CCM practice questions: Quality & Outcomes Evaluation & Measurements Flashcards
Which performance improvement tactic might case managers use to enhance their time management skills?
A. quickly reviewing A discharge summary with recently a discharged client
B. examining the caseload for the day before start of shift
C. skipping medication reconciliation on medications the client has taken before
D. educating the client about his or her condition without allowing time for questions
B. Correct. Examining A caseload before the start of a shift helps the case manager understand how busy the day will be. The CCM can work at a steady pace to maintain a productive, but not overburdened, workflow.
Incorrect answers
A. Upon transition of care, especially from hospital to home, the CCM should thoroughly review the discharge summary with the client and allow time for questions and further explanation, if necessary. If a client does not understand the discharge instructions, the client could end up back in the hospital.
C. Even if a client takes a medication before, it is important to review the following: medication, dosage, frequency, route of administration, reason for medication, possible side effects, and adverse reactions.
D. One of a case manager’s main responsibilities is to educate clients about their health conditions. A case manager who does not allow time for questions or feedback may mistakenly assume that the client understands a situation.
Documentation of a client’s non-emergent hospital admission has been submitted to the client’s insurance company by the provider. Who would initially assess for medical necessity?
A. Claims examiner
B. Medical director
C. Utilization review nurse
D. Financial analyst
C. Correct. The Utilization Review Nurse is the first-line responder to authorization requests and will review the clinical information once it is submitted by the provider or facility.
Incorrect answers
A. He claims Examiner does not review clinical information. He or she processes the claim once it is submitted.
B. The medical director will review the information only if the utilization review nurse submits the request for medical review.
D. Financial analysts do not review clinical information. They review expenditures and assess financial liability.
During which phase of PDCA would the QA team meet to discuss ways to facilitate a better method of case manager-client interaction?
A. Do
B. Act
C. Check
D. Plan
D. Correct. The Plan phase normally involves discussing how to resolve an issue.
Incorrect answers
A. The Do phase is also known as the implementation phase. Discussing a plan is not implementing a plan.
B. The Act phase is the last component of PDCA. It consists of creating a new process to address the issues revealed during the “check” phase.
C. The Check phase, which occurs after the plan has been implemented, evaluates the outcome of the plan.
Which technique is NOT used by organizations that monitor quality?
A. Studying protected health information
B. Relying on evidence-based standards
C. Granting accreditation to healthcare organizations
D. Conducting research and experimentation
A. Correct. Agencies that conduct accreditation reviews and monitor quality do not assess protected health information as part of their process.
Incorrect answers
B. The NCQA uses evidence-based standards, among their criteria, to measure the quality of care delivered by health care plans.
C. Both the NCQA and URAC are accrediting bodies that employ extensive processes to evaluate the quality of healthcare.
D. The AHRQ focuses on research and experimental results to ascertain which practices are relevant and which ones are obsolete.
Which of the following is NOT a reason for an agency or organization to seek accreditation?
A. Increase its credibility
B. Distinguish itself from the competition
C. Gain more control over pricing
D. Meet regulatory requirements
C. Correct. Accreditation does not directly affect an organization’s pricing structure.
Incorrect answers
A. Increasing the organization’s credibility is an important reason to seek accreditation.
B. Accreditation helps to set an organization apart from the others.
D. Many organizations will need to become accredited to meet regulatory requirements.
How might a case manager determine that a client’s enrollment in an asthma case management program has been successful?
A. The client has attended all his grandson’s baseball games.
B. The client has stopped refilling his medications.
C. The client has had more acute visits to the pulmonologist.
D. The client has reported increased exposure to asthma triggers.
A. Correct. A client who has mismanaged asthma would be less likely to attend outdoor sporting events.
Incorrect answers
B. Decreased frequency of medication refills shows that it client has not been thoroughly educated about the importance of refilling all medications in a timely manner.
C. If a client is visiting his pulmonologist more frequently, he has most likely not been fully educated about controlling his condition. If this condition were under control, the visits would not be necessary.
D. If a client reports increased or more frequent exposure to asthma triggers, he most likely has not been comprehensively educated about the reduction of exposure to triggers, or he may be non-compliant due to a lack of education from his case manager.
Which of the following would NOT be considered relevant health risk assessment information from an elderly female client?
