CCMC exam 1-25

B: The functional capacity exam is a process of assessing a person's physical andfunctional abilities to perform tasks. The patient's performance level should match thedemands of the occupation in question. The purpose of the exam is to determine if a patient

C: There are six domains for case management practice. These include case managementconcepts, case management principles and practice strategies/practice, psychosocial andsuppqrt systems, healthcare management and delivery, healthcare reimbursement, andvocational concepts/strategies. Risk management is a subdomain of case managementprinciples and practice/strategies.

C: Planning is the process by which a case manager documents goals, objectives, andactions that will meet a client's needs. Assessment entails gathering data about a client'sspecial needs and situation prior to forming a case management plan. Coordination involvesorganization, modification, and documentation of resources necessary to achieve goals setforth in the plan, and monitoring involves securing information needed to gauge theeffectiveness of the plan.

A: Healthcare reimbursement is one of the major categories of knowledge necessary for acase manager, because there are many different reimbursement mechanisms availabledepending upon the patient's particular situation.

A: Patient advocate is the best answer. Advocacy is essential to a case manager's dailypractice. A case manager acts on behalf of clients who may not be able to speak forthemselves or who are not knowledgeable about health care. Above all, the case managershould always have the client's best interest in mind.

B: A relationship between healthcare practitioners and patients is paternalistic andbeneficent. This means that people trust the practitioner to do what is in the best medicalinterest of the patient. Paternalism is justified in that patients usually don't comprehendmedical concepts well enough to make the correct decision about their care. In the patientsovereignty model, the patient is "boss." In this case, one could argue that the patient knowsbetter than anyone else what is in his best interests. Shared decision making means thehealth care team and the patient work together.

C: The four key functions of a case manager are planner, assessor, facilitator, andadvocate. A case manager must assess a situation to identify problems that need casemanagement. The case manager must also plan long- and short-term goals in collaborationwith the client, the client's family, and with other healthcare professionals. Facilitationincludes coordinating and implementing the care plan, maintaining communication, andexpediting care. As an advocate, the case manager ensure that the client's needs areidentified and addressed.

d: The term "within the walls" (WTW) refers to activities within the acute hospital environment. This is distinct from "beyond the walls" (BTW), which refers to case management in outpatient and community settings.

C: This scenario describes the process known as a viatical settlement whereby a patient can obtain cash value from a life insurance policy prior to death. Answers A, B, and D are irrelevant to the situation.

A: A case manager establishes a relationship with a client to advocate for his best interests. This makes the case manager a fiduciary. The term ex parte refers to a legal proceeding or a legal order. A tort, on the other hand, refers to a wrongful act performed willfully. When a person investigates a business or personal relationship prior to signing a contract, he is performing due diligence.

C: The relationship that exists between the case manager and a referral provider is an ostensible agency. If that provider were to perform negligent actions, the referring case manager may also become subject to litigation. A fiduciary is a relationship whereby the case manager acts in the client's best interests. The case manager is an advocate for the client, not the provider.

D: A case manager has to have knowledge of the referral provider's credentials and clinical experience. If a case manager sends a patient to an unqualified referral provider,this constitutes a negligent referral. It is important for the case manager to check in with patients afterward to assure that they had a positive experience with the provider. It is also the case manager's responsibility to report any misconduct on the part of that provider.

C: This type of relationship is a dual relationship, because you are both friend and case manager. This often leads to a conflict of interest Having a friendship with the client outside of the clinical arena introduces biases that interfere with your performance as a professional.

B: In a managed healthcare plan, a gag clause prevents healthcare providers from discussing with the patient treatment options that are not covered by that particular managed care plan.

B: An advance directive is legally executed. The document delineates the patient's healthcare-related decisions. The patient draws it up while he/she is still mentally competent.

D: Medical power of attorney is a document allowing a person to appoint someone else to make medical care decisions in the event that he/she can't communicate. Living wills,medical power of attorney, and durable power of attorney are all types of advance directives.

A: Polypharmacy refers to the use of multiple medicines or the taking of more medications than are medically indicated. It is a common phenomenon in the elderly.

C: Physicians who care for hospitalized patients are known as hospitalists. This eliminates the burden on the PCP so that he or she can focus on office practice. There isoften at least one case manager on a hospitalist team. Entrepreneurial case managers run their own case management businesses. Hospice case managers coordinate care of dying patients and their families. A skilled nursing facility is for patients who can no longer perform self-care.

B: Sometimes patients oppose treatment due to inadequate understanding of clinical information and treatment options. Before proceeding with other actions, the case manager should ensure that the patient has a complete understanding. Discussions and decisions are carefully documented in the chart.

A: In cases such as this one where no parent, spouse, sibling, significant other, or close friend is available to make decisions, two physicians can serve as surrogates.

D: With anonymous testing, oral consent is acceptable. Other exceptions include emergency situations when a diagnosis is needed and the patient is unable to sign, to determine the cause of death, and for research purposes in which the patient remains anonymous.

C: A quality review helps determine if a patient received recognized standards of care.An incident report is a tool used to document adverse or unusual occurrences. Risk management identifies, evaluates, and corrects risks that may lead to injury to patients,staff, or visitors. During utilization review, medical services are evaluated for necessity and appropriateness.

B: Patient under subacute care don't need diagnostic work-ups. Subacute care includes all levels of care not requiring acute hospitalization. The patients are medically stable and have a constant treatment plan.

C: The scenario describes intermediate care. Under assisted living or custodial care, the client is stable, takes a consistent regimen of oral medications, and does not need suctioning. Skilled nursing is for complex, but generally stable, patients who may need central line care, IV push medications, variable adjustments in dosages of medicines, and assessment of laboratory values.

B: A PPO is an insurance model that offers patients a preferred panel of physicians. A patient may choose to utilize an "outside" physician, but this would result in lower reimbursement and a greater cost to the patient member. HMOs use physicians as gatekeepers.