CCM Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

A prognosis of 12 months or less from one physician: Medicare hospice uses a 6-month prognosis, not 12 months.

Certification of a prognosis of 6 months or less: Correct. A physician must certify that life expectancy is 6 months or less if the illness runs its normal course, and the client chooses comfort care over curative treatment for it.

A signed do-not-resuscitate order on file: A DNR order is not required to elect the Medicare hospice benefit.

A qualifying hospital stay of three days: The 3-day stay is a SNF rule; hospice needs no prior hospitalization.

Medicare hospice: terminal prognosis of 6 months or less certified by a physician, and election of comfort care; no DNR or hospital stay required.

Answer: D

Hospice care under the Medicare benefit.: Electing hospice means giving up curative treatment for the terminal illness, which she is still receiving.

Home health aide services for daily help.: Aide services help with personal care but do not provide expert symptom management.

A pain clinic for opioid management only.: A pain clinic addresses one symptom; she needs whole-person symptom and goals-of-care support.

Palliative care during her chemotherapy.: Correct. Palliative care manages symptoms and supports quality of life at any stage of serious illness and can be given together with curative treatment.

Palliative care can accompany curative treatment; hospice is for a prognosis of 6 months or less when curative treatment stops.

Answer: D

Yes, because her total hospital stay was three days: Observation is outpatient care, so the observation night does not count toward the qualifying stay.

Yes, because she needs daily skilled therapy: A daily skilled need is required, but it does not replace the qualifying inpatient stay.

No, because an observation stay blocks SNF coverage: Observation does not block coverage; it simply does not count toward the three inpatient days.

No, because her inpatient stay was under three days: Correct. Original Medicare requires a qualifying inpatient stay of at least three consecutive days (the discharge day not counted); her two inpatient days fall short.

SNF coverage under Original Medicare needs a 3-day inpatient stay plus a daily skilled need; observation days do not count.

Answer: A

The physician's expectation that needed hospital care will span two midnights: Correct. Under the CMS two-midnight benchmark, inpatient admission is generally appropriate when the admitting practitioner reasonably expects the client to need medically necessary hospital care spanning at least two midnights, documented in the record.

Total emergency and observation time already over 24 hours: Twenty-four hours is the MOON threshold; elapsed time alone does not establish the expectation the rule requires.

An order for intravenous antibiotics: A treatment that can be given in observation or outpatient settings does not by itself support inpatient status.

The client's age and number of chronic conditions: Risk factors may inform the decision, but the benchmark rests on the expected duration of medically necessary hospital care.

Two-midnight rule: inpatient status is supported by a documented, reasonable expectation of medically necessary hospital care spanning two or more midnights.

Answer: D

12 months.: Twelve months is not a COBRA period; it is often confused with FMLA's 12 workweeks.

18 months.: Eighteen months applies when the qualifying event is the employee's job loss or reduced hours.

29 months.: Twenty-nine months is the extension for a Social Security disability determination.

36 months.: Correct. When the employee dies, the qualified beneficiary spouse may continue COBRA coverage for up to 36 months.

COBRA: 18 months (job loss/hours), 29 (SSA disability extension), 36 for dependents after death, divorce or Medicare entitlement.

Answer: D

Ask the family to vote and follow the majority view.: A family vote treats the decision as the family's, but a client with capacity makes his own decision.

Defer the decision to the attending physician.: The physician advises on medical needs, but placement for a capable client is his choice.

Meet with each adult child separately, then reconvene.: Separate meetings may lower tension, but they still center the children rather than the father.

Refocus the discussion on the father's own goals.: Correct. Redirecting to the client's goals de-escalates the conflict and respects the self-determination of a client with capacity.

In family conflict, the case manager facilitates by returning to the client's goals; a client with capacity decides, and family input is weighed by him.

Answer: C

Explain that the agency assigns staff by geographic area: Citing agency routine puts the system first and gives her no voice in how care is delivered.

Reassure her that every visiting clinician has passed a background check: Reassurance may help, but it decides for her what should make her feel safe instead of asking.

Ask her preferences for visit times, location and clinician gender: Correct. Offering choice and control applies the SAMHSA principles of safety and of empowerment, voice and choice, and helps avoid re-traumatization.

Refer her to a trauma therapist before scheduling any visits: Therapy may help, but delaying needed care until trauma is treated is not trauma-informed; every service should be delivered in a trauma-informed way.

