CCM Overview

Question 1

Case manager reassessment of a patient’s situation and needs is important because:
A. A patient’s clinical condition, personal/family circumstances and discharge needs can change frequently.
B. Discharge needs change year over year.
C. Clinical conditions solely determine discharge needs and those can change.
D. It’s really all about their personal and family circumstances and we know those can change frequently.

Answer 1

A.
A patients clinical condition, personal/family circumstances and discharge needs can change frequently

Question 2

The case manager’s role in managing hospital readmissions can involve many activities. Which of the following is not typically a role for a case manager?
A. Assisting with determining why the patient readmitted.
B. Calling the patient’s pharmacy to check on recent refills to assess medication compliance.
C. reporting to the multidisciplinary team when a patient is a readmission.
D. Ensuring the patient has a follow up appointment scheduled

Answer 2

B. Calling the patients pharmacy to check on recent refills to assess medication compliance

Question 3

Medicare has a category for certain surgical procedures called “inpatient only.” What is the penalty for performing an inpatient only procedure on a patient and discharging him or her without an inpatient order?
A. Nothing, it’s not really a thing.
B. No penalty to the hospital, only to the patient since their bill doesn’t get covered.
C. The hospital does not get paid for the procedure.
D. None of the above.

Answer 3

C. The hospital does not get paid for the procedure

Question 4

Mr. T is being transferred to a skilled nursing facility (SNF). The case manager did not send a complete set of documents to the facility along with the patient. All transfer documents are important, but the lack of which one carries the highest risk of leading to a rapid readmission?
A. transfer orders
B. Discharge summary
C. PASSAR
D. Medication Reconciliation

Answer 4

D. Medication reconciliation

Question 5

The case manager has been asked to join a process improvement team concerning patient care rounding. The rounds are very lengthy, do not start on time, and some complain about the requirement to attend daily. Using the LEAN model, what should be the focus areas for process improvement:
A. Deciding on a goal of developing standard work that can be replicated, Listening every step in patient care rounding for each team member and Evaluating wasted time such as waiting for physician to begin rounds.
B. Telling the team members what the process should be rather then listening, excluding those who are not able to show up on time and contribute to the process.
C. Determine whether rounds are needed at all or if this could be done better with a morning email.
D. What team members need to be involved and what information should be shared.

Answer 5

A. Deciding on a goal of developing standard work that can be replicated.
Listening every step in patient care rounding for each team member.
Evaluating wasted time such as waiting for physician to begin rounds.

Question 6

The case manager has completed the initial discharge assessment on Mr. Smith, who was admitted today, and knows that the average length of stay for a patient with his diagnosis is 4 days. When should the case manager review the patient and his plan again?
A. On day 3
B. On day 2
C. On the day of discharge
D. On day 4

Answer 6

B. On Day 2

Question 7

The discharge planning evaluation must:
A. discuss the patient’s support at home and any needs they potentially will have based on diagnosis.
B. always include a SNF recommendation because patients don’t do well going straight home.
C. Include an evaluation of discharge needs, which also must consider the possible need for post-hospital services, evaluate the patient’s capacity for self-care and whether he/she can return to previous setting and, be documented in the medical record.
D. Include what type of transportation they will use to discharge home.

Answer 7

C.
1) Include an evaluation of discharge needs, which also must consider the possible need for post-hospital services.
2) Evaluate the patients capacity for self-care and whether he/she can return to previous setting.
3) Be documented in medical record.

Question 8

Health literacy can be assessed by:
A. Asking the patient to explain back the information that has been provided.
B. determining what their highest level of education is and basing it on that
C. Asking the patient a lot of questions about health related issues to see how much they know.
D. None of the above.