A. How often she takes her medication
B. Her feelings about her illness and current support system
C. The name of the pediatrician she saw as a child
D. How many meals and snacks she eats daily
C. Correct. The client’s pediatrician when she was a child is not relevant. It is not pertinent to current conditions.
Incorrect answers
A. Medication reconciliation is a necessary part of risk health assessment and helps to assess the client’s knowledge of her medication(s).
B. A client’s feelings about her illness or conditions provides the case manager with an insight into possible barriers to compliance, as well as her emotional status.
D. Inquiring about meals and snacks provides the case manager with information about the client’s nutritional status, eating habits, and access to certain foods.
A case manager uses predictive modeling to assess the risk of hospitalization for a client with adult-onset diabetes. Which of the following factors is MOST important for the case manager to consider?
A. Childhood visit to neurologist for headaches
B. Previous hemoglobin A1C result
C. Family history of hypertension
D. Current marital status
B. Correct. To help determine the current risk for a diabetic client, it is necessary to know the most recent hemoglobin A1C result.
Incorrect answers
A. While the case manager needs to know why a client visited a neurologist as a child, it is not the most important factor to consider in a diabetic patient.
C. While a family history of hypertension would be one factor to consider, it would not be the most important.
D. The client’s marital status is not relevant to the client’s condition or plan of care.
The results of an Adjusted Clinical Group (ACG) study can help determine all of the following EXCEPT:
A. increased profitability of certain members of the group to develop congestive heart failure (CHF)
B. resemblances in how providers formulate a plan of care
C. who in the group is most likely to experience the loss of a child
D. how many people in the group will visit the emergency department more than twice a year
C. Correct. How likely a group member is to experience the loss of a child is not one of the criteria measured by an ACG study.
Incorrect answers
A. The likelihood of development of CHF in certain members of the group can be determined by conducting an AGC study, as one of the studies main purposes is to predict the incidence of illness, given a set of criteria.
B. ACG studies use information about shared practices within a provider specialty and compare how providers formulate care plans.
D. Using the data collected in the study, and, a CG study can ascertain who visited the ED, if the study defines the criteria for that outcome.
A team lead in case management performs many of the duties of a supervisor, like auditing, development and implementation of process improvement, and so on. At the same time, the team lead manages a caseload. Based on this information, which of the following would be accurate?
A. A team lead should have as many cases as the other case managers.
B. A team lead should have more cases than the other case managers.
C. A team lead should have no cases at all.
D. A team lead should have fewer cases than the other case managers.
D. Correct. A team lead should have a reasonable caseload to manage but fewer cases than the rest of the case managers because of other duties.
Incorrect answers
A. Because the team lead has also taken on supervisory duties, it is not appropriate that he or she have as many cases as the other case managers.
B. 18 Lead should not have more cases than the rest of the case managers, as he or she is responsible for other duties as well as case management.
C. A team lead is often expected to maintain a caseload, so having no cases at all is not appropriate.
A case manager is managing a 38 weeks pregnant client who has diabetes. Her previous pregnancy ended in the delivery of an infant at 33 weeks gestation, who remained in the NICU for seven weeks. If the client were to deliver within the next 24 hours, and the infant was not admitted to the NICU, how would cost savings be calculated?
A. Cost of one NICU day multiplied by the number of days previous infant was in the NICU
B. Cost of one NICU day divided by the number of days previous infant was in the NICU
C. Cost of one NICU day rounded down, then multiplied by the number of days the previous infant was in the NICU
D. Cost of all the NICU days combined and divided by 30
A. Correct. The cost of one NICU day multiplied by 49 days (number of days previous infant was in the NICU) Would give the amount of money spent for the child’s NICU stay. Because that cost has been avoided during this pregnancy, that cost represents soft savings.
The other answers are incorrect.
What type of question is NOT likely to appear on a client satisfaction survey?
A. How often did your case manager contact you?
B. Was your case manager friendly and helpful?
C. What is your marital status?
D. On a scale from 1 - 10, with 1 being poor and 10 being excellent, How would you rate your case management experience?
C. Correct. Marital status is not relevant data on a client satisfaction survey and has no bearing on whether the case management program was successful.
Incorrect answers
A. Client satisfaction surveys will often elicit information about the frequency of case manager interaction to anticipate successful outcomes.
B. The survey will ask about case manager’s friendliness/helpfulness to determine how a report is developed.
D. Providing a rating scale helps to ascertain if a client would participate again in a case management program.
