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Case Management CMAC Daily Question

Past questions

Try each one first, then tap to see the answer and the explanation.

Question 1 · Using Data to Create Information, Understanding, and Improvement

A case management department has only 12 cases in a quarter for a quality measure. What caution applies?

  • A. Small numbers make the rate more precise
  • B. Rates cannot be calculated with fewer than 100 cases
  • C. Small numbers make rates unstable, so trend over time
  • D. Small numbers mean the measure should be ignored
Show the answer
C. Small numbers make rates unstable, so trend over time

Small denominators cause large swings that may not reflect true change.

Question 2 · Using Data to Create Information, Understanding, and Improvement

How long does a provider have to request a Medicare redetermination after an initial claim decision?

  • A. 30 days from the date of service
  • B. 120 days from receipt of the notice
  • C. 1 year from the date of service
  • D. 180 days from the redetermination
Show the answer
B. 120 days from receipt of the notice

Redetermination requests to the MAC are due within 120 days.

Question 3 · Using Data to Create Information, Understanding, and Improvement

A predictive model flags 30% of patients as high risk, and case managers cannot reach all of them. What should the director do?

  • A. Turn the model off until staffing improves
  • B. Have staff work the list in alphabetical order
  • C. Tier responses to fit staff capacity
  • D. Lower the threshold so more patients are flagged
Show the answer
C. Tier responses to fit staff capacity

Matching the alert threshold and intervention intensity to staff capacity keeps the program usable.

Question 4 · Using Data to Create Information, Understanding, and Improvement

Which value-based program withholds part of Medicare payments and redistributes it based on quality and efficiency?

  • A. The Hospital Readmissions Reduction Program
  • B. The HAC Reduction Program
  • C. Hospital Value-Based Purchasing
  • D. The Medicare Shared Savings Program
Show the answer
C. Hospital Value-Based Purchasing

HVBP withholds 2% and returns it based on performance.

Question 5 · Using Data to Create Information, Understanding, and Improvement

In a readmission prediction model, what does sensitivity measure?

  • A. The share of flagged patients who were readmitted
  • B. The share of non-readmitted patients not flagged
  • C. Share of readmitted patients flagged
  • D. The overall accuracy of all predictions
Show the answer
C. Share of readmitted patients flagged

Sensitivity is true positives divided by all who were readmitted.

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