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ACM practice questions

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Question 1Case Management Concepts, Models, and Principles

Which statement best defines case management as a professional practice?

  1. A marketing function that health plans use to recruit employer groups
  2. A financial audit that verifies whether submitted claims were coded correctly
  3. A collaborative process of assessing, planning, and coordinating services Correct answer.
  4. A clinical procedure performed only by physicians during a hospital stay

Explanation

Case management is a collaborative process of assessment, planning, facilitation, coordination, and evaluation of options and services to meet an individual's health needs. It is a coordination discipline, not a payment-integrity audit, a physician-only procedure, or a marketing activity.

Question 2Case Management Concepts, Models, and Principles

Which activity begins the case management process for a newly referred client?

  1. Reporting outcome measures to the program sponsor
  2. Developing a long-range cost projection for the payer organization
  3. Assessing the client's needs, strengths, and functional status Correct answer.
  4. Scheduling the discharge planning meeting

Explanation

The process opens with a comprehensive assessment that gathers clinical, functional, social, and resource information about the client. Planning, facilitation, coordination, monitoring, and evaluation all build on that assessment data.

Question 3Case Management Concepts, Models, and Principles

A case manager arranges a transportation voucher and enrolls a client in a food assistance program. Which role is being performed?

  1. Educator
  2. Broker Correct answer.
  3. Clinician
  4. Auditor

Explanation

The broker role links clients to needed services, benefits, and resources that exist outside the case manager's own practice. Delivering treatment, auditing records, and teaching self-care skills belong to other roles.

Question 4Case Management Concepts, Models, and Principles

Which action best illustrates the advocate role?

  1. Scheduling appointments and confirming that the client attends
  2. Reviewing claims history to identify duplicate payments
  3. Making sure the client's preferences are heard during care planning Correct answer.
  4. Submitting the payer's authorization request before the deadline

Explanation

Advocacy means representing the client's interests and voice so that preferences and rights are honored in decisions made by others. Meeting payer deadlines, scheduling, and claims review are administrative or coordination tasks.

Question 5Case Management Concepts, Models, and Principles

A neighbor calls a case manager and asks about a client's diagnosis. What is the most appropriate response?

  1. Transfer the call to the client's primary care physician
  2. Describe the treatment plan without stating the client's name
  3. Decline to confirm or discuss the client's health information Correct answer.
  4. Confirm the diagnosis but ask the neighbor to keep it confidential

Explanation

Protected health information may be shared only with the client or with persons the client has authorized, so the case manager must neither confirm nor deny clinical details. Promising confidentiality, anonymizing details, or redirecting the call still discloses or mishandles the information.

Question 6Case Management Concepts, Models, and Principles

Which practice is most consistent with a client-centered approach?

  1. Goals are chosen to match the services the agency already offers
  2. The team sets the goals and then explains them to the client
  3. Goals are set jointly with the client around the client's priorities Correct answer.
  4. Goals reflect the payer's cost targets rather than client preference

Explanation

A client-centered approach places the person's own values, priorities, and preferences at the center of goal setting, which requires collaboration rather than announcement. Agency convenience and payer cost targets are legitimate considerations but cannot displace the client's stated priorities.

Question 7Case Management Concepts, Models, and Principles

Which action best demonstrates cultural competence?

  1. Asking how decisions are made within the client's family Correct answer.
  2. Using published group norms to predict a client's behavior
  3. Avoiding any mention of culture so that bias cannot enter
  4. Applying one standard care plan to every client for consistency

Explanation

Cultural competence requires learning how each individual client and family understand health, make decisions, and prefer to communicate. Uniform plans ignore differences, silence leaves assumptions unchecked, and group generalizations substitute stereotypes for assessment.

Question 8Case Management Concepts, Models, and Principles

What is the main purpose of the case management care plan?

  1. To serve as the permanent legal record of all clinical orders
  2. To provide department managers with a productivity measure
  3. To list every covered benefit available under the payer contract
  4. To record agreed goals, actions, and assigned responsibilities Correct answer.