Trauma-informed care realizes the impact of trauma, recognizes its signs, responds with safety, transparency and choice, and actively resists re-traumatization.

Answer: D

Give the client the 988 Suicide & Crisis Lifeline number.: The 988 Lifeline is a key resource, but handing it over before assessing risk may leave an imminent danger unrecognized.

Notify the client's primary care provider before the end of the day.: Notifying the provider is appropriate after the call, but delaying assessment while the client is on the line is unsafe.

Schedule a home visit later this week to assess her mood.: A visit days later delays assessment of a statement that may signal current suicidal intent.

Ask her directly whether she is having thoughts of suicide.: Correct. A statement of being a burden is a warning sign; asking directly about suicidal thoughts does not increase risk and determines the urgency of the next step.

In crisis intervention, assess safety first: ask directly about suicidal thoughts, plan and means, then connect to the right level of help (988, emergency services or the provider).

Answer: D

NCQA case management accreditation standards.: NCQA standards apply to health plans and programs that seek accreditation, not to every hospital.

URAC hospital case management standards.: URAC accreditation is voluntary and does not set this baseline hospital rule.

HEDIS reporting requirements.: HEDIS is a health plan performance measure set, not a hospital process requirement.

The Medicare Conditions of Participation.: Correct. The CMS Conditions of Participation require hospitals to have an effective discharge planning process, as well as utilization review, to take part in Medicare.

CMS Conditions of Participation set mandatory hospital requirements, including discharge planning and utilization review.

Answer: B

Captioned telephone service.: Captioned phones serve people with hearing loss who speak for themselves and read captions; English text is not her primary language.

Video relay service.: Correct. Video relay lets her sign with a qualified ASL interpreter by video, who voices the call, so she communicates in her own language.

Amplified telephone handset.: Amplification helps people with partial hearing loss; it does not help a client who is Deaf.

Text telephone (TTY) relay call.: TTY relay works but requires typed English; for a fluent ASL user, video relay is the better fit.

Match the relay service to the client: video relay for sign language users, TTY or text relay for typed communication, captioned telephone for people who speak but cannot hear well.

Answer: D

Ask the friend to leave, since only relatives may hear PHI.: HIPAA does not limit sharing to relatives; the client may involve any person she chooses.

Get a signed authorization before talking in front of the friend.: No written authorization is needed when the client is present and agrees to the disclosure.

Share only the facts the friend could already observe.: Limiting the discussion is unnecessary once the client has agreed, and it may weaken the friend's ability to help.

Go ahead, since the client agreed to have the friend present.: Correct. When a capable client is present and agrees, or does not object, PHI may be shared with a family member or friend involved in her care.

HIPAA lets providers share relevant information with family or friends involved in care when the client agrees, or is given the chance to object and does not.

Answer: B

Owes the balance, because anesthesia is billed separately.: Separate billing does not matter; the Act protects patients from out-of-network clinicians at in-network facilities.

Owes only her in-network cost-sharing for the anesthesia.: Correct. For non-emergency services by out-of-network clinicians at an in-network facility, the patient pays only in-network cost-sharing and cannot be balance billed.

Can be billed the balance if she signed a consent at check-in.: Notice-and-consent waivers cannot be used for ancillary services such as anesthesiology, so a consent form does not permit this bill.

The No Surprises Act (in force since January 1, 2022) bans surprise balance bills for emergency care and for out-of-network clinicians at in-network facilities; ancillary clinicians such as anesthesiologists cannot use notice-and-consent waivers.

Answer: C

Ventilation cannot be withdrawn once it has been started.: Ethics and law treat withholding and withdrawing treatment as equivalent; starting treatment does not create a duty to continue it.

Withdrawal requires a court order because death will follow.: Courts are not routinely involved when a capable client refuses treatment.

A capable client may refuse life support, including its withdrawal.: Correct. Refusing or withdrawing treatment allows the disease to take its course and is distinct from assisted suicide; the client's informed choice is honored with comfort care.

Withdrawal is allowed only if the client's family agrees with the decision.: Family agreement is not required for a capable adult's own treatment decision, though support for the family is part of care.

A client with capacity may refuse or stop any treatment, including life support; withdrawing treatment is ethically equivalent to withholding it and is not assisted suicide.