Board-Certified Case Manager (CCM) Cheat Sheet

Care Management

30% of exam
Assessment Care planning Coordination Transitions Medication management

Reimbursement Methods

12% of exam
Public benefits Private benefits Payment methods Utilization review Coding

Psychosocial Concepts and Support Systems

20% of exam
Behavior change Client engagement Support systems Social drivers Trauma-informed care

Quality and Outcomes Evaluation and Measurements

10% of exam
Quality indicators Analytics Performance improvement Accreditation Value-based care

Rehabilitation Concepts and Strategies

10% of exam
Functional capacity Adaptive technology Rehab settings Vocational rehabilitation Return to work

Ethical, Legal, and Practice Standards

18% of exam
Ethics Legislation Privacy Documentation Advocacy

Quick Facts

Credential CCM
Credential owner The Commission
Total items 180 multiple-choice
Scored items 150 operational
Unscored items 30 pretest
Exam time 3 hours
Appointment 3.5 hours
Scheduled break 10 minutes; clock pauses
Exam sessions Two; Section 1 locks
Answer choices Three or four

APICME Process CA

Assess Plan Implement Coordinate Monitor Evaluate
A — Assess P — Plan I — Implement C — Coordinate M — Monitor E — Evaluate

Palliative Care vs Hospice CA

Palliative care

Any serious illness stage
May accompany disease treatment

Hospice

Terminal prognosis criteria
Comfort-focused benefit election
Goals and eligibility distinguish them

Choose the First Case Action CA

Immediate safety threat → Stabilize and escalate ( Safety precedes routine planning )
Suspected abuse or neglect → Follow reporting law ( Protect client promptly )
New case referral → Complete comprehensive assessment ( Start with client needs )
Multiple unmet needs → Prioritize acuity and risk ( Address highest risk first )
Client remains uncertain → Elicit values and preferences ( Use shared decisions )
Plan stops progressing → Identify barriers and reassess ( Revise measurable goals )
Care setting changes → Reconcile and hand off ( Close continuity gaps )
Goals are achieved → Evaluate and close ( Document follow-up plan )

Current Exam Blueprint CA

Current administration Updated August 2025
Care Management 45 scored items ±2
Reimbursement Methods 18 scored items ±2
Psychosocial Support 30 scored items ±2
Quality and Outcomes 15 scored items ±2
Rehabilitation 15 scored items ±2
Ethical, Legal, Practice Standards 27 scored items ±2
Exam sessions Two
Scheduled break 10 minutes; clock pauses
Section boundary Section 1 answers lock
Exam time Three hours total
Appointment Three and one-half hours
Answer options Blend of three and four

SMART Goals CA

Specific Measurable Achievable Relevant Time-bound
S — Specific M — Measurable A — Achievable R — Relevant T — Time-bound

Case Management Process CA

Assessment Identify strengths, risks, and needs Start
Planning Set client-centered measurable goals Goals
Implementation Activate agreed interventions Action
Coordination Connect people, services, and settings Link
Monitoring Track progress and barriers Track
Evaluation Compare outcomes against goals Measure
Reassessment Update needs after change Repeat
Transition Ensure safe care continuity Handoff
Closure Document outcomes and follow-up Close
Advocacy Advance informed client preferences Voice

Care Planning Tools CA

SMART goal Specific, measurable, achievable, relevant, time-bound
Shared decision-making Combine evidence with client preferences
Teach-back Client restates instructions
Medication reconciliation Compare lists across transitions
Red-flag education Teach symptoms requiring prompt action
Warm handoff Directly connect receiving provider
Follow-up visit Confirm timely post-transition care
Caregiver readiness Assess ability, willingness, and burden
Health literacy Match information to comprehension
Least restrictive care Maximize safe client autonomy

Care Settings and Levels CA

Inpatient Hospital admission for intensive care
Observation Outpatient status under monitoring
Outpatient Care without inpatient admission
Acute rehabilitation Intensive multidisciplinary rehabilitation
Skilled nursing facility Daily skilled nursing or therapy
LTACH Extended hospital-level complex care
Home health Skilled services in residence
Hospice Comfort-focused terminal care
Palliative care Symptom relief during serious illness
Group home Supported community residential setting