Explanation

The care plan documents the goals agreed with the client, the actions to be taken, the responsible parties, and the time frames, and it is revised as needs change. It is a working coordination tool, not a benefits list, a productivity metric, or the medical order record.

Question 9Case Management Concepts, Models, and Principles

Which activity falls most clearly within utilization review rather than case management?

  1. Building a long-term plan around the client's life goals
  2. Applying medical necessity criteria to a requested admission Correct answer.
  3. Coaching a client on medication self-management
  4. Linkage to community resources across several agencies

Explanation

Utilization review evaluates whether a requested service or level of care meets medical necessity and coverage criteria. Coaching, resource linkage, and long-range goal planning are case management activities aimed at coordinating care rather than adjudicating appropriateness.

Question 10Case Management Concepts, Models, and Principles

Which is a component of the Chronic Care Model developed by Wagner and colleagues?

  1. Provider credentialing
  2. Claims adjudication workflow
  3. Formulary tier assignment
  4. Delivery system design Correct answer.

Explanation

The Chronic Care Model identifies community resources, health system organization, self-management support, delivery system design, decision support, and clinical information systems as the elements that drive better chronic illness outcomes. Claims workflows, credentialing, and formulary tiers are payer administrative functions, not model components.

Question 11Case Management Concepts, Models, and Principles

The Transitional Care Model is best described as:

  1. A payer program that denies payment for readmissions within thirty days
  2. A volunteer program that pairs hospitalized adults with community mentors
  3. A pharmacy model that manages drug interactions in ambulatory clinics
  4. An advanced practice nurse-led program for high-risk elders leaving the hospital Correct answer.

Explanation

The Transitional Care Model uses advanced practice nurses to manage the hospital-to-home transition for high-risk older adults through assessment, planning, coaching, and follow-up. It is a structured clinical model, not a payment policy, a pharmacy program, or a volunteer match.

Question 12Case Management Concepts, Models, and Principles

Which description matches the Guided Care model?

  1. A nurse in primary care coordinating care for multimorbid adults Correct answer.
  2. A telephonic vendor that performs annual health risk appraisals
  3. A hospitalist team that rounds daily on every admitted patient
  4. A specialty clinic focused on a single chronic disease

Explanation

Guided Care embeds a registered nurse within a primary care practice to coordinate care for older adults with multiple chronic conditions, working closely with the physicians and the patient's family. It is practice-based and longitudinal rather than hospital-based, telephonic, or disease-specific.

Question 13Case Management Concepts, Models, and Principles

A plan uses a predictive model to identify members most likely to be hospitalized next year. This practice is called:

  1. Retrospective claims audit
  2. Credentialing
  3. Risk stratification Correct answer.
  4. Concurrent review

Explanation

Risk stratification uses clinical and utilization data to sort a population by likelihood of future high-cost events so that case management resources go where they are most needed. Concurrent review judges care during an episode, and retrospective audit looks backward at paid claims.

Question 14Case Management Concepts, Models, and Principles

Which factor should most influence how a case manager's caseload is sized?

  1. The square footage of the case management office
  2. The acuity and complexity of the clients on the panel Correct answer.
  3. The weekday on which most referrals happen to arrive
  4. The number of years the case manager has been licensed

Explanation

Caseloads are sized by the intensity of work the panel requires, which is driven by acuity, complexity, and the number of transitions and psychosocial needs involved. Tenure, office space, and referral timing do not describe the work demands of the panel.

Question 15Case Management Concepts, Models, and Principles

A client says, "I know I should check my blood sugar, but I just can't face it." Which reply fits motivational interviewing?

  1. It sounds exhausting to keep that up every single day. Correct answer.
  2. Have you thought about how much better you would feel?
  3. Most people your age find daily testing difficult too.
  4. You really need to check it or you will end up in the hospital.

Explanation

Motivational interviewing relies on reflective listening that acknowledges the client's experience and supports autonomy, which lowers resistance and opens the door to change talk. Warning, persuading, and normalizing all direct the conversation away from the client's own reasons for change.

Question 16Case Management Concepts, Models, and Principles

A competent adult declines a skilled nursing placement that the team considers safest. What should the case manager do?

