ACMA Case Management Certification Practice Test

These questions are part of the practice quiz. Start practicing

• Who sets CMS Conditions of Participation for Medicare providers?
• HINN 1 is given prior to admission to an entirely noncovered hospital stay.
• Which item is NOT used to assign a DRG?
• Which step helps ensure a timely discharge by having all items ready?
• Which is not one of the four stages of case management?
• Differentiate a care plan from a treatment plan in case management practice.
• What is the purpose of monitoring and evaluation in case management?
• Which service is NOT covered by Medicare Part A?
• Which is an essential element of a patient-centered care plan?
• Which option describes a potential discharge path for a patient in observation who may require care outside the home?
• In population-specific assessment considerations beyond medical status, which factors are helpful to assess?
• How can data be used to drive continuous improvement in case management programs?
• Which RED step addresses language barriers?
• What is the purpose of a case conference in case management?
• What type of data is typically analyzed to drive process improvement in case management?
• Which legal framework addresses who may make medical decisions for a patient lacking capacity?
• Which risk stratification model is used to predict the risk of hospitalization and emergency department visits?
• What are the goals of CM?
• Which statement best describes a physician advisor?
• Which statement best describes the purpose of value-based care models?
• Which entity focuses on improving care for Medicare beneficiaries by managing complaints and appeals?
• Which strategy is used to reduce readmissions after hospitalization?
• Which of the following is an example of a skilled home health need?
• Which statement best describes CM's goal regarding setting?
• HINN 10 is associated with which process?
• What is a medical necessity denial and how would you structure an appeal?
• Explain the concept of evidence hierarchy and how it informs guideline application.
• Which item is included in discharge follow-up calls?
• Which statement best describes Medicaid qualification?
• Which statement best describes the primary function of a QIO?
• What is the role of open-ended questions in motivational interviewing within case management?
• Which statement best describes decision-making capacity in relation to competency?
• Which is an allowed method for delivering HINN notices?
• Which statement best describes decision-making capacity?
• Which is a common risk stratification model?
• Which patient group may require closer follow-up after discharge?
• HINN 12 is given to inform beneficiaries about potential financial liability for non-covered continued stay and is given along with which notices?
• Discharge planning should address which of the following?
• What are the time frames to submit a QIO review appeal?
• In utilization and review, what does 'observation' status describe?
• Which characteristic is more typical of home health compared with SNF?
• Which immigration statuses are eligible to purchase health coverage through the Health Insurance Marketplace?
• Which factors are used to determine payout based on efficiency?
• Physician certification or recertification for admissions longer than 20 days requires what documentation?
• Which factors affect social determinants of health?
• What does HINN stand for?
• Which risk stratification model is used to predict the risk of one-year mortality based on diagnosis?
• In documenting consent for information sharing, which elements must be included?
• Which of the following is listed as a skilled home health need?
• What privacy considerations apply to telehealth encounters?
• Which part of Medicare covers DME equipment?
• What is an example of assessing for health literacy?
• What are social determinants of health?
• Which document commonly designates who can make medical decisions for an incapacitated patient?
• When must the HINN be given?
• How should ethical concerns be addressed when a patient refuses recommended care?
• Which best describes Peer Review Quality Improvement Organization (QIO)?
• HINN 11 is given in which situation?
• What best describes Conditions of Coverage and Participation in Medicare and Medicaid programs?
• Which statement about Medicare Part C is true?
• Which approach helps address ethical dilemmas in case management?
• Under capitation, which payment arrangement is typical?
• What is a durable power of attorney for health care?
• What are the three functions of integrated CM?
• What is cost-to-care analysis and how is it used to demonstrate value?
• Under the Uniform Health Care Decisions Act, if a patient is incapacitated and lacks an advance directive, who is first in the hierarchy to make medical decisions?
• Which statement best describes the elements that support medical necessity for hospital admission?
• Which are the five rights of utilization and review?
• Discharge planning often includes which administrative step?
• What is the outcome of an effective case conference?
• Which item is included under CMS conditions of participation related to patient rights and consent?
• In the workers' compensation population assessments, which should be evaluated?
• InterQual is described as?
• What factors affect value-based purchasing?
• Which factor is NOT considered when determining the appropriate level of care across inpatient, observation, and home-based services?
• Which part of Medicare pays for hospice services?
• Which option is a utilization management intervention that can reduce hospital readmissions?
• Which of the following is a common risk stratification model among the listed options?
• Which item is included in IMPACT Act reporting related to patient transfer?
• Which statement best describes the scope of a comprehensive care plan?
• How should you respond when a patient expresses safety concerns about a care plan?
• Which option describes a consideration in observation status?
