CCM (The Commission CCM & CDMS Exams) study plan

Differentiate fee-for-service, capitation, per-diem, DRG, bundled, and shared-savings/value-based models by naming the party that holds financial risk in each

Trace the reimbursement pathway for Medicare, Medicaid, and commercial payers and state the case manager's role at each step

Compute three worked reimbursement scenarios (per-diem, DRG outlier, shared-savings split) without reference notes

Select the correct level of care (inpatient, observation, SNF, home health, outpatient) for 15 written vignettes using explicit criteria

Explain pre-certification, concurrent review, and discharge-planning workflows and the point at which each occurs in an episode

Identify where standard versus expedited appeal processes apply and outline the denial-management sequence

Define each of the six Institute of Medicine aims and attach a case management example to each

Classify 25 quality indicators as structure, process, or outcome and justify each classification

Interpret rates, ratios, risk-adjusted comparisons, and confidence intervals as reported in outcomes studies

Apply a full PDSA cycle to a fictional case management process gap and specify the measures to re-check

Distinguish the focus of NCQA, URAC, and The Joint Commission and state what each accredits or certifies

Read a sample benchmark/report-card table and identify the outlier unit and the likely driver of variation

Match autonomy, beneficence, nonmaleficence, justice, and fidelity to 12 written case scenarios

Apply the case manager's code of conduct to conflicts of interest, dual roles, and boundary situations

Describe how outcome data are used for payer contracting and public reporting

Apply stages-of-change and motivational interviewing techniques to five client-resistance scenarios

Distinguish normal grief, complicated grief, depression, and adjustment reaction, and state the case manager's response to each

Assess family systems and caregiver burden using a structured framework and record findings

Select culturally responsive, health-literate communication strategies for three differing client profiles

Map social determinants and community resources onto a written discharge scenario and justify every referral made

Recognize behavioral health red flags (suicidality, substance misuse, psychosis) and state immediate escalation steps

Score an ADL/IADL functional assessment and convert the scores into prioritized care plan goals

Compare the intensity, eligibility, and payer rules of acute inpatient rehab, SNF, home health, outpatient therapy, and day programs

Describe the adjustment-to-disability process and the case manager's role in vocational, adaptive-equipment, and independent-living planning

Apply HIPAA, ADA, guardianship, and advance-directive rules to 10 scenario prompts

Outline the certification ethics complaint process, record-keeping duties, and mandatory reporting triggers

Explain informed consent and decision-making capacity in the context of transitions of care

Complete two full-length timed practice exams under test-day conditions

Categorize every missed item by domain and by root cause (knowledge gap, misread, elimination error, guess)

Re-drill the two weakest domains with targeted sets until reaching 85% or better

Recite the core reimbursement, quality, psychosocial, rehabilitation, and ethics frameworks from memory in a 20-minute self-quiz