  1. Ask a family member to sign the placement paperwork instead
  2. Respect the refusal and explore alternatives the client will accept Correct answer.
  3. Override the refusal because the team's judgment is stronger
  4. Document the refusal and close the case as noncompliant

Explanation

A decisionally capable adult holds the right to accept or refuse recommended care, so the case manager must honor autonomy while continuing to offer and arrange acceptable alternatives. Overriding the refusal, routing around it through the family, or closing the case as noncompliant all violate that principle.

Question 17Case Management Concepts, Models, and Principles

Team members disagree about discharge timing. What is the most effective first step?

  1. Clarify each discipline's concerns and agree on shared goals Correct answer.
  2. Defer to the physician, who carries legal responsibility
  3. Escalate immediately to the payer's medical director
  4. Follow a majority vote of the team members present

Explanation

Interdisciplinary collaboration works by surfacing each discipline's perspective and re-anchoring the team on shared client-centered goals before deciding. Automatic deference, majority voting, or immediate escalation bypasses the collaboration that produces durable plans.

Question 18Case Management Concepts, Models, and Principles

A client keeps missing appointments because of unreliable transportation. What is the best response?

  1. Report the client to a licensing board for abandoning treatment
  2. Keep scheduling the same times and note the pattern in the record
  3. Discharge the client for repeated noncompliance with the plan
  4. Address transportation as a barrier and link the client to resources Correct answer.

Explanation

Missed appointments usually signal an unmet practical need rather than unwillingness, so the case manager treats transportation as a barrier to be solved and connects the client to resources. Discharge, reporting, or passive record-keeping leaves the underlying cause untouched.

Question 19Case Management Concepts, Models, and Principles

Which statement best distinguishes care coordination from case management?

  1. Case management is limited by law to nurses, while care coordination is not
  2. Care coordination centers on sharing information, while case management is broader Correct answer.
  3. The two terms are legally identical and may be used interchangeably
  4. Care coordination applies only to inpatients, not to outpatients

Explanation

Care coordination describes the deliberate organization of information and activities among participants, and it is one component of the larger case management process. Case management also includes assessment, planning, monitoring, evaluation, and outcome accountability.

Question 20Case Management Concepts, Models, and Principles

Which set of interventions is most strongly linked to fewer thirty-day readmissions?

  1. Limiting the discharge summary to the attending physician
  2. Medication reconciliation, prompt follow-up, and teach-back education Correct answer.
  3. Higher copayments for inpatient stays and emergency visits
  4. Longer lengths of stay with no post-discharge contact

Explanation

Readmission risk falls when medications are reconciled across settings, follow-up occurs soon after discharge, and clients can restate their instructions, which confirms understanding. Cost shifting, longer stays without follow-up, and restricted communication all leave transition gaps in place.

Question 21Case Management Concepts, Models, and Principles

An employer asks the case management program to show its financial value. Which measure is most appropriate?

  1. Total telephone contacts completed during the year
  2. Average length of each documentation note
  3. Number of case managers employed per thousand members
  4. Cost avoidance versus a matched comparison group Correct answer.

Explanation

Value is demonstrated by comparing outcomes and costs with a credible comparison group so that savings can be attributed to the program rather than to trend or selection. Staffing ratios, contact counts, and note length describe activity, not financial impact.

Question 22Case Management Concepts, Models, and Principles

In a primary care case management model, the case manager usually:

  1. Is a payer employee with no contact with the practice
  2. Provides psychotherapy to every patient in the practice
  3. Reviews only inpatient stays after an admission occurs
  4. Works with the practice to coordinate referrals and follow-up Correct answer.

Explanation

Primary care case management places the coordinating function close to the medical home, so the case manager collaborates with the practice on referrals, follow-up, and self-management support. The model is neither a detached payer function nor an inpatient-only or psychotherapy service.

Question 23Case Management Concepts, Models, and Principles

A case manager and a payer reviewer disagree about the appropriate level of care. Which approach is best?

