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ACA CCM practice questions

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Question 1Case Management Process and Practice

Which activity is the first step in the case management process after a client is referred for services?

  1. Screening and intake to determine eligibility and needs Correct answer.
  2. Closing the case file
  3. Ongoing monitoring of the care plan
  4. Discharge planning and transition of care

Explanation

The case management process begins with referral, screening, and intake, where eligibility, needs, and appropriateness for case management services are established. Later steps such as planning, monitoring, and closure depend on this initial determination.

Question 2Case Management Process and Practice

A case manager gathers information about a client's medical history, functional status, and social supports. Which phase of the case management process does this describe?

  1. Assessment Correct answer.
  2. Termination
  3. Implementation
  4. Evaluation

Explanation

Assessment is the systematic collection of data about the client's health, function, resources, and needs that forms the basis for the care plan. Implementation, evaluation, and termination all occur after a plan exists.

Question 3Case Management Process and Practice

What is the primary purpose of developing a written case management care plan with the client?

  1. To define goals, interventions, and responsibilities that guide coordinated care Correct answer.
  2. To satisfy accreditation requirements only
  3. To document billable hours for reimbursement
  4. To replace the physician's treatment orders

Explanation

A care plan sets individualized goals and specifies the interventions, resources, and responsibilities needed to meet them, serving as the coordinating roadmap for the team. It does not substitute for clinical orders or exist merely for billing or accreditation.

Question 4Case Management Process and Practice

A client with diabetes is referred to a dietitian, an ophthalmologist, and a diabetes education program. Which case management function does this best illustrate?

  1. Utilization review
  2. Outcome measurement
  3. Risk stratification
  4. Coordination of care Correct answer.

Explanation

Coordination of care involves arranging and linking the client with multiple services and providers so care is integrated rather than fragmented. Utilization review, risk stratification, and outcome measurement are related but distinct functions.

Question 5Case Management Process and Practice

Which document typically authorizes a case manager to obtain and share a client's protected health information with other providers?

  1. A signed release of information Correct answer.
  2. A living will
  3. A durable power of attorney
  4. A do-not-resuscitate order

Explanation

A release of information is the client's signed authorization permitting disclosure of protected health information to specified parties for specified purposes. The other documents address advance directives or legal decision-making, not information sharing.

Question 6Case Management Process and Practice

During which phase does the case manager compare the client's actual progress against the goals in the care plan?

  1. Referral
  2. Monitoring and evaluation Correct answer.
  3. Intake
  4. Screening

Explanation

Monitoring and evaluation involve tracking progress, comparing outcomes to goals, and revising the plan as needed. Intake, referral, and screening occur earlier and do not involve measuring goal attainment.

Question 7Case Management Process and Practice

What is the case manager's role when a client's needs exceed the resources available in the current plan?

  1. Transfer all responsibility to the family
  2. Modify the plan and identify additional or alternative resources Correct answer.
  3. Discharge the client for noncompliance
  4. Continue the existing plan unchanged

Explanation

Case management is dynamic; when needs change or resources are insufficient, the case manager reassesses and revises the plan, seeking additional or alternative resources. Abandoning the client or leaving an inadequate plan in place is inconsistent with the advocacy role.

Question 8Case Management Process and Practice

Which term describes the process of determining whether a client is appropriate for and likely to benefit from case management services?

  1. Certification
  2. Authorization
  3. Screening Correct answer.
  4. Stratification

Explanation

Screening evaluates a referred client's needs and circumstances to decide whether case management is appropriate and beneficial. Stratification, certification, and authorization serve different purposes in the care system.

Question 9Case Management Process and Practice

A case manager suspects a client is being financially exploited by a relative. What is the most appropriate immediate action?

  1. Wait until the next scheduled reassessment
  2. Report the concern according to mandatory reporting laws and agency policy Correct answer.
  3. Discuss it only with other clients
  4. Confront the relative in the client's home

Explanation

Suspected abuse, neglect, or exploitation triggers a duty to report to the appropriate protective agency per law and agency policy, while safeguarding the client. Confrontation or delay risks further harm and violates reporting obligations.

