Care Delivery & Reimbursement Methods
Both the Commission for Case Management Certification (CCMC)and the ______________________________address in their philosophies of case management the collaborative, comprehensive, integrative, and holistic approach that must be present in case management. The Very definition of case management states that it is a collaborative process
A) Case by Case Associates of Health Care (CCAHC)
B) Commission of Managed Care and Coordination (CMCC)
C) Case Management Society of America (CMSA)
D) Coordination of Ethical and Sensitive Care (CESC
What is C Case Management Society of America (CMSA)
Services for the intellectually and developmentally disabled population are available through every state. Which of the following is true about these public services?
A.Eligibility includes all individuals who sustained an acquired disorder.
B.Eligibility is often limited to those who acquired a brain injury or disorder prior to age 22.
C.Eligible individuals must meet income requirements.
D.Case management is not provided.
What is B Eligibility is often limited to those who acquired a brain injury or disorder prior to age 22.
The outcomes related to the use of clinical pathways in the acute care setting do NOT include:
A.Appropriate length of stay in the hospital
B.Improved quality of care indicators
C.Decreased recidivism rates
D.Patient satisfaction
What is D Patient satisfaction
Vocational rehabilitation is a process that aims to return workers with some type of disability to work. After a work-related injury, the goal is for the worker to achieve ______ and return to work as soon as possible.
A. A job analysis
B. Multidisciplinary therapy
C. Maximum Medical Improvement (MMI)
D. SSI or SSDI
What is C Maximum Medical Improvement (MMI)
The case manager documents all interactions with the client because:
A. documentation substantiates the case manager-patient interaction from a legal perspective.
B. the CMSA mandates such documentation.
C .the physician may request a summary note of the contact.
D. the client may request this information later.
What is documentation substantiates the case manager-patient interaction from a legal perspective.
Patient information is reviewed to decide appropriateness of case management, this process is called _______________________________.
A) Assessing
B) Planning
C) Screening
D) Implementing
What is C Screening
A challenging psychological factor in contributing to difficulties in performing self-care for disabled adults is:
A.impaired motor and sensory function.
B.impaired mobility.
C.poor motivation
D.little time.
What is C poor motivation
Although mistakes are inevitable, even in the best organizations, the case manager recognizes that which of the following strategies can be used for care coordination to fight against medical errors in the hospital?
A.Clinical pathways
B.Private rooms
C.Flexible payment options
D.Multi-dose medication vials available on the nursing units
What is A Clinical pathways
________ are the basic duties fundamental to the job, and the employee Must be able to perform then with or without reasonable accommodations
A- Essential job functions
B- Job modifications
C- Transferable skills
D- Work Adjustment
What is A Essential job functions
Case managers minimize exposure to potential liability for breach of contract by:
A. making decisions that are difficult for the client.
B. confirming claims coverage for necessary services.
C. making treatment and coverage recommendations to the payer after the client has declined case management intervention.
D.providing the client information that allows him/her to make decisions independently.
What is providing the client information that allows him/her to make decisions independently.
Uses biometric screening and health risk assessment tools to classify clients into low, moderate, or high-risk categories. Allows for proper interventions based on the client’s needs.
A) Assessing
B) Transitioning
C) Stratifying Risk
D) Screening
What is C Stratifying Risk
What assistance is available to the patient who is unable to afford prescription medications?
A.Financial aid assistance programs are available in all states.
B.Financial assistance is not available unless the medication cost exceeds $1,000/month.
C.Many pharmaceutical companies provide these medications based on financial eligibility.
D. Most health insurance plans provide full reimbursement for the cost of the medications.
What is C Many pharmaceutical companies provide these medications based on financial eligibility.
A case manager cannot achieve successful outcomes without specialized skills and knowledge applied throughout the case management process. The least important skill is:
A.Positive relationship building and effective verbal/written communication
B.Ability to effect change and perform critical analysis
C.Plan and organize effectively and promote client/family autonomy
D.Clinical skills
What is D Clinical skills
In order for a hospitalized patient to quality for an Inpatient Rehabilitation facility, the patient must be medically stable and able to tolerate a minimum of __ hours of therapy per day, __ to __ days per week.
A- 5hours, 5-7 days per week
B- No minimum amount of time is required
C- 3hours, 5-7days per week
D- 1hour, 3-5 days per week
What is C 3hours, 5-7days per week
Under the Older Americans Act, which of the following services is NOT required?
A.An ombudsman program for nursing home residents
B.Case management and/or outreach and referral services
C.Volunteers to provide home visits to the elderly
D.Social services in the community
What is Volunteers to provide home visits to the elderly
One of the three case management models is a variations of: ___________________ This model is similar to the Dyad model but a third person is involved who takes over the Utilization Manager activities working with the third party payers, leaving the RN and SW CMs to focus on patient flow, transitions and Discharge planning.
A) Triple Model
B) Triad Model
C) Third Model
D) None of these
What is Triad Model
Inpatient psychiatric treatment may not be indicated for:
A.Behavior that is dangerous to self or others
B.History of positive response to therapeutic psychotropic drugs
C.Paranoia, delusions and hallucinations
D.History of unsuccessful outpatient therapy
What is B History of positive response to therapeutic psychotropic drugs
Metrics used to evaluate health coaching programs include adherence and financial measures. Which of the following would be considered a financial measure?
A.Adherence to filling medication prescriptions
B.Independence in managing medical appointments
C.Reduction in emergency department visits for avoidable medical complications
D.Reduction in primary care physician visits
What is C Reduction in emergency department visits for avoidable medical complications
Which of the following is not the role of vocational rehabilitation case managers?
A.Establishing rapport with clients
B.Communication and client participation
C.Individualist treatment of clients
D.Coordination of health care services
What is D Coordination of health care services
Which of the following is not considered a driving force for the identification of best practices in case management?
A.Management surveillance and oversight
B.Professional code of ethics
C.Standards of care
D.Industry standards
What is Management surveillance and oversight
The case manager in these settings combine the role of caregiver with case manager. The case manager may have hands on nursing experience.
A) Hospitals and Ambulatory Care Clinics
B) Palliative Care, home care, and hospice care
C)Ambulatory care clinics, Accountable Care organizations, and hospice care
D) None of these
What is Palliative Care, home care, and hospice care
A case manager is developing a plan for a client without an established support system, who is being transitioned home from a skilled nursing facility, following a stroke. The knowledge area that will best assist the case manager during this phase of the case management process is:
A.cost-benefit analysis.
B.insurance principles.
C.community resources and support programs.
D.psychosocial aspects of chronic illness and disability.
What is C community resources and support programs.
The National Committee on Quality Assurance accredits several types of health care organizations. Which of the following does NCQA NOT accredit?
A.Disability insurers
B.Health plans
C.Managed behavioral health organizations
D.Credentials verification organizations
What is A Disability insurers
The vocational counselor can:
A.find and place an injured worker in a new position regardless of the client's position in the matter.
B.assist the individual with identifying permanent restrictions and apply for viable job options.
C.require the insurance carrier to pay for vocational retraining.
D.make recommendations for lifting restrictions so that other jobs can be considered.
What is B assist the individual with identifying permanent restrictions and apply for viable job options.
The American with Disabilities Act can:
A.supply the answer for each employment decision concerning an individual with a disability.
B.establish parameters to guide employers in making decisions regarding employment issues.
C.identify a specific form of accommodation for each type of disability.
D.require an employer to go to any steps necessary to hire the disabled.
What is establish parameters to guide employers in making decisions regarding employment issues.