  1. Accept the denial without discussion in order to avoid conflict
  2. Resubmit the same request repeatedly until the reviewer approves it
  3. Discuss documented criteria and seek mutually acceptable options Correct answer.
  4. Report the reviewer to an accreditation body unless approval is granted

Explanation

Interest-based negotiation anchors the conversation in the documented clinical criteria and the shared goal of appropriate care, which makes a durable agreement more likely. Repetition, threats, and silent acceptance either fail to resolve the disagreement or harm the working relationship.

Question 24Case Management Concepts, Models, and Principles

A non-licensed case manager is asked whether a new medication is safe. What is the appropriate action?

  1. Read the package insert aloud and interpret it for the client
  2. Decline to help and end the conversation abruptly
  3. Refer the question to the prescriber or a pharmacist Correct answer.
  4. Answer from personal experience with the medication

Explanation

Clinical interpretation of medication safety falls outside a non-licensed case manager's scope, so the correct move is to connect the client to a qualified professional. Guessing from personal experience, interpreting labeling, or abandoning the client all fail either scope or duty.

Question 25Case Management Concepts, Models, and Principles

Which statement best describes case management intensity?

  1. The length of the initial assessment document
  2. The frequency and depth of contact matched to client risk Correct answer.
  3. The number of hours a case manager works each week
  4. The dollar value of services authorized per member

Explanation

Intensity describes how often and how deeply the case manager engages with a client, calibrated to acuity, complexity, and stability, and it is adjusted as risk changes. Work hours, document length, and authorization dollars describe the worker, the paperwork, or the benefit rather than the service level.

Question 26Case Management Concepts, Models, and Principles

Within the case management process, which activity is normally performed first for a newly referred client?

  1. Reviewing the discharge plan with the treatment team before meeting the client
  2. Closing the case and summarizing outcomes achieved against the plan
  3. Negotiating the reimbursement rate for each service the client will receive prior to intake
  4. Assessing the client's needs, strengths, and available resources Correct answer.

Explanation

The case management process is sequential, and a comprehensive assessment of needs, strengths, and resources must precede planning and coordination. Rate negotiation, discharge planning, and case closure all depend on information gathered during assessment.

Question 27Case Management Concepts, Models, and Principles

Which source most directly defines the expected roles, functions, and competencies of case management practice?

  1. The payer's claims submission, coding, and billing policy manual
  2. The facility's annual employee engagement and satisfaction survey results
  3. The client's signed advance directive and durable power of attorney documents
  4. The Standards of Practice issued by the professional case management body Correct answer.

Explanation

Professional standards of practice describe the scope, roles, functions, and competencies expected of case managers and serve as the benchmark for practice and evaluation. The other documents address individual preferences, payment mechanics, or workforce morale rather than professional role expectations.

Question 28Case Management Concepts, Models, and Principles

In the brokerage model of case management, the case manager's central function is to:

  1. Provide long-term psychotherapy focused on resolving early childhood experiences
  2. Link the client to needed services and coordinate referrals within a time-limited role Correct answer.
  3. Assume full financial risk for the client's total cost of care across the continuum
  4. Deliver most of the client's direct clinical, nursing, and personal care personally

Explanation

Brokerage case management is a linkage model: the case manager matches the client to existing services, coordinates referrals, and advocates for access rather than providing treatment. It is typically time-limited and does not carry financial risk or a clinical treatment role.

Question 29Case Management Concepts, Models, and Principles

A program serves adults with serious mental illness through a multidisciplinary team, shared caseloads, low client-to-staff ratios, and assertive outreach that continues through crises. This program design is best identified as:

  1. A wellness and health promotion program
  2. A patient-centered medical home
  3. Assertive community treatment Correct answer.
  4. A disease management program

Explanation

Assertive community treatment is defined by team-based, shared caseloads, low ratios, and persistent outreach in the community, including during crises. Disease management, medical homes, and wellness programs do not carry this specific staffing and outreach structure.

Question 30Case Management Concepts, Models, and Principles

A case manager has one opening in a supported housing program and two eligible clients whose needs are similarly urgent. Which approach best reflects sound ethical practice?