Answer 8

A. Asking the patient to explain back the information that has been provided.

Question 9

Key elements of a well- formulated discharge plan include the following:
A. Destination, Date, DME, and Doctor appointment
B. Collaboration, financial responsibility, patient centrality and engagement, responsive to changing circumstances.
C. Collaboration and responsiveness to change.
D. Both A and B

Answer 9

B.
1) Collaboration
2) Financial responsibility
3) Patient centrality and engagement
4) Responsive to changing circumstances

Question 10

A traditional Medicare patient as been hospitalized for one midnight on observation status and is expected to be ready for discharge tomorrow. His care needs are most appropriate for short term skilled nursing facility placement. The most appropriate action for the case manager is:

A): Advise that Medicare benefits will not cover SNF placement in this instance, and explore a home discharge with intensive home health/caregiver support.
B): Talk to the physician about changing the patient’s admission type to inpatient and keeping the patient for three midnights.
C): Let the family and patient know that their only option is to go home and then return to the emergency room for readmission if they can’t handle things at home.

Answer 10

Advise that Medicare benefits will not cover SNF placement in this instance, and explore a home discharge with intensive home health/caregiver support.

Question 11

Medicare requires a 3-day medically necessary qualifying stay for a patient who will be discharged to a skilled nursing facility (SNF). Which of the following is correct:

A): The patient needs to meet level of care before using SNF benefits
B): The patient only needs to be admitted under observation to qualify
C): The physician ordered level of care status must be inpatient for 3 days and medically necessary for an inpatient level of care must be justified.

Answer 11

The physician ordered level of care status must be inpatient for 3 days and medically necessary for an inpatient level of care must be justified

Question 12

A patient has been in an”Observation” status for 2 days and is now clinically stable for discharge to a SNF. Given the case manager’s understanding of the Medicare guidelines for SNF placement and reimbursement, he or she should:
A. Tell the doctor that the patient needs to be admitted “inpatient” for three days before they can discharge.
B. Send the patient home since Medicare will not pay for the SNF
C. Offer the patient multiple options for both home and SNF due to the cost.
D. Inform the patient and family that they may need to pay privately.

Answer 12

D.
Inform the patient and family that they may need to pay privately.

Question 13

When should the anticipated discharge date should be discussed with the patient?

A): When the physician tells you they are discharging the next day.
B): As early in the hospitalization as possible, by every member of the treatment team.
C): Once the plan has been finalized with therapy and the family, then let the patient know what will be happening.
D): As soon as the patient is admitted.

Answer 13

As early in the hospitalization as possible, by every member of the treatment team.

Question 14

EMTALA is a regulatory agency that impacts case management functions? True or False?

Answer 14

False

Question 15

When offering patient choice to a patient with managed care insurance, the process includes providing a listing of the preferred providers for post-acute care services (i.e., home health agencies and SNF’s contracted with the payer). The case manager should also advise the patient:

A): This is the only list they can choose from.
B): That they should change to traditional Medicare if they want better choices.
C): The case manager can contact the payor to identify benefit and coverage if the patient wishes to go out-of-network.
D): We prefer they remain within our quality alliance.

Answer 15

The case manager can contact the payor to identify benefit and coverage if the patient wishes to go out-of-network.

Question 16

The key components of an evaluation or performance improvement plan (PIP) does not include:
A): Creating a risk analysis tool
B): Analyzing and monitoring key metrics
C): Developing strategies to improve the metric scores
D): The impact on patient care and experience.

Answer 16

Creating a risk analysis tool

Question 17

What is the goal of discharge planning?

A): Ensure a smooth Transition from hospital to home or another facility.
B): Provide high quality care that meets the needs of the patient in the most cost-effective manner.
C): To free up patient beds in a timely manner for new admissions.
D) Both A and B.

Answer 17

1) Ensure a smooth transition from hospital to home or another facility.
2) Provide high-quality care that meets the needs of the patient in the most cost-effective manner.

Question 18

Risk Management is NOT a utilization management function? True or False?

Answer 18

True

Question 19

AHRQ uses which acronym to define the patient/caregiver role in the discharge planning process?