Question 10Case Management Process and Practice

Which action best demonstrates client advocacy in case management?

  1. Selecting services based on the agency's convenience
  2. Making all decisions on the client's behalf
  3. Limiting the client's access to information to reduce confusion
  4. Ensuring the client's preferences and rights are represented in care decisions Correct answer.

Explanation

Advocacy means representing the client's interests, preferences, and rights, and empowering the client to participate in decisions. Acting for agency convenience, withholding information, or overriding client autonomy undermines advocacy.

Question 11Case Management Process and Practice

A case manager is prioritizing a caseload. Which client should generally receive the most immediate attention?

  1. A client whose annual review is due next month
  2. A stable client requesting a routine equipment update
  3. A client recently discharged from the hospital with new wound care needs and no caregiver Correct answer.
  4. A client asking for a list of community classes

Explanation

Prioritization weighs acuity, risk, and unmet immediate needs; a newly discharged client with clinical needs and no support carries high risk. Stable, routine, or informational requests can be scheduled later.

Question 12Case Management Process and Practice

What is the primary focus of utilization management within case management?

  1. Ensuring every client receives identical services
  2. Reducing documentation requirements
  3. Maximizing the number of services a client receives
  4. Evaluating the appropriateness, necessity, and efficiency of care and resources Correct answer.

Explanation

Utilization management examines whether services are appropriate, necessary, and efficiently delivered, balancing quality and cost. It does not aim to maximize volume, standardize all care identically, or reduce documentation.

Question 13Case Management Process and Practice

A client repeatedly misses appointments. What is the best initial case management approach?

  1. Explore barriers such as transportation, cost, and health literacy and adjust the plan Correct answer.
  2. Close the case for noncompliance
  3. Reduce all future contact
  4. Report the client to the authorities

Explanation

Missed appointments often reflect addressable barriers like transportation, scheduling, or understanding, so the case manager investigates and adapts the plan. Closing the case or punitive responses without exploring causes is premature.

Question 14Case Management Process and Practice

Which element is essential for a measurable case management goal?

  1. A specific, time-bound target with observable criteria Correct answer.
  2. A goal that cannot be evaluated
  3. A vague aspiration to improve health
  4. A statement written only by the agency

Explanation

Effective goals are specific, measurable, achievable, relevant, and time-bound, with observable criteria so progress can be evaluated. Vague, unilateral, or unmeasurable goals cannot guide or assess care.

Question 15Case Management Process and Practice

A case manager shares a client's diagnosis with an unauthorized party. Which principle has been violated?

  1. Autonomy
  2. Veracity
  3. Beneficence
  4. Confidentiality Correct answer.

Explanation

Confidentiality protects a client's health information from disclosure without authorization. Beneficence, autonomy, and veracity concern doing good, respecting self-determination, and truthfulness, respectively.

Question 16Case Management Process and Practice

Which activity is part of the transition-of-care planning phase?

  1. Determining caseload ratios
  2. Selecting the initial assessment tool
  3. Coordinating handoffs, follow-up, and needed supports before discharge Correct answer.
  4. Establishing eligibility at intake

Explanation

Transition planning prepares for safe movement between settings by arranging handoffs, follow-up, and supports. Intake eligibility, tool selection, and caseload ratios belong to other phases or administrative functions.

Question 17Case Management Process and Practice

A client lacks capacity to make a specific treatment decision and has no advance directive. What should the case manager do first?

  1. Ask another client for advice
  2. Identify the legally authorized surrogate decision-maker per state law Correct answer.
  3. Make the decision independently
  4. Delay all care indefinitely

Explanation

When a client lacks capacity and no directive exists, decisions should be made by the legally authorized surrogate under state law, guided by the client's known wishes. Independent decision-making, indefinite delay, or consulting other clients is inappropriate.

Question 18Case Management Process and Practice

Which best describes the role of the interdisciplinary team in case management?

