Deck 2

Question 1

The process of organizing, securing, integrating and modifying the resources necessary to accomplish the goals set forth in the case management plan is what?
A. negotiation
B. discharge planning
C. Coordination
D. utilization review

Answer 1

C. Coordination

Question 2

Agreement that uses language developed by the National Association of Insurance Commissioners and prevents double payment for services when a subscriber has coverage from two or more sources
A. Billing and Coding Compliance
B. Coordination of Benefits (COB)
C. Utilization Review
D. None of the above

Answer 2

B. Coordination of Benefits (COB)

Question 3

Cost-sharing arrangement between the member and insurer in which the member pays a set charge for a specific service at the time of service. It may be a flat or variable amount per unit of service.
A. copayment
B. price transparency
C. bundled payments
D. cost-estimate

Answer 3

A. Copayment

Question 4

Basic therapy services provided by professionals on a rehabilitation unit such as nursing, physical and occupational therapy, speech-language pathology, neuropsychology and social work are considered what?
A. part B services
B. regulatory required services
C. skilled services
D. core therapies

Answer 4

D. Core therapies

Question 5

Process that contrasts the benefits with the costs of an action, intervention service or treatment to determine if the benefits outweigh the costs and to make informed decisions.
A. insurance review
B. Cost-benefit analysis
C. ethics review
D. None of the above

Answer 5

B. Cost-benefit analysis

Question 6

The provision of services by a trained professional to assist or guide a client in resolving personal, social or psychological problems and difficulties.
A. Counseling
B. case management
C. education
D. none of the above

Answer 6

A. Counseling

Question 7

Fostering independence, growth, development and behavioral change in a client guided by a trained counselor and involving focused communication and strategies to effect desirable change and coping.
A. behavioral modification
B. cognitive therapy
C. counseling process
D. coping skills counseling

Answer 7

C. Counseling Process

Question 8

Review process to approve a provider who applies to participate in a health plan to be sure specific criteria (e.g., licensure verification, malpractice insurance, training and experience) are met.
A. Authorization
B. Credentialing
C. Verification
D. None of the above

Answer 8

B. Credentialing

Question 9

The questioning of a witness during a trial or deposition by the party/attorney opposing the one who originally brought the witness; this may entail redirect examination by the original attorney.
A. Cross examination
B. mediation
C. Witness statement
D. None of the above

Answer 9

A. Cross examination

Question 10

Congruent behaviors, attitudes and overarching policies that come together in a system or among individuals to enable awareness, understanding and positive attitudes across different worldviews.
A. Linguistic competency
B. Cultural sensitivity
C. Traditional assessment
D. Cultural Competence

Answer 10

D. Cultural Competence

Question 11

A pediatric patient who is ventilator-dependent and has a gastrostomy button is scheduled to be discharged to home with visits from a home health nurse. Prior to discharge, the case manager’s most critical action is to:

A. assess the patient’s long-term home care needs.
B. procure the required home medical equipment.
C. secure funding sources for home health care.
D. verify that the patient is being discharged to a safe environment.

Answer 11

D. Verify the patient is being discharged to a safe environment.

Question 12

Which type of authorization is generated when services are rendered?

A. Concurrent.
B. Prospective.
C. Retrospective.
D. Subauthorization.

Answer 12

A. Concurrent

Question 13

Managing clinical outcomes, studying variance trends, and evaluating actions taken to correct deviations from critical pathways are components of:

A. performance improvement.
B. risk management.
C. the nursing process.
D. utilization review.

Answer 13

A. Performance Improvement

Question 14

Medication errors, orders for unnecessary tests, and omission of standard tests or procedures are classified as which type of variance?

A. Community.
B. Operational.
C. Patient.
D. Practitioner.

Answer 14

D. Practitioner

Question 15

To avoid hospital readmission, a patient requires services at a specialty clinic. Because the services are not covered under the patient’s healthcare plan, the case manager intercedes with the patient’s insurance company. In this situation, the nurse is acting in the role of:

A. broker.
B. consultant.
C. negotiator.
D. provider.

Answer 15

C. Negotiator

Question 16

When using a utilization tool to perform a concurrent review, the case manager recognizes that:

A. discharge is required whenever the tool so indicates.
B. exceptions exist because utilization tools reflect only average circumstances.
C. patients have a right to set length of stay without incurring nonreimbursable costs.
D. the use of utilization tools guarantees payment for services.

Answer 16

B. exceptions exist because utilization tools reflect only average circumstances.

Question 17

Ideally, case management planning identifies goals that are:

A. anticipated, acceptable, and appropriate.
B. challenging and timely.
C. patient focused and cost effective.
D. realistic, measurable, and specific.

Answer 17

D. realistic, measurable, and specific.

Question 18

A patient who is homeless has been admitted to the hospital with multiple health care problems. The nursing case manager, physician, social worker, and clinical dietician work together to care for the patient. This interprofessional interaction is referred to as:

A. collaboration.
B. consultation.
C. continuity.
D. coordination.

Answer 18

A. Collaboration

Question 19

Which healthcare provider at a rehabilitation facility addresses the cognitive, behavioral, and psychological problems that result following a patient’s traumatic brain injury?

A. Medical social worker.
B. Neuropsychiatrist.
C. Neurosurgeon.
D. Psychologist.

Answer 19

B. Neuropsychiatrist

Question 20

A 15-year-old single mother has a three-month-old infant. If the infant needs to be hospitalized for a nonemergent illness, the consent for admission and treatment must be signed by the:

A. infant’s grandparent.
B. infant’s mother.
C. mother’s attorney.
D. mother’s legal guardian.

Answer 20

B. Infant’s mother