A) IRB
B) IDEAL
C) PDSA
D) MATCH

Answer 19

IDEAL
Include
Discuss
Educate
Assess
Listen

Question 20

The criteria for a Medicare patient being accepted for home health care include:
A): Physician must prescribe/order home healthcare
B): Must require part-time skilled nursing care or physical, speech or occupational therapy.
C): Patient must be confined to home by an injury, illness or other medical condition.
D): All of the above

Answer 20

1) Physician must prescribe/order home healthcare
2) Must require part-time skilled nursing care or physical, speech, or occupational therapy.
3) Patient must be confined to home by an injury, illness or other medical condition.

Question 21

Case managers in the acute care setting often encounter patient issues with decision-making capacity. Who determines if a patient can make a decision?

A): The patient’s family member appointed as POA
B): The patient’s doctor
C): The care team members who completed a competency evaluation
D): Competence can only be determined by a court of law

Answer 21

Competence can only be determined by a court of law

Question 22

True or False?
The hospital must identify at an an early stage of hospitalization all patients who are likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning.

Answer 22

True

Question 23

A post-discharge call by a case manager would likely touch on which topics?

A): Were they satisfied with the care received at the hospital?
B): Are prescriptions filled and next appointment made?
C): What shows they are watching on netflix while recovering
D): whether or not they want to be involved in regular patient outreach calls

Answer 23

Are prescriptions filled and next appointment made?

Question 24

A family is having a crisis in healthcare decision making for a relative in the ICU, and they cannot agree. The eldest son is making the most “noise” and getting the most attention. The patient’s spouse sits quietly in the corner. The two daughters are in their alliances - one with her brother and one seems to support the mother, who appears disagrees with the son. There is no known Health Care proxy. As the case manager, what is the first step?

A): Talk to the group all at the same time to avoid upsetting anyone.
B): Whichever family member seems to be the most reasonable.
C): Call for a private meeting with the patient’s wife
D): Wait a little longer to see if the situation resolves itself

Answer 24

Call for a private meeting with the patients wife

Question 25

A case manager is assessing an 81 year old female patient hospitalized yesterday after a fall at her home. She has a number of bumps and bruises but no fractures. Her physician indicates she will be ready for discharge tomorrow. A physical therapy consult has recommended sub-acute rehab services in a skilled nursing facility setting.
Upon talking to the patient the case manager learns the following:
-the patient lives alone in a one story house and has been losing balance a lot lately, with two other falls in the last month.
-the patient has two adult children who live more than two hours away and cannot provide daily direct assistance.
-the patient understands she is at risk for serious injury in a future fall and acknowledges the need for help.
-She is not opposed to a short stay at a rehab facility.
What is the most appropriate next action for the case manager?

A): Push the therapist to change the recommendation to Acute Rehab to avoid worrying about the type of admission the patient has.
B): Investigate whether the patient is on an inpatient or observation status
C): Provide a list of SNF options to the patient and family and ask that they pick one.
D): None of the above

Answer 25

Investigate whether the patient is on an inpatient or observation status.

Question 26

Medicare requires a 3-day minimum inpatient qualifying stay prior to transition to:
A): Home with home care services
B): Inpatient hospice
C): A long-term acute care facility
D): A skilled nursing facility

Answer 26

D): A skilled nursing facility

Question 27

A case manager is asked to evaluate a female patient with a new fracture and a history of multiple visits to the emergency department. The possibility of domestic violence has been raised by the radiologist. All of the following assessment findings may indicate the presence of domestic violence except
A). Repeated traumatic injuries
B). Spouse will not leave patient unattended
C). Vague explanation of injuries
D). Spouse not present during visits

Answer 27

D). Spouse not present during visits

Question 28

A hospital’s length of stay has increased markedly within the last 6 months. The chief financial officer has asked the case management department to investigate the underlying cause of this increase. Case management data revealed the following:​

Hospital admissions have decreased​

Skilled nursing facility placements have increased​

The time between referral and placement in a skilled nursing facility has increased​

Given this information, the next step to identify the most likely explanation for the increase in length of stay should be to examine​

A. The proportion of current admissions being placed in nursing homes​

B. Bed availability in community skilled nursing facilities​

C. The timeliness of initiating the discharge planning process​

D. Physician admission practice patterns ​

Answer 28

B. Bed availability in community skilled nursing facilities