A hospital case manager receives a referral for a 72-year- old client admitted with a new diagnosis of lung cancer. The client lives alone, was flagged as high risk on admission screening, and agrees to case management services. Which action should the case manager take NEXT?

Complete a comprehensive assessment with the client and family

Request prior authorization for outpatient chemotherapy

Write short-term and long-term goals for the care plan

Arrange home health services to start on the day of discharge

A workers' compensation case manager is assigned to a 26-year-old worker who sustained a complete T6 spinal cord injury and was admitted to a trauma intensive care unit yesterday. Which approach to case management is MOST appropriate?

Begin now, with planning that anticipates rehabilitation, home modification, and long-term needs

Begin after the client leaves the intensive care unit and can participate in goal setting

Begin at transfer to inpatient rehabilitation, when return-to- work planning becomes relevant

Begin when claim costs exceed the carrier's threshold for catastrophic case review

A client with COPD is admitted and placed on BiPAP. The physician’s progress notes describe only “shortness of breath,” although blood gas results and the client’s respiratory status suggest acute respiratory failure. Which action is appropriate?

A clinical documentation specialist sends the physician a compliant, non-leading query to clarify the condition

The coder assigns the code for acute respiratory failure based on the documented BiPAP use

The team accepts the documentation because symptom codes carry the same DRG weight as specific diagnoses

The case manager adds acute respiratory failure to the problem list because the clinical indicators support it

At a family meeting about a client with advancing dementia, one son insists, "Dad has to go to a nursing home." His sister refuses, saying, "We are keeping him at home." The client can no longer participate in the decision. Which approach by the case manager is MOST likely to produce a durable agreement?

Ask each sibling what concerns lie behind their position, such as safety, cost, or promises made to their father

Present the team's recommendation and ask the siblings to vote on the options

Postpone the discussion until the siblings can settle the matter between themselves

Propose that the father live at home for six months and then move to a nursing home as a compromise

A case manager in a pediatric endocrinology practice is assisting the parents of a 9-year-old with type 1 diabetes. The child performs at grade level but needs blood glucose checks and snacks in class, access to the school nurse for insulin, and extra time on tests after a hypoglycemic episode. Which school-based plan BEST fits these needs?

An Individualized Family Service Plan

An Individualized Education Program under the Individuals with Disabilities Education Act

A health plan wants to identify members who would benefit from case management before they experience a health crisis. Which case-finding approach BEST achieves this goal?

Apply predictive modeling to claims, pharmacy, and health risk assessment data

Accept provider referrals for members after they have been hospitalized

Review members who have had three or more admissions in the past year

Enroll members who call customer service asking for help with their care

A client with bipolar disorder who has been stable on medication reports increased stress at work, reduced sleep, and racing thoughts over the past week. He denies suicidal ideation, is taking his medication, and has a supportive partner. Which level of care is MOST appropriate?

More frequent outpatient visits and review of his crisis plan

Admission to a residential treatment program

Referral to an Assertive Community Treatment team

Inpatient psychiatric admission for stabilization

A psychiatrist evaluates a client and diagnoses major depressive disorder, recurrent, moderate, using DSM-5- TR criteria. The case manager is reviewing the claim submitted for the visit. Which code set identifies the diagnosis on the claim?

ICD-10-CM, the diagnosis code set that DSM-5-TR diagnoses correspond to

HCPCS Level II, because behavioral health services are billed separately from medical care

CPT, because the service was a physician evaluation

DSM-5-TR, which serves as a stand-alone billing code set for mental health diagnoses

During an interdisciplinary team meeting, a physician pushes to discharge a client home that afternoon to free a bed. The case manager has confirmed that the client, who has new hemiplegia, lives alone in a second-floor apartment with no caregiver and no home services in place. Which conflict-management style is MOST appropriate for the case manager to use?