Medicare vs Medicaid RE

Medicare

Federal health insurance
Eligibility-based program
Multiple coverage parts

Medicaid

Federal-state partnership
Needs-based eligibility
Rules vary by state
Verify eligibility and coordination rules

Choose the Coverage Review RE

Service has not started → Prior authorization ( Verify plan requirements )
Care is underway → Concurrent review ( Assess continued necessity )
Care already ended → Retrospective review ( Evaluate delivered services )
Coverage was denied → Follow appeal process ( Meet notice deadlines )
Benefit remains unclear → Verify plan documents ( Avoid promising coverage )
Network option is inadequate → Negotiate single-case agreement ( Document clinical rationale )
Condition is work-related → Review workers compensation ( Coordinate return-to-work needs )
Multiple payers apply → Coordinate benefit rules ( Verify payer order )

Benefit Programs RE

Medicare Federal eligibility-based health coverage Public
Medicaid Joint needs-based health coverage Public
SSI Needs-based disability cash benefit Cash
SSDI Work-credit disability cash benefit Cash
TRICARE Military health benefit program Military
VA benefits Veteran health and benefit system Veterans
COBRA Temporary group coverage continuation Private
PBM Manages prescription drug benefits Pharmacy
Workers compensation Covers work-related injury or illness Employment
Special needs trust Holds assets while preserving benefits Resource
Waiver program Funds home and community services Resource

Capitation vs Fee-for-Service RE

Capitation

Fixed per-member payment
Provider accepts utilization risk

Fee-for-service

Payment per service
Volume increases reimbursement
Follow when payment occurs

Payment and Utilization RE

Fee-for-service Pays per delivered service
Capitation Fixed payment per enrolled member
Bundled payment One payment for episode
Case rate Predetermined amount per case
DRG Inpatient prospective payment category
Value-based care Rewards outcomes and value
Prior authorization Approval before covered service
Concurrent review Review during ongoing care
Retrospective review Review after care delivery
Medical necessity Coverage-linked clinical appropriateness
Deductible Member pays before plan coverage
Copayment Fixed member service payment
Coinsurance Member pays percentage share

Prior Authorization vs Concurrent Review RE

Prior authorization

Occurs before service
Checks prospective coverage

Concurrent review

Occurs during care
Checks continued necessity
Timing determines review type

Psychosocial Tools and Supports PS

Motivational interviewing Elicit personal reasons for change
Active listening Attend, clarify, and summarize
Reflection Mirror meaning without judgment
Trauma-informed care Prioritize safety, choice, and trust
Formal support Agency or professional assistance
Informal support Family, friends, or community
Social drivers Conditions shaping health and access
Health equity Fair opportunity for optimal health
Caregiver burden Strain from caregiving demands
Abuse or neglect Assess safety and reporting duties
Crisis intervention Stabilize immediate risk first
Self-efficacy Belief in performing behavior
Precontemplation Change not yet considered
Preparation Planning near-term behavior change

PDSA Cycle QU

Plan Do Study Act
P — Plan change D — Do test S — Study results A — Act next

Quality Improvement vs Research QU

Quality improvement

Improves local processes
Uses iterative testing

Research

Creates generalizable knowledge
Follows research oversight
Purpose drives classification

Quality and Analytics Tools QU

Structure measure Measures resources and capacity
Process measure Measures delivered care steps
Outcome measure Measures resulting health status
PDSA Test changes through iterative cycles
Root cause analysis Examines causes after event
FMEA Anticipates failures before harm
Benchmark Comparison performance reference
Readmission rate Returns after prior discharge
Length of stay Time occupying care setting
Denial rate Share of claims denied
HEDIS Standardized health plan measures
Predictive modeling Forecasts risk from data
Cost-benefit analysis Compares benefits against costs

Core ADLs RE

Bathing Dressing Toileting Transferring Continence Feeding
Basic self-care Assess needed assistance Link functional supports