  1. Each member works in isolation without sharing information
  2. Members collaborate, share information, and coordinate to meet the client's needs Correct answer.
  3. The team replaces the client's role in planning
  4. Only the physician makes all care decisions

Explanation

Interdisciplinary teams bring varied expertise together, sharing information and coordinating to address the client's full range of needs. Isolation, unilateral physician control, or excluding the client undermines the model.

Question 19Case Management Process and Practice

A case manager documents a home visit. Which entry best meets documentation standards?

  1. "Client doing fine, will follow up."
  2. "Client difficult today."
  3. "See prior note."
  4. "Visited client; noted wound, vital signs, interventions, client response, and next steps with date and signature." Correct answer.

Explanation

Documentation should be objective, specific, and include date, observations, interventions, client response, and follow-up, with proper signature. Vague, judgmental, or cross-referencing entries fail these standards.

Question 20Case Management Process and Practice

Which situation best warrants escalation to a supervisor or clinical team?

  1. A routine request for a resource list
  2. A client asking to reschedule a non-urgent visit
  3. A client expressing imminent intent to harm self or others Correct answer.
  4. A client requesting information about a support group

Explanation

Imminent risk of harm to self or others requires immediate escalation and crisis response per protocol. Routine requests, rescheduling, and informational needs can be handled through standard procedures.

Question 21Case Management Process and Practice

What is the purpose of case closure in the case management process?

  1. To abruptly end services without notice
  2. To avoid documenting outcomes
  3. To transfer all records to the client without review
  4. To formally conclude services when goals are met or services are no longer appropriate, with a transition plan Correct answer.

Explanation

Closure is a planned conclusion that occurs when goals are achieved, the client no longer needs or benefits from services, or the client disengages, and it includes a transition plan and outcome summary. Abrupt termination or skipped documentation is improper.

Question 22Case Management Process and Practice

A case manager notices a pattern of duplicate services across providers for one client. Which action best reflects efficient resource management?

  1. Review the services with providers and the client to eliminate redundancy while preserving needed care Correct answer.
  2. Cancel all services for the client
  3. Ignore the duplication to avoid conflict
  4. Increase the client's services further

Explanation

Efficient resource management involves identifying redundancy and coordinating with providers and the client to streamline services without sacrificing necessary care. Ignoring, eliminating all services, or adding more services are not appropriate responses.

Question 23Case Management Process and Practice

A client's cultural beliefs conflict with a proposed care recommendation. What is the most appropriate case management response?

  1. Discharge the client for noncompliance
  2. Insist on the original recommendation without discussion
  3. Explore the beliefs, negotiate a culturally congruent plan, and document the discussion Correct answer.
  4. Dismiss the beliefs as irrelevant

Explanation

Culturally competent practice explores the client's values and beliefs and negotiates a plan that respects them while addressing health needs, documenting the process. Dismissing beliefs, coercion, or discharge for disagreement is inappropriate.

Question 24Case Management Process and Practice

A case manager receives a request for records from a legal party without a subpoena or client authorization. What is the correct action?

  1. Ask the client to authorize release after disclosing the records
  2. Decline to release until proper legal authority or client authorization is verified Correct answer.
  3. Release the full record immediately
  4. Release a summary of the record

Explanation

Protected health information should only be disclosed with valid authorization or lawful compulsion such as a valid subpoena or court order, verified before release. Immediate release, informal summaries, or post-hoc authorization violate privacy rules.

Question 25Case Management Process and Practice

A client's condition changes significantly, making the existing care plan unsafe. What is the most appropriate case manager action?

  1. Wait for the client to request a change
  2. Document the concern and take no action
  3. Continue the plan until the next scheduled review
  4. Conduct an immediate reassessment, revise the plan, and communicate changes to the team Correct answer.

Explanation

Significant changes in condition require prompt reassessment and revision of the plan, with communication to the care team to ensure safety. Waiting, deferring to the client, or merely documenting without acting leaves the client at risk.

Question 26Case Management Process and Practice

Which document typically authorizes a case manager to share protected health information with a payer for care coordination purposes?