Competing, firmly advocating against the unsafe discharge

Avoiding, postponing the discussion until the physician is less busy

Compromising, agreeing to a discharge the next morning without services in place

Accommodating, deferring to the physician to preserve the working relationship

Medicare denies a request for a Group 3 power wheelchair for a client with amyotrophic lateral sclerosis, citing insufficient documentation of medical necessity. The client can no longer self-propel a manual wheelchair. What should the case manager do FIRST?

Review the denial reason and strengthen medical necessity documentation with the prescriber

File a complaint with the state insurance regulator

Recommend a power scooter as a less costly alternative

Apply to the state Assistive Technology Act program for a low-interest loan

CCM

Free CCM Practice Questions

10 sample questions for the CCM, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Care Management, Thecasemanagementprocess, Ethical, Legal, and Practice Standards, Quality and Outcomes Evaluation and Measurements, Levelsofcareandcaresettings, Long-Termcare, Transitionsofcare, Medicationmanagement, Managingclientsbytypeofcare, Populationhealthandage-Specificcare, Palliativecare,Hospice,Andchronicpain, Reimbursement Methods, Managedcareorganizations, Reimbursementandpaymentmethodologies, Utilizationmanagement, Publicbenefitprograms, Private,Military,Andveteranbenefits, Negotiatingwithpayersandproviders, Psychosocial Concepts And Support, Psychosocial Concepts and Support Systems, Rehabilitation Concepts and Strategies, Trauma-Informedcare, Psychologicalandcognitivecapacityassessment, Needs, Supportsystemsandcaregivers, Healthliteracy,Languageaccess,Andclient, Genderhealthandsexualorientation, Interpersonalcommunication,Conflictresolution,, Wellnessandillnessprevention, Quality And Outcomes Evaluation And, Qualityandperformanceimprovementmethods, Qualityindicatorsources, Predictivemodeling, Rehabilitation Concepts And Strategies, Rehabilitationforspecificconditions, Vocationalrehabilitationandworkers', Lifecareplanning, Typesofrehabilitationprograms, Ethical, Legal, And Practice Standards, Standardsofpracticeandcodesofconduct, Healthcareanddisabilitylegislation, Hipaaprivacy,Security,Andconfidentiality, Legalandregulatoryrequirements, Riskmanagementanddocumentation, Self-Care,Safety,Andprofessionalwell-Being, Levelsofrehabilitationcareandcarecoordination.

