employs 4 case managers. Two spend most of their time in the office, calling employers, injured employees, and providers. The other two accompany injured workers to doctor and therapy appointments. This is best described as:
A. Telephonic and field case management.
B. Office based and provider based case management.
C. Disability case management.
D. Workers’ compensation case management model.

Answer 127

A. Telephonic and field case management are the appropriate definitions of these functions.

Question 128

The PAM is:
A. A patient satisfaction survey.
B. A survey to evaluate a patient’s ability to manage his own health.
C. A survey used to measure how case management is advocated for the patient.
D. A measure of patient activity after hospitalization.

Answer 128

B. The patient activation measure evaluates the knowledge, skills, and confidence patients need to manage their own health care.

Question 129

The Pregnancy Discrimination Act states that:
A. An employee on leave with pregnancy related conditions is not treated the same as a temporarily disabled employee.
B. Expenses for pregnancy related conditions are not covered on the same basis as other health related conditions.
C. The pregnant employee might have her pay rate decreased while pregnant.
D. The pregnant employee may keep her same job with same pay and insurance when returning to work.

Answer 129

D. No employment discrimination is allowed because an employee is pregnant. This means the employee may keep her same job with same pay and insurance when returning to work.

Question 130

A chronic pain treatment program employs A psychologist, rehabilitation counselor, physical therapist, and case manager. They meet every week to discuss their individual findings and goals, and to update the team on the status of the client. This is known as a(n):
A. Interdisciplinary team.
B. Multidisciplinary team.
C. Integrated team.
D. Clinical treatment team.

Answer 130

B. This is a multidisciplinary team because people from different disciplines are working together but drawing from their own individual expertise. An interdisciplinary team is similar, but involves team members working as an integrated whole, often with overlapping roles and goals.

Question 131

Your client today at a primary care office has a concussion and a wrist fracture from an assault and robbery outside his condominium complex. He is now home and receiving outpatient neurology and orthopedic care. When you perform your assessment, he tells you he is having trouble sleeping and keeps having “flashbacks” of the incident. You recommend referral to:
A. The sleep clinic at a local hospital.
B. A psychiatrist.
C. A psychologist.
D. No one; You await the doctor’s decision.

Answer 131

C. A psychologist is best suited to provide cognitive and behavioral therapy. Since the client told you about these symptoms, it is appropriate to make this recommendation to the physician. The psychologist may recommend the patient see a psychiatrist for further treatment with medication, but the case manager should suggest referral to a psychologist first.

Question 132

The PAM is:
A. Preadmission and management.
B. Patient action measures.
C. Patient activation measure.
D. Patient advocacy model.

Answer 132

C. The patient activation measure is a commonly used measure to assess a patient’s ability to manage her health care.

Question 133

Health and Human service organizations, such as one-stop career centers and aging services centers, can obtain accreditation through:
A. CARF
B. TJC
C. URAC
D. CMS

Answer 133

A. The Commission on Accreditation of Rehabilitation Facilities (CARF) is the accrediting body for Health and Human services organizations.

Question 134

The term disability does not refer to:
A. An individual’s neurological or physical deviation.
B. A condition that may cause the individual physical or mental challenges.
C. Being unable to conduct an activity without certain accommodations.
D. Carrying out activities in what is considered a standard way to perform them.

Answer 134

D. A disability may be described as the inability to perform activities in what is considered a standard way for a person to carry them out.

Question 135

Joe, a 79 year old veteran, fell at home and sustained a calcaneus fracture. He also has diabetes, is obese, and has had bilateral total knee arthroplasties. These secondary conditions are known as:
A. Significant health problems.
B. The medical problem list.
C. The medical history.
D. Comorbid conditions.

Answer 135

D. Comorbid conditions such as Joe’s are usually long-term and chronic.

Question 136

The nonprofit, membership based organization that works to catalyze improvements in healthcare with a focus on measures and standards is the:
A. URAC
B. CARF
C. NCQA
D. TJC

Answer 136

C. The National Quality Forum (NQF) has done extensive work in continuous quality improvement and has an endorsement process for health care measures.

Question 137

A developmental disability is not:
A. A mental disability that emerged before the age of 22.
B. A physical disability with an onset after the age of 22.
C. A disability that continues indefinitely and limits major activities in life.
D. A traumatic brain injury.

Answer 137

B. A physical or mental disability must emerge before age 22 to be considered a developmental disability.

Question 138

A successful health coach realizes that:
A. She needs to convince her patient to do what she wishes to achieve optimum health care goals.
B. She must listen more than she talks.
C. The patient will need to see the primary care physician frequently.
D. The family will be heavily involved.