Acute Rehabilitation vs Skilled Nursing RE

Acute rehabilitation

Intensive coordinated therapy
Rehabilitation physician oversight

Skilled nursing

Daily skilled services
Lower therapy intensity
Match intensity and tolerance

Choose the Rehabilitation Direction RE

Intensive multidisciplinary therapy tolerated → Consider acute rehabilitation ( Verify admission criteria )
Extended hospital intensity required → Consider LTACH ( Match complex medical needs )
Daily skilled services required → Consider skilled nursing ( Verify benefit criteria )
Homebound skilled need exists → Consider home health ( Assess home safety )
Terminal comfort goals dominate → Consider hospice referral ( Verify program eligibility )
Serious illness symptoms persist → Consider palliative care ( Concurrent treatment may continue )
Job demands exceed function → Start vocational rehabilitation ( Analyze essential duties )
Daily function is unclear → Assess ADLs and IADLs ( Match supports to deficits )

Rehabilitation Tools and Resources RE

ADL Basic personal care activity
IADL Complex independent living activity
Functional capacity evaluation Measures work-related functional abilities
Job analysis Defines essential job demands
Reasonable accommodation Enables qualified worker participation
Assistive technology Supports function and independence
Life care plan Projects lifelong support needs
Return-to-work plan Coordinates safe work reintegration
Vocational rehabilitation Restores employment participation
Substance-use rehabilitation Supports recovery and functioning
Orientation and mobility Builds safe navigation skills

Ethics Compass PR

Choice Benefit No Harm Fairness Truth Trust
Choice — Autonomy Benefit — Beneficence No harm — Nonmaleficence Fairness — Justice Truth — Veracity Trust — Fidelity

Capacity vs Competence PR

Capacity

Clinical decision ability
Decision-specific and changeable

Competence

Legal status
Determined by court
Clinicians assess; courts determine

Ethical Principles PR

Autonomy Respect informed client choices
Beneficence Act for client benefit
Nonmaleficence Avoid causing preventable harm
Justice Promote fairness and equity
Veracity Communicate truthfully
Fidelity Keep commitments and trust
Informed consent Voluntary decision after disclosure
Self-determination Client directs personal goals
Conflict of interest Disclose and manage competing interests
Scope of practice Stay within authorized competence

Law and Documentation PR

HIPAA Protects identifiable health information
Minimum necessary Limit non-treatment disclosures appropriately
EMTALA Requires screening and stabilization
ADA Prohibits disability discrimination
FMLA Provides qualifying job-protected leave
Affordable Care Act Federal health coverage reforms
No Surprises Act Limits qualifying surprise bills
OSHA Sets workplace safety requirements
Mandatory reporting Follow applicable reporting law
Objective documentation Record observable relevant facts
Late entry Label additions with actual date
Incident report Supports organizational risk review
Advance directive States future care preferences
Health care proxy Designates surrogate decision-maker
Capacity Clinical ability to decide
Competence Legal status determined judicially

Common Traps

Operational vs Pretest Items

150 operational items are scored ≠ 30 pretest items are unscored

Coverage Is Never Guaranteed

Verify current plan terms ≠ Explain limitations clearly

Assessment Comes Before Intervention

Address immediate safety first ≠ Otherwise assess before planning

Client Choice Drives Planning

Provide informed options ≠ Respect capable refusal

Capacity Is Not Competence

Capacity is clinically assessed ≠ Competence is legally determined

Privacy Has Permitted Uses

Apply applicable privacy rules ≠ Limit unnecessary disclosures

Palliative Is Not Hospice

Palliative care spans illness stages ≠ Hospice requires qualifying criteria

Document Facts Not Conclusions

Use objective observable language ≠ Record actions and responses

Section 1 Locks at Break

Review Section 1 before break ≠ Earlier items cannot be revisited

Last Minute

1. Care 30%; psychosocial 20%; ethics 18%
2. Reimbursement 12%; quality and rehab 10%
3. Lead with safety and assessment
4. Center client goals and autonomy
5. Match review type to timing
6. Separate Medicare from Medicaid
7. Compare care setting intensity
8. Know ADLs versus IADLs
9. Use PDSA for improvement
10. Separate capacity from competence
11. Protect privacy and confidentiality
12. Document objectively and promptly
13. Escalate mandatory reporting duties
14. 30 pretest items are unscored
15. Three exam hours; two sessions
16. Break = 10 paused minutes
17. Review Section 1 before break

CCM

Practice Questions 251 questions Study Guide 34 topics Cheat Sheet 131 facts Flashcards 50 cards Shorts 2 short s Free CE Podcast