Question 1 · Care Management
A hospital case manager receives a referral for a 72-year- old client admitted with a new diagnosis of lung cancer. The client lives alone, was flagged as high risk on admission screening, and agrees to case management services. Which action should the case manager take NEXT?
- A.Request prior authorization for outpatient chemotherapy
- B.Complete a comprehensive assessment with the client and family
- C.Write short-term and long-term goals for the care plan
- D.Arrange home health services to start on the day of discharge
Show answer and explanation
Answer: B. Complete a comprehensive assessment with the client and family
Screening has established that the client qualifies for case management; a comprehensive assessment of physical, functional, psychosocial, and financial needs, strengths, and preferences must come before any planning. Writing goals for the care plan without assessment data produces a plan that is not client-centered, and arranging home health or requesting authorization for chemotherapy are implementation steps that would be premature at this point.
Question 2 · Managingclientsbytypeofcare
A workers' compensation case manager is assigned to a 26-year-old worker who sustained a complete T6 spinal cord injury and was admitted to a trauma intensive care unit yesterday. Which approach to case management is MOST appropriate?
- A.Begin now, with planning that anticipates rehabilitation, home modification, and long-term needs
- B.Begin after the client leaves the intensive care unit and can participate in goal setting
- C.Begin at transfer to inpatient rehabilitation, when return-to- work planning becomes relevant
- D.Begin when claim costs exceed the carrier's threshold for catastrophic case review
Show answer and explanation
Answer: A. Begin now, with planning that anticipates rehabilitation, home modification, and long-term needs
For catastrophic injuries, the earliest possible case management involvement produces the greatest effect on outcomes and cost, and planning should address the entire continuum, including rehabilitation, home modification, equipment, family support, and return to community or work. Waiting until the client leaves the ICU, reaches rehabilitation, or crosses a cost threshold loses the opportunity to coordinate early decisions and support the family during the acute phase.
Question 3 · Reimbursement Methods
A client with COPD is admitted and placed on BiPAP. The physician’s progress notes describe only “shortness of breath,” although blood gas results and the client’s respiratory status suggest acute respiratory failure. Which action is appropriate?
- A.The coder assigns the code for acute respiratory failure based on the documented BiPAP use
- B.The team accepts the documentation because symptom codes carry the same DRG weight as specific diagnoses
- C.The case manager adds acute respiratory failure to the problem list because the clinical indicators support it
- D.A clinical documentation specialist sends the physician a compliant, non-leading query to clarify the condition
Show answer and explanation
Answer: D. A clinical documentation specialist sends the physician a compliant, non-leading query to clarify the condition
Only the treating provider can document a diagnosis, so a compliant, non-leading query is the correct way to clarify a condition that the clinical record supports. Adding a diagnosis to the record or coding it from clinical indicators without physician documentation is noncompliant and can constitute upcoding. Symptom codes do not carry the same weight: vague documentation understates severity, and a condition such as acute respiratory failure can change the MS-DRG.
Question 4 · Interpersonalcommunication,Conflictresolution,
At a family meeting about a client with advancing dementia, one son insists, "Dad has to go to a nursing home." His sister refuses, saying, "We are keeping him at home." The client can no longer participate in the decision. Which approach by the case manager is MOST likely to produce a durable agreement?
- A.Present the team's recommendation and ask the siblings to vote on the options
- B.Ask each sibling what concerns lie behind their position, such as safety, cost, or promises made to their father
- C.Postpone the discussion until the siblings can settle the matter between themselves
- D.Propose that the father live at home for six months and then move to a nursing home as a compromise
Show answer and explanation
Answer: B. Ask each sibling what concerns lie behind their position, such as safety, cost, or promises made to their father
Interest-based negotiation looks beneath stated positions to the underlying needs, such as the son's fear of a fall or the daughter's promise to keep him home, which opens creative solutions that satisfy both. Splitting the difference is a compromise that may leave value on the table and satisfy neither sibling. A vote sets up winners and losers, and avoidance leaves the conflict unresolved while care needs grow.
Question 5 · Typesofrehabilitationprograms
A case manager in a pediatric endocrinology practice is assisting the parents of a 9-year-old with type 1 diabetes. The child performs at grade level but needs blood glucose checks and snacks in class, access to the school nurse for insulin, and extra time on tests after a hypoglycemic episode. Which school-based plan BEST fits these needs?
- A.An Individualized Family Service Plan
- B.An Individualized Education Program under the Individuals with Disabilities Education Act
- C.A Section 504 plan
Show answer and explanation
Answer: C. A Section 504 plan
Section 504 of the Rehabilitation Act requires accommodations such as a nurse-administered medication schedule and extra test time for a student whose disability substantially limits a major life activity but who does not need specialized instruction. An Individualized Education Program is for a child in an IDEA disability category who needs specialized instruction, which this child does not. An Individualized Family Service Plan governs early intervention from birth to age 3.