  1. Assign the opening to the client who has been enrolled in the program's services the longest
  2. Apply transparent, pre-established, needs-based criteria and document the rationale for the decision Correct answer.
  3. Reserve the opening for the client whose family has contacted the program most often and most persistently
  4. Hold the opening until the two clients and their families agree between themselves who should receive it

Explanation

When a scarce resource must be allocated among similarly situated clients, distributive justice requires consistent, predefined, needs-based criteria applied transparently and documented. Pressure from families, self-selection by clients, and simple tenure do not provide an equitable or defensible basis for allocation.

Question 31Assessment, Planning, and Care Coordination

A case manager is assessing an older adult's ability to live independently. Which activity is classified as an instrumental activity of daily living (IADL)?

  1. Bathing without assistance
  2. Transferring from bed to a chair
  3. Managing personal finances Correct answer.
  4. Maintaining bowel and bladder control

Explanation

Instrumental activities of daily living are the higher-order tasks required to function in the community, such as managing money, shopping, cooking, using transportation, and handling medications. Bathing, transferring, and continence are basic self-care activities (ADLs) rather than IADLs.

Question 32Assessment, Planning, and Care Coordination

A hospital case manager receives a new referral for a patient admitted two hours ago. When should the initial case management assessment ideally be completed?

  1. Within 30 days of the admission date
  2. Early in the admission, once the patient is stable enough to participate Correct answer.
  3. Only after the physician writes the discharge orders
  4. After the payer has issued the authorization decision

Explanation

The initial assessment is performed early in the stay, as soon as the patient can participate meaningfully, because discharge needs, risk factors, and barriers must be identified while there is still time to plan and intervene. Delaying until discharge orders or payer authorization eliminates the opportunity to prevent avoidable days and unsafe transitions.

Question 33Assessment, Planning, and Care Coordination

Which statement represents a well-written, measurable goal in a case management care plan?

  1. Patient will be motivated to improve overall health
  2. Patient will receive appropriate follow-up care after discharge
  3. Ambulate 100 feet with a walker by day 3 Correct answer.
  4. Patient will understand discharge instructions fully

Explanation

A measurable goal specifies an observable behavior, a performance criterion, and a timeframe. Ambulating a defined distance with a device by a specific day contains all three elements, allowing the team to evaluate whether the goal was met.

Question 34Assessment, Planning, and Care Coordination

Which factor most strongly supports a safe discharge to the patient's own home?

  1. The availability of a hospital bed in case a readmission occurs
  2. The patient's strong preference to return home regardless of support
  3. A caregiver and environment that can meet the patient's needs Correct answer.
  4. The driving distance between the hospital and the patient's home

Explanation

Discharge safety is determined chiefly by whether the receiving environment and caregivers can meet the patient's functional, medical, and supervision needs. Preference and proximity matter for logistics but do not by themselves make a discharge plan safe.

Question 35Assessment, Planning, and Care Coordination

A case manager wants an efficient way to identify patients who may have limited health literacy. Which approach is most appropriate?

  1. Rely on the questions the patient asks during rounds
  2. Ask whether the patient speaks English fluently
  3. Review the patient's highest level of education completed
  4. Use a validated health literacy screening tool Correct answer.

Explanation

Health literacy cannot be reliably inferred from education level, language fluency, or question-asking behavior, so a validated screening instrument is recommended. Screening then guides the use of teach-back, plain-language materials, and additional support.

Question 36Assessment, Planning, and Care Coordination

Before a patient with a new stroke resumes oral intake, which team member is primarily responsible for evaluating swallowing safety?

  1. Occupational therapist
  2. Registered dietitian
  3. Respiratory therapist
  4. Speech-language pathologist Correct answer.

Explanation

Swallowing function and aspiration risk are assessed by the speech-language pathologist, who also recommends diet textures and compensatory strategies. Other team members contribute to nutrition and airway management but do not perform the swallow evaluation.

Question 37Assessment, Planning, and Care Coordination

A hospitalized patient with intact decision-making capacity tells the case manager he does not want cardiopulmonary resuscitation. What is the most appropriate action?