• Which of the following is NOT typically part of the role of a care navigator within case management?
• When must an Advanced Beneficiary Notice be provided?
• What is the DMAIC sequence in Six Sigma?
• Which is a key element of effective discharge planning?
• Which strategy improves health literacy in patient education materials?
• What is the role of families and caregivers in the care planning process?
• Who is responsible for ensuring regulatory compliance, medical necessity, length of stay, denials, ICD-10 codes, peer review, and utilization of healthcare services?
• Which of the following lists the five core steps of the case management process?
• Which method is an allowed means of delivering HINN notices?
• Which of the following is NOT an example of a social determinant of health?
• HINN 12 is issued along with which notices?
• Which strategy is specifically designed to bridge care after hospitalization to reduce readmissions?
• Which statement best reflects the patient self-determination act?
• When does care coordination begin and end?
• What is health literacy?
• What is a Medicare condition code 44?
• What describes the IMPACT Act?
• Under DRG, what is the role of the Utilization Review department and case managers?
• Which assessment is NOT listed under IMPACT Act reporting items?
• In payer oversight, which statement best defines utilization management and utilization review?
• In population-specific workers' comp assessments, which is essential?
• Under EMTALA, which statement is true?
• Which item is typically included in a psychosocial history?
• Which notice is issued to inform beneficiaries that a non-covered item or service was not medically necessary and may be charged, and is associated with the Hospital Issued Notice of Non-Coverage?
• Which agency maintains the National Coverage Database used in determining care decisions?
• Which option is a SMART objective example for adherence to antihypertensive medication?
• Which statement accurately reflects the typical difference between SNF care and home health in the post-acute phase?
• Which of the following is part of a standard risk assessment method for a new patient?
• DRG payments are determined by which variables?
• Which item is NOT typically a component of a psychosocial history?
• Which element is essential in a comprehensive discharge plan to ensure continuity of care after hospital discharge?
• What is the correct approach to consent for information sharing in care coordination?
• How does patient advocacy manifest in day-to-day case management?
• What is the purpose of the Important Message from Medicare handout?
• Six Sigma is a data-driven quality management process that aims to eliminate defects and is defined by which sequence?
• When a privacy breach involves patient information, which sequence of steps is recommended?
• What is the purpose of the Advanced Beneficiary Notice?
• Which technique aligns with effective conflict resolution within a multidisciplinary team?
• In observation status, what is a typical consideration for determining next steps?
• Which statement describes when a HINN is issued before admission to an entirely noncovered hospital stay?
• A 'care gap' is defined as?
• What is utilization and review?
• Which of the following best describes the required documentation to support continued hospitalization and escalation of care?
• For admissions longer than 20 days, which documentation is required for physician certification or recertification?
• Which part covers admission to SNF?
• Which of the following is NOT typically included in a psychosocial history?
• Which of the following is NOT among the essential elements of a comprehensive discharge plan?
• In discharge planning, which statement reflects the role of families and caregivers?
• What is motivational interviewing and how is it used in case management?
• Which statement best describes quality of care in value-based purchasing?
• Which is NOT a key element of CM planning?
• Which notice explains observation status vs inpatient status and must be provided within 36 hours?
• Which item is not among the five rights of utilization review?
• Which element is included in discharge follow-up calls to monitor treatment safety?
• How is value-based pricing scored?
• Under HINN policies, when is a patient liable for services delivered after an HINN is submitted?
• Which part of Medicare covers skilled nursing facility services?
• What are the guidelines regarding SNF admission under Medicare?
• In discharge planning for elderly, which domains should be considered?
• Describe the role of telehealth in modern case management.
• How can a decision of competence be determined?
• In Value Based Pricing, which factor weighs heavily in clinical care outcomes?
• Which of the following demonstrates cultural competence in case management?
• Which statement best describes the overall use of HINN notices?
• Which factors determine payout for safety?
• Why is medication reconciliation critical at discharge?
• What is the purpose of including red flags in a discharge summary?
• What areas do pay-for-performance models emphasize?
• Which item is considered a social determinant of health?
• Which pricing formula reimburses a fixed amount based on diagnosis?
• What does DRG stand for?
• Which law requires hospitals to provide written information to patients about their rights to make medical decisions and execute advance directives?
• Which item is included in pre-admission assessment?
• How should social determinants of health be screened and acted upon in case management?
• In ED population-specific assessment considerations, what is a recommended action regarding patients who present with the same symptoms as prior visits?
• Why is medication reconciliation important during patient transfer?
• Which item is included in IMPACT Act data reporting categories?
• Which service may accompany skilled home health services?
• Under the Family and Medical Leave Act (FMLA), which statement is accurate?