Question 6 · Care Management
A health plan wants to identify members who would benefit from case management before they experience a health crisis. Which case-finding approach BEST achieves this goal?
- A.Accept provider referrals for members after they have been hospitalized
- B.Review members who have had three or more admissions in the past year
- C.Apply predictive modeling to claims, pharmacy, and health risk assessment data
- D.Enroll members who call customer service asking for help with their care
Show answer and explanation
Answer: C. Apply predictive modeling to claims, pharmacy, and health risk assessment data
Predictive modeling of claims, pharmacy, and health risk assessment data identifies rising-risk members early, which is the goal of effective case finding. Referrals after hospitalization and lists of members with repeated admissions find clients only after costly events have occurred, and relying on members who call for help misses most at-risk people.
Question 7 · Managingclientsbytypeofcare
A client with bipolar disorder who has been stable on medication reports increased stress at work, reduced sleep, and racing thoughts over the past week. He denies suicidal ideation, is taking his medication, and has a supportive partner. Which level of care is MOST appropriate?
- A.Admission to a residential treatment program
- B.Referral to an Assertive Community Treatment team
- C.More frequent outpatient visits and review of his crisis plan
- D.Inpatient psychiatric admission for stabilization
Show answer and explanation
Answer: C. More frequent outpatient visits and review of his crisis plan
Behavioral health case management seeks the least restrictive level of care that safely meets need; early warning signs in an engaged, safe client with support call for closer outpatient follow-up and review of the crisis plan. Inpatient and residential care are more restrictive than his condition requires, and Assertive Community Treatment is for clients with serious mental illness who cannot engage with clinic-based services.
Question 8 · Reimbursement Methods
A psychiatrist evaluates a client and diagnoses major depressive disorder, recurrent, moderate, using DSM-5- TR criteria. The case manager is reviewing the claim submitted for the visit. Which code set identifies the diagnosis on the claim?
- A.HCPCS Level II, because behavioral health services are billed separately from medical care
- B.CPT, because the service was a physician evaluation
- C.ICD-10-CM, the diagnosis code set that DSM-5-TR diagnoses correspond to
- D.DSM-5-TR, which serves as a stand-alone billing code set for mental health diagnoses
Show answer and explanation
Answer: C. ICD-10-CM, the diagnosis code set that DSM-5-TR diagnoses correspond to
DSM-5-TR provides the diagnostic criteria for mental and behavioral health disorders, and its diagnoses correspond to ICD-10-CM codes, which are used for diagnosis coding on claims in all settings. CPT codes describe the service performed, such as the evaluation visit, not the diagnosis. HCPCS Level II covers products, supplies, and services outside CPT, such as durable medical equipment, and DSM-5-TR is not a separate billing code set.
Question 9 · Interpersonalcommunication,Conflictresolution,
During an interdisciplinary team meeting, a physician pushes to discharge a client home that afternoon to free a bed. The case manager has confirmed that the client, who has new hemiplegia, lives alone in a second-floor apartment with no caregiver and no home services in place. Which conflict-management style is MOST appropriate for the case manager to use?
- A.Avoiding, postponing the discussion until the physician is less busy
- B.Compromising, agreeing to a discharge the next morning without services in place
- C.Competing, firmly advocating against the unsafe discharge
- D.Accommodating, deferring to the physician to preserve the working relationship
Show answer and explanation
Answer: C. Competing, firmly advocating against the unsafe discharge
The Thomas-Kilmann model identifies competing (high assertiveness, low cooperativeness) as appropriate for emergencies and client safety issues, and an unsafe discharge threatens this client's safety. Accommodating and avoiding sacrifice the client's safety to harmony or delay. A compromise that simply moves the discharge time does not resolve the lack of care at home.
Question 10 · Lifecareplanning
Medicare denies a request for a Group 3 power wheelchair for a client with amyotrophic lateral sclerosis, citing insufficient documentation of medical necessity. The client can no longer self-propel a manual wheelchair. What should the case manager do FIRST?
- A.Review the denial reason and strengthen medical necessity documentation with the prescriber
- B.File a complaint with the state insurance regulator
- C.Recommend a power scooter as a less costly alternative
- D.Apply to the state Assistive Technology Act program for a low-interest loan
Show answer and explanation
Answer: A. Review the denial reason and strengthen medical necessity documentation with the prescriber
The first step after a funding denial is to review the stated reason and strengthen documentation of functional limitations, the tasks the device enables, and why less costly alternatives are inadequate before appealing. An Assistive Technology Act loan is a secondary source pursued after coverage options are exhausted. A power scooter requires independent transfers and good trunk control and is a poor match for progressive disease, and Medicare denials are appealed through Medicare's appeal process rather than the state insurance regulator.

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