  1. Obtain the family's approval before documenting the wish
  2. Ask the ethics committee to review and override the decision
  3. Document the wish and ensure the proper form is completed and filed Correct answer.
  4. Defer the discussion until the patient loses decision-making capacity

Explanation

A patient with capacity may accept or refuse any treatment, including resuscitation, and the case manager's role is to make sure that decision is captured in the record and in the correct state-recognized document. The order or directive must then travel with the patient across settings.

Question 38Assessment, Planning, and Care Coordination

During a home visit, a case manager notes that the daughter caring for a patient with advanced dementia has missed several workdays and appears exhausted. What is the most appropriate response?

  1. Complete a caregiver assessment and offer respite services Correct answer.
  2. Reassess the patient for nursing home placement immediately
  3. Advise the daughter to hire a private caregiver at her own expense
  4. Report the daughter to adult protective services for neglect

Explanation

Caregiver strain is a common and treatable barrier to a sustainable home plan; a structured caregiver assessment identifies burden and links the family to respite, training, and financial support. Exhaustion alone is not evidence of abuse and does not automatically require institutional placement.

Question 39Assessment, Planning, and Care Coordination

A patient with heart failure says, "I don't see why I need to weigh myself every day." Which response best reflects motivational interviewing?

  1. What have you heard about why daily weights might matter for you? Correct answer.
  2. Daily weights help you catch fluid gain before you feel short of breath
  3. You will end up back in the hospital if you skip your daily weights
  4. I will have the clinic nurse weigh you at your next visit

Explanation

Motivational interviewing uses open-ended questions and reflective listening to evoke the patient's own reasons for a behavior rather than supplying warnings or unsolicited advice. Eliciting the patient's perspective supports autonomy and builds commitment.

Question 40Assessment, Planning, and Care Coordination

At discharge, the case manager learns the patient is still taking a medication that was discontinued during the hospitalization. What is the priority action?

  1. Resolve the discrepancy with the prescriber and provide a reconciled list Correct answer.
  2. Ask the outpatient pharmacy to call the patient in one week
  3. Instruct the patient to bring all bottles to the next clinic visit
  4. Note the discrepancy in the discharge summary for the primary care provider

Explanation

Medication reconciliation at a transition requires resolving the discrepancy with the prescriber and giving the patient and the next provider an accurate, current list. Simply flagging the problem shifts the risk of error to the patient and the receiving clinician.

Question 41Assessment, Planning, and Care Coordination

A patient no longer requires acute hospital care but needs daily skilled nursing and physical therapy before returning home. Which setting best matches these needs?

  1. Long-term acute care hospital
  2. Inpatient psychiatric unit
  3. Assisted living facility
  4. Skilled nursing facility Correct answer.

Explanation

A skilled nursing facility provides daily skilled nursing and rehabilitative therapy for patients who are medically stable but not yet able to manage at home. Long-term acute care is for prolonged complex medical care, assisted living is non-skilled, and psychiatric care addresses behavioral health needs.

Question 42Assessment, Planning, and Care Coordination

Which patient best meets the criteria for admission to an inpatient rehabilitation facility rather than a skilled nursing facility?

  1. A patient who requires continuous cardiac monitoring
  2. A patient whose main need is help with bathing and dressing
  3. A patient who can participate in three hours of therapy daily Correct answer.
  4. A patient who needs IV antibiotics and frequent wound checks

Explanation

Inpatient rehabilitation facilities require that the patient need and be able to tolerate at least three hours of therapy per day, with a rehabilitation physician directing care. Patients who need primarily medical monitoring belong in a hospital or skilled nursing setting, and those needing only custodial help do not meet rehab criteria.

Question 43Assessment, Planning, and Care Coordination

Before ordering a hospital bed for a patient's home, the case manager should first do which of the following?

  1. Obtain the family's verbal agreement to accept the bed
  2. Document the order in the chart after the bed is delivered
  3. Ask the vendor to deliver the bed on the day of discharge
  4. Confirm the home can accommodate it and verify payer coverage Correct answer.

Explanation

Durable medical equipment must fit the physical environment and be a covered benefit with the required documentation before it is ordered. Delivery logistics and documentation follow these verifications rather than preceding them.