  1. A verbal approval from the client
  2. A referral from the treating physician
  3. A signed consent form specific to the disclosure Correct answer.
  4. A note in the progress record

Explanation

Disclosure of protected health information for coordination with a payer generally requires a valid, signed authorization that identifies the information and recipient. Verbal approval or a chart note does not substitute for a written authorization. A physician referral alone does not authorize disclosure.

Question 27Case Management Process and Practice

Which practice best reflects the principle of client self-determination during care planning?

  1. Setting goals before meeting the client
  2. Selecting the plan the case manager judges safest
  3. Presenting options and supporting the client's informed choice Correct answer.
  4. Deferring all decisions to the family

Explanation

Self-determination means the client makes informed choices about their own care with the case manager's support. The case manager's role is to inform, not to override. Family or clinician preferences do not replace the client's informed decision when the client has capacity.

Question 28Case Management Process and Practice

Which action is the first step when a case manager receives a new referral?

  1. Assigning the client to a caseload
  2. Screening the referral for appropriateness and eligibility Correct answer.
  3. Writing the initial care plan
  4. Scheduling the first home visit

Explanation

The case management process begins with intake and screening to determine whether the client is appropriate for services. Care planning, scheduling, and caseload assignment follow only after eligibility is established. Screening prevents inappropriate allocation of resources.

Question 29Case Management Process and Practice

Which record-keeping practice best supports continuity of care across providers?

  1. Updating the plan only at discharge
  2. Sharing a current, standardized care plan with the care team Correct answer.
  3. Limiting plan access to the case manager
  4. Keeping the plan in the case manager's personal notes

Explanation

Continuity depends on all team members having access to a current, standardized plan that describes goals, interventions, and responsibilities. Restricting access or delaying updates creates gaps in care. Personal notes are not a substitute for the shared record.

Question 30Case Management Process and Practice

A client with diabetes is readmitted twice within 30 days. Which case management action best addresses the underlying pattern?

  1. Scheduling routine follow-up in three months
  2. Closing the case as noncompliant
  3. Conducting a reassessment to identify barriers and revising the plan Correct answer.
  4. Referring the client to a new specialist without review

Explanation

Repeat readmissions signal that the current plan is not meeting the client's needs, so a reassessment identifies barriers such as access, understanding, or social factors. The plan is then revised to address them. Closing the case or delaying follow-up does not resolve the underlying issue.

Question 31Case Management Process and Practice

A client's goal reads: "Client will improve mobility." Which revision makes the goal measurable?

  1. Client will walk 50 feet with a walker unassisted within four weeks Correct answer.
  2. Client will try to be more active
  3. Client will work on mobility as tolerated
  4. Client will feel better about walking soon

Explanation

A measurable goal specifies an observable behavior, a criterion, and a timeframe. Walking a defined distance with a specified device within four weeks meets those criteria. The other options lack measurable targets or timeframes.

Question 32Case Management Process and Practice

A client is discharged from a hospital to home but has no transportation for follow-up appointments. Which case management response is most appropriate?

  1. Advise the client to reschedule when transportation is available
  2. Note the barrier and take no further action
  3. Arrange a transportation resource and document it in the transition plan Correct answer.
  4. Cancel the follow-up appointments

Explanation

Transition planning requires identifying and resolving practical barriers that threaten continuity, such as transportation. Arranging a resource and documenting it supports adherence to follow-up. Leaving the barrier unaddressed increases the risk of poor outcomes.

Question 33Case Management Process and Practice

A case manager must decide which of two clients to contact first. Client A has stable vitals but reports new chest tightness. Client B requests a routine medication refill. Which principle should guide the decision?

  1. Client preference for contact time
  2. Urgency of the presenting need Correct answer.
  3. Order of referral receipt
  4. Length of time on the caseload

Explanation

Prioritization in case management is driven by the urgency and acuity of client needs. New chest tightness is a potentially serious symptom that warrants immediate attention. Administrative requests and referral order are secondary to clinical urgency.