Answer 138

B. A successful health coach will need to listen to the patient and set goals based on the patient’s conversations.

Question 139

Your client is a 48 year old injured worker who installs drywall. He is now 20 weeks post rotator cuff surgery and biceps repair and is stalled out in physical therapy, lifting just 35 pounds. His job requires him to lift 100 pounds. You can contact the Orthopedic surgeon and request consideration for a referral to:
A. A psychologist for counseling.
B. A neurologist for an EMG.
C. Another orthopedic surgeon for a second opinion.
D. A work conditioning facility for work simulated therapy.

Answer 139

D. A work conditioning facility will provide more aggressive and individualized therapy that simulates work.

Question 140

The quality improvement (QI) cycle begins with:
A. Data collection.
B. Defining the problem.
C. A Sentinel event.
D. A patient complaint.

Answer 140

B. The first step in QI models is defining the problem or area to be studied.

Question 141

Which statement is not true of the Americans with Disabilities Act (ADA)?
A. Cases are determined individually to consider eligibility.
B. The disabled individual is not defined by ADA as being perceived by employers to have a substantially limiting impairment.
C. The disabled employee can be promoted in their job equally to an employee who is not disabled.
D. The disabled employee must be able to meet the employer’s job requirements.

Answer 141

B. The disabled individual is defined by the Americans with Disabilities Act (ADA) as being perceived by employers to have a substantially limiting impairment.

Question 142

A special needs trust:
A. Protects assets for disabled individuals without interfering with SSI and Medicaid benefits.
B. Pays for a disabled individual’s medical care and negates the need for Medicaid.
C. Protects assets from other family members.
D. Is for anyone who has medical problems and needs to receive SSI and Medicaid benefits.

Answer 142

A. The trust names a trustee as administrator; since the disabled individual does not have a direct access to the funds, it protects the individual’s ability to receive SSI and Medicaid.

Question 143

A benefit of a 12 step program like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), in addition to long term effectiveness, is:
A. It allows participants to chart their own course.
B. It is a well known program.
C. There is no cost to the participant.
D. It is physician monitored.

Answer 143

C. AA & NA are free and operate with member donations only, providing a proven outpatient treat model at no cost.

Question 144

A highly disciplined, data-intensive methodology for eliminating defects is:
A. A root cause analysis.
B. Black Belt.
C. Six Sigma.
D. Project management.

Answer 144

C. Six Sigma is a methodology that drives to attain 6 deviation points between mean and nearest specification.

Question 145

CMS recently promulgated conditions of participation for community mental health centers. These conditions include:
A. Establishing a QAPI program.
B. Providing free services to needy patients.
C. Implementing a CQI program.
D. Offering multiple locations in a state.

Answer 145

A. Community Mental Health Centers must develop and implement a Quality Assurance Performance Improvement (QAPI) program as established by CMS in its 2014 regulations.

Question 146

The process in which a party of a civil lawsuit can obtain relevant information pertaining to his or her case is referred to as:
A. Respondeat superior.
B. Respondeat inferior.
C. Discovery.
D. Subpoena.

Answer 146

C. Discovery is the term used to describe the process in which a party of a civil lawsuit can obtain relevant information pertaining to his or her case.

Question 147

Medicare Part A provides coverage for:
A. Physical therapy.
B. Hospitalization.
C. Prescriptions.
D. Preventative care.

Answer 147

B. Medicare Part A provides coverage for inpatient hospital care, inpatient skilled nursing care, and Hospice care.

Question 148

One of the most critical aspects of negotiation is:
A. Being friendly to the other party.
B. Adhering to company guidelines.
C. Being polite but firm in negotiations.
D. Listening actively.

Answer 148

D. Active listening involves listening to the other party to find possible areas of compromise.

Question 149

To establish the mean, you:
A. Determine the most common number.
B. Average the numbers.
C. Add all the numbers.
D. Establish a range.

Answer 149

B. The mean is obtained by averaging the numbers (adding all the numbers and dividing by the number of numbers).

Question 150

Knowing the family dynamics of the patient will assist the CCM in all ways except:
A. Making referrals for family counseling.
B. Encouraging normal daily routines.
C. Providing interventions for the care plan.
D. Explaining the patient’s insurance plan benefits.

Answer 150

D. The CCM may educate the patient or family member about insurance plan benefits without knowing the family dynamics.