Question 44Assessment, Planning, and Care Coordination

Which element is essential to include in a structured handoff to the next care setting?

  1. The names of all clinicians who rounded during the stay
  2. A list of the patient's hospitalizations over the past five years
  3. Pending test results and the plan for following them up Correct answer.
  4. The patient's full insurance and financial history

Explanation

A structured handoff must convey pending results, who is accountable for follow-up, current medications, active problems, and the patient's condition and goals. Omitting pending results is a well-recognized cause of missed follow-up and readmission.

Question 45Assessment, Planning, and Care Coordination

A patient with limited English proficiency is being taught how to take a new medication. Which approach is appropriate?

  1. Have the patient sign a form stating teaching was given in English
  2. Ask the patient's 12-year-old child to interpret the teaching
  3. Speak slowly and loudly in English and check for understanding
  4. Use a qualified medical interpreter and translated written materials Correct answer.

Explanation

Patients with limited English proficiency are entitled to a qualified medical interpreter and written materials in their preferred language. Using untrained family members, especially children, or simply speaking louder does not provide meaningful access and increases the risk of error.

Question 46Assessment, Planning, and Care Coordination

A patient with advanced cancer has been hospitalized three times in two months and reports steadily declining function. Which action best fits the case manager's role?

  1. Enroll the family in another readmission prevention education class
  2. Arrange a skilled nursing facility placement without further discussion
  3. Delay any discussion until the oncologist raises the topic at a later visit
  4. Explore goals and values and offer a palliative care consult Correct answer.

Explanation

Repeated admissions with declining function suggest unmet goals-of-care and symptom needs. The case manager should elicit what matters most to the patient and offer specialty palliative support, which can be provided alongside curative treatment.

Question 47Assessment, Planning, and Care Coordination

Which method best confirms that a patient understands the discharge plan?

  1. Documenting that education was provided before discharge
  2. Having the patient explain the plan in his or her own words Correct answer.
  3. Asking the patient whether there are any questions
  4. Providing a written summary at a twelfth-grade reading level

Explanation

Teach-back, in which the patient restates the plan in his or her own words, is the most reliable way to confirm comprehension because it reveals specific misunderstandings. General question prompts and documentation of teaching do not demonstrate that learning occurred.

Question 48Assessment, Planning, and Care Coordination

A payer denies a continued inpatient stay as not medically necessary. What is the case manager's most appropriate first step?

  1. Ask the family to pay privately for the remaining days
  2. Discharge the patient immediately to avoid financial liability
  3. Bill the patient for the days the payer has denied
  4. Review the criteria with the physician and appeal if warranted Correct answer.

Explanation

When a denial occurs, the case manager reviews the level-of-care criteria with the treating physician, confirms that documentation supports the continued stay, and initiates the appeal process when the clinical picture justifies it. Discharge or patient billing decisions are never driven by the denial alone.

Question 49Assessment, Planning, and Care Coordination

An older adult who lives alone has adequate income but cannot shop for groceries or prepare meals. Which resource best addresses this specific gap?

  1. Home-delivered meals and grocery delivery services Correct answer.
  2. A caregiver support group
  3. Medicaid nursing home placement
  4. Admission to a long-term acute care hospital

Explanation

The identified need is a practical IADL deficit in meal preparation and shopping, which home-delivered meals and grocery delivery directly address while allowing the person to remain at home. Institutional options are disproportionate to the need and do not match the person's resources.

Question 50Assessment, Planning, and Care Coordination

Which entry best reflects effective case management documentation?

  1. Case reviewed with the team; no further case management action needed at this time
  2. No caregiver at home; home health evaluation ordered for 3/12; PCP appointment scheduled 3/15 Correct answer.
  3. Family members were difficult during the visit and required repeated redirection
  4. Patient seen by case management today; will continue to follow as needed

Explanation

Case management documentation should record the identified need, the intervention initiated, and the follow-up plan with specific dates so care is coordinated and auditable. Entries that record impressions or intentions without concrete actions cannot support continuity or demonstrate value.