• Which statement correctly describes DRG pricing in Medicare?
• Under CMS guidelines for Home Health Services, which condition is required?
• Which statement best describes the LEAN framework?
• Which requirement must be met to bill a Condition Code 44?
• Which of the following is covered under Medicare Part B?
• If a QIO appeal is lost, what happens next?
• Which is NOT one of the 8 Ps?
• Identify common ethical dilemmas and how to approach them in case management?
• Why is medication reconciliation important during transitions of care?
• Explain risk adjustment and its purpose in performance reporting for case management.
• What is palliative care?
• When should medication reconciliation be performed?
• Which of the following statements best reflects when a case manager should escalate concerns up the chain of command?
• Which Medicare Part covers prescription drugs?
• Which statement best describes the role of evidence-based guidelines in case management decisions?
• Which statement is true regarding Medicare Part A deductible?
• Is long term care covered by Medicare?
• In performing a risk assessment, which step directly follows collecting medical history and social data?
• What is the term for the process of compiling a single, accurate list of a patient's medications across transitions of care?
• What is the required assessment for admission to a nursing home for a patient with a diagnosis of mental retardation or mental illness to assure appropriate placement?
• Which is NOT considered in Patient Experience of Care under value-based pricing?
• In what year was the Patient Self-Determination Act enacted?
• Which service is covered by Medicare Part B?
• Which facilities are required to submit standardized data under the IMPACT Act?
• What should comprehensive discharge planning include to lower readmission risk?
• Which statement best describes palliative care?
• HINN 10 is issued under which circumstance?
• What documentation supports medical necessity for hospital admission?
• Which Medicare Part B coverage option is listed below?
• In population-specific assessment considerations, which factor is explicitly mentioned as important for tailoring care to elderly patients?
• Is there a premium for Medicare Part A?
• Under capitation, which of the following is true?
• Which element is essential to ensure care plans are culturally respectful?
• Which item is included in post-discharge follow-up?
• Integrated CM comprises roles?
• Medicare Part B coinsurance and deductible structure includes which of the following?
• Prospective pay refers to which type of Medicare reimbursement?
• Which statement best describes the difference between patient adherence, acceptance, and shared decision-making?
• Who must sign the Medicare Outpatient Observation Notice?
• Which set of strategies best promotes safe transitions of care?
• Which statement describes variations in screening requirements for admissions across states?
• Which factor is addressed by the 8 Ps in Project Boost Readmission Assessment?
• Which components are included in Medicare hospice coverage under Part A?
• What does the Detailed Notice of Discharge explain?
• Which is NOT a component of RED (Reengineered Discharge)?
• Which statement about Medicare Part C is NOT true?
• What does the acronym QIO stand for?
• Which of the following is NOT used to assign a DRG?
• Which of the following factors is commonly addressed by case managers to reduce hospital readmission risk?
• What are the three choices a patient has when presented with an Advanced Beneficiary Notice?
• Which tools are commonly used to determine the appropriate level of care for newly hospitalized patients?
• Which action demonstrates cultural competence in patient interactions?
• Which metric is commonly used to evaluate case management outcomes related to readmissions?
• Which of the following is a social determinant of health?
• What is the role of the Office of Inspector General in healthcare?
• Effective discharge planning requires communication with which groups?
• Which statement best defines social determinants of health?
• Which is a direct RED component?
• Which statement best differentiates case management from care coordination?
• How do payer policies influence case management decisions and documentation?
• Which statement best describes health literacy?
• Which statement best differentiates functional status outcomes from clinical outcomes?
• After screening for social determinants, what is an appropriate next step?
• When are interpreter services particularly important in patient education?
• Medical necessity in case management means services are what?
• Which step should occur first when performing an initial risk assessment for a new patient?
• HIPAA individual right number 3 gives individuals the right to do what with their health information?
• What does LACE stand for in the Lace Assessment tool?
• List best practices for accurate and compliant case management documentation.
• In case management, which statement best describes the role of evidence-based guidelines?
• Which of the following statements best reflects HIPAA privacy rules as they apply to case management communications?
• Which practice best aligns with effective conflict resolution in a multidisciplinary team?
• SMART goals are Specific, Measurable, Achievable, Relevant, and Time-bound. Which of the following is NOT a SMART component?
• Which statement best defines a QIO Review?
• Name a standardized risk assessment tool relevant to case management and its purpose.
• What information should be included in an effective discharge summary?
• Which item is not one of the three functions of integrated CM?
• Which statement about Medicare Advantage (Part C) is true?
• What did the HITECH portion of the American Recovery and Reinvestment Act of 2009 promote in regards to healthcare?