Question 34Case Management Process and Practice

A client with limited health literacy repeatedly misunderstands medication instructions. Which approach is most appropriate?

  1. Provide the standard printed handout again
  2. Increase the number of medications
  3. Ask a family member to manage all medications
  4. Use teach-back and simplified written materials Correct answer.

Explanation

Teach-back confirms understanding by asking the client to explain instructions in their own words, and simplified materials reduce literacy demands. Repeating the same handout or shifting responsibility to family does not build the client's understanding.

Question 35Case Management Process and Practice

A case manager is coordinating care for a client who sees several specialists. Which action best reduces fragmentation?

  1. Maintaining a single shared plan with defined roles for each provider Correct answer.
  2. Limiting communication to written correspondence
  3. Referring the client to additional specialists
  4. Allowing each provider to keep separate records

Explanation

Fragmentation is reduced when all providers work from one coordinated plan with clear role definitions and shared information. Separate records and added referrals increase fragmentation. Communication method matters less than coordination of content.

Question 36Case Management Process and Practice

A client refuses a recommended service that the case manager believes is beneficial. The client has decision-making capacity. What is the most appropriate response?

  1. Report the client as noncompliant to the payer
  2. Override the refusal in the care plan
  3. Terminate the case immediately
  4. Document the informed refusal and continue to offer support Correct answer.

Explanation

A client with capacity may refuse services, and the case manager respects that choice while documenting the informed refusal. The relationship continues with ongoing support and the option to revisit the decision. Overriding or penalizing the client violates autonomy.

Question 37Case Management Process and Practice

A case manager identifies that a client's caregiver is experiencing burnout. Which action best supports the plan of care?

  1. Discharge the client from services
  2. Assess caregiver needs and connect them with respite resources Correct answer.
  3. Take no action because the caregiver is not the client
  4. Increase the caregiver's responsibilities

Explanation

Caregiver burnout threatens the sustainability of the care plan, so the case manager assesses caregiver needs and links them to supports such as respite. Ignoring the caregiver or adding duties increases the risk of breakdown.

Question 38Case Management Process and Practice

A case manager is asked to approve continued inpatient stay for a client whose medical necessity is unclear. Which action best reflects appropriate utilization review practice?

  1. Apply objective criteria and document the clinical rationale Correct answer.
  2. Defer the decision indefinitely
  3. Deny the stay without review
  4. Approve the stay to avoid conflict

Explanation

Utilization review applies objective, evidence-based criteria to determine medical necessity and documents the rationale for the determination. Decisions made to avoid conflict, without review, or left pending undermine the process.

Question 39Case Management Process and Practice

A case manager discovers that a colleague has documented services that were never delivered. What is the most appropriate action?

  1. Discuss it only with the colleague and drop the matter
  2. Ignore it because it is not the case manager's client
  3. Report the concern through the organization's compliance process Correct answer.
  4. Correct the records personally and say nothing

Explanation

Falsified documentation is a compliance and integrity issue that must be reported through established organizational channels. Independently altering records or keeping the matter informal does not meet professional and legal obligations.

Question 40Case Management Process and Practice

A case manager is building a discharge plan for a client with complex needs and limited resources. Which approach best supports a safe transition?

  1. Assume family will provide all needed care
  2. Match services to assessed needs and confirm they are in place before discharge Correct answer.
  3. Rely on the client to arrange services after discharge
  4. Delay planning until the day of discharge

Explanation

Safe transitions require that services match assessed needs and are confirmed before discharge. Assuming family capacity or leaving arrangements to the client after discharge risks gaps in care. Early, verified planning reduces readmission risk.

Question 41Psychosocial and Behavioral Health Concepts

Which theorist is most closely associated with the eight stages of psychosocial development across the lifespan?

  1. Erik Erikson Correct answer.
  2. Jean Piaget
  3. B.F. Skinner
  4. Sigmund Freud

Explanation

Erikson proposed eight psychosocial stages, each defined by a developmental crisis such as trust versus mistrust. His framework spans infancy through late adulthood and emphasizes social and cultural influences.

Question 42Psychosocial and Behavioral Health Concepts

A case manager wants to strengthen a client's commitment to a new behavior by having the client verbally state the plan in front of supportive others. This technique best reflects which concept?

  1. Systematic desensitization
  2. Flooding
  3. Public commitment Correct answer.
  4. Extinction

Explanation

Public commitment draws on the principle that people strive to act consistently with statements made openly, increasing follow-through. It is commonly used to support behavior change plans.

Question 43Psychosocial and Behavioral Health Concepts

In the stages-of-change model, a person who is aware of a problem and intends to take action within the next month is in which stage?

  1. Precontemplation
  2. Contemplation
  3. Maintenance
  4. Preparation Correct answer.

Explanation

The preparation stage is marked by intention to act soon, often within the next 30 days, and may include small initial steps. Contemplation involves awareness without a near-term commitment.

Question 44Psychosocial and Behavioral Health Concepts

A client says, "I know I should stop drinking, but I'm not ready to set a date yet." Which stage of change is most consistent with this statement?

  1. Maintenance
  2. Termination
  3. Contemplation Correct answer.
  4. Action

Explanation

The statement shows awareness of a problem combined with ambivalence and no immediate commitment, which characterizes contemplation. Action and maintenance require the change to already be underway.

Question 45Psychosocial and Behavioral Health Concepts

Which statement best describes the concept of self-efficacy as defined by Bandura?

  1. The degree to which a behavior is reinforced by external rewards
  2. An inherited trait that remains fixed across the lifespan
  3. A person's overall sense of being liked by peers
  4. A person's belief in their capability to execute the actions needed to reach a goal Correct answer.

Explanation

Self-efficacy is a task-specific belief in one's ability to organize and carry out the actions required for a goal. It is shaped by mastery experiences, vicarious learning, persuasion, and physiological states.

Question 46Psychosocial and Behavioral Health Concepts

A client who previously avoided elevators now rides them without distress after gradual practice. This outcome most directly illustrates which process?

  1. Habituation through exposure Correct answer.
  2. Negative reinforcement
  3. Observational learning
  4. Punishment

Explanation

Repeated, graduated exposure to a feared stimulus reduces the conditioned fear response, a process often described as habituation or extinction of the fear response. The client's distress diminishes through practice.

Question 47Psychosocial and Behavioral Health Concepts

Which defense mechanism involves attributing one's own unacceptable feelings to another person?

  1. Regression
  2. Rationalization
  3. Sublimation
  4. Projection Correct answer.

Explanation

Projection is the defense mechanism in which a person attributes their own disowned impulses or feelings to someone else. It differs from rationalization, which involves logical justifications.

Question 48Psychosocial and Behavioral Health Concepts

A client under stress begins sucking their thumb and speaking in a childlike voice. Which defense mechanism is most consistent with this presentation?

  1. Intellectualization
  2. Displacement
  3. Regression Correct answer.
  4. Denial

Explanation

Regression is a return to behaviors characteristic of an earlier developmental stage when faced with stress. The childlike behaviors in this scenario are the hallmark of that mechanism.

Question 49Psychosocial and Behavioral Health Concepts

A person with a strong social support network is most likely to experience which of the following?

  1. Lower adherence to treatment plans
  2. Reduced access to health information
  3. Better coping with stressful life events Correct answer.
  4. Increased physiological stress reactivity

Explanation

Social support serves as a buffer that improves coping and is associated with better psychological and physical health outcomes. Support networks also encourage help-seeking and adherence.

Question 50Psychosocial and Behavioral Health Concepts

According to the biopsychosocial model, which set of factors best explains a client's chronic pain experience?

  1. Social factors only
  2. Psychological factors only
  3. Biological factors only
  4. Biological, psychological, and social factors interacting Correct answer.

Explanation

The biopsychosocial model holds that health outcomes arise from the interaction of biological, psychological, and social factors. Applying it means assessing all three domains rather than privileging one.