We recently received this article written by Vivian Campagna, MSN, RN-BC, CCM, from CCMC and thought it would be beneficial to know how to use the knowledge domains to study for the CCM. (Note the highlighter tip, which is part of Deanna’s Successful Study Strategies.)
Whenever I’m with a group of case managers, it’s common to get questions about the essential knowledge domains and corresponding subdomains used as the content blueprint for the exam. Where do they come from? Why do they matter? And (the most frequent question) how do I use them to study?
The CCM® exam is designed to evaluate a case manager’s job-based competency. That requires us to stay on top of current trends and practices in case management. The Commission is the only case management certification body that fields a research-based survey every five years (the CCMC Role and Function Study), to ensure we do just that. We ask thousands of case managers—both certified and not yet certified—about knowledge, skills and activities required in today’s practice. The robust, statistically significant findings inform the knowledge tested by the CCM exam and that’s where the knowledge domains come from.
The most recent study identified five major domains of essential knowledge, each of which represents the core knowledge used by case management professionals across the care continuum. Every time the exam is administered, it contains a carefully weighted number of “items” (questions) from each of the knowledge domains. In that way, the exam as a whole reflects the job-based competency knowledge, skills and activities revealed through the Role and Function Study. That’s important to employers and the health care industry because it’s assurance that a CCM is truly prepared with the essential knowledge required to perform the job with competence.
To further illuminate the essential knowledge included within those domains, the Commission divides them into more than 80 subdomains. So, for example, the Ethical, Legal, and Practice Standards domain has a dozen subdomains that include what types of ethical, legal and practice standards are tested on the CCM exam.
When applicants first see that long list of subdomains in the Certification Guide, it can be intimidating. That’s a lot of information to study!
I prefer to look at the knowledge domains and subdomains as a means to focus the majority of study time on areas where you don’t use the knowledge regularly in your work. So, for example, if your job doesn’t touch much on rehabilitation, that’s a knowledge domain you’ll need to study more.
There are some simple tricks to ease your mind when you look at that long list. First, print out the knowledge domains and subdomains so you have a hard copy in hand. You’ll find a handy version in our new Develop Others toolkit.
Next, take a highlighter and mark the subdomains where you have the most familiarity with the content. Then take a different colored highlighter and mark the areas where you have less experience or don’t use the information as often in your work.
Now you have a document to guide your study and focus. Although you’ll need to review information in all the knowledge domains and subdomains before taking the exam, the areas highlighted with the second color are the ones you’ll need to focus more time and effort to learn. (Hat-tip to Deanna Gillingham for the highlighter study idea!)
With your study topics prioritized, we recommend you set aside regular study periods at least three times a week (more often, depending on how much preparation you need) to review knowledge domain and subdomain content. The Commission’s new Pocket Prep study roadmap is a high-intensity guide for CCM exam prep based on an eight-week circuit. It moves you in a stepwise fashion through the knowledge domains, and also offers guidance for studying the required glossary terms (using the Commission’s official CCM Glossary App (1) is a smart study tip as well). Whether you complete the circuit once, twice, or even more, the Pocket Prep study roadmap is a handy way to ensure you’re systematically using the knowledge domains as the framework for your CCM exam preparation.
Getting certified is itself a journey that strengthens your skill set and adds to your professional knowledge. That’s a comment I often hear, too. Knowing that the knowledge framework on which the exam is based is relevant, validated and representative of case management practice across the care continuum only adds to the value of the CCM credential—for those who hold it and for the clients and employers who rely on what it represents.
Vivian Campagna, MSN, RN-BC, CCM is the chief industry relations officer (CIRO) for The Commission for Case Manager Certification. As CIRO, Vivian’s primary focus is to work with individuals and/or organizations that are interested in Certification (CCM®/CDMS®), related products and services through CCMC’s broader marketing and promotions efforts; foster strategic partnerships and alliances; and provide insight and guidance related to industry trends and developments.
1Purchase of the CCM Glossary App or any other CCM study materials is NOT required for certification and does not guarantee the applicant will pass the exam.
First of all, I want to let you know I am very sorry you did not pass. I know that you invested a lot of time and money into passing this exam. I hope you plan to take the exam again. Many people do not pass their first attempt and go on to pass later. This article should help you to do that.
CCMC will waive the application fee for your first retest during the next testing cycle only. For example, if you fail the test in April you can take the August exam without reapplying and paying the application fee again. You will have to pay the test center (Prometric) fee though. If you do not test during the next exam cycle, but wish to retest later or this is not your first retest, CCMC will require the entire application fee and test fee again. Also, if you rescheduled your first test and failed, you will have to reapply and pay the application and test center fees again. Basically, the application only covers 2 testing cycles, if for any reason you do not pass the test by the 2 test cycles after your application is accepted you must reapply.
Where to Start
The first thing you need to do is understand that you will go through the grieving process. Yes, you heard me right. You need to grieve the fact that something you put so much time, effort, and hope into did not end as you wanted it to. Allow yourself to go through all five stages, denial, anger, bargaining, depression, and finally acceptance where you will be able to put the past behind you and move forward with your new study plan.
As soon as you can, definitely within a day or two of taking the exam, brainstorm and write notes on every question you remember from the test, both those you knew the answer to and those you did not. Review your study resources for subjects that you recognize from the exam as this will help you remember questions from the test. Just mark or highlight everything you remember being on the test. Don’t study now. You will wait to begin studying again after you get the breakdown of your exam results from CCMC. Instead, once you have completed this take some time off and relax until after your results are listed on the exam dashboard.
How to Use Your Exam Results Breakdown
You should receive a notification from CCMC with a breakdown of your results. This will list each area of the exam with a proficient, marginal, or deficient rating. It may take a few weeks for you to get this. Once you receive this, call CCMC Customer Service to receive your numeric score for the exam.
You are going to want to spend the majority of your study time in the area(s) where you were deficient. Read over the chapter(s) in CCM Certification Made Easy, taking notes on the areas and subjects you are not proficient in. To be proficient you need to be able to relate the subject to best practice case management and understand how it would be used by a case manager. Use the links at the back of the chapter to further understand the concepts and subjects. You may even have to Google some of the terms if you are still having trouble.
As you learn something, stop and take the time to apply it. This can be done by thinking of a situation where you would use this new knowledge. You can make up a situation in your head. Just imagine DOING what you learned or TEACHING it to someone.
In the areas you are marginal you will do the same, but will not have as much to study as you already have a base.
For the areas you are proficient, be sure to review before the test to refresh your memory.
Additional Study Strategies
If you have not done so already, review my 10 page Study Strategies PDF. This free resource will help you to understand the test better, and give you links to additional free resources that are imperative to passing the CCM Exam. You can get it by clicking HERE and filling out the form on the right-hand side of the page. Then watch your inbox for a link to the PDF. (Use a personal email address as work email addresses do not allow emails with links to get through.) You will also get a series of additional emails from me with additional information you can use to help you pass the CCM Exam.
When I was preparing for the CCM Exam, I found that reading and studying small chunks at a time helped. I would read up on one subdomain and make sure I understood it well enough to explain it to someone else before moving on to the next. Sometimes the subdomain I was studying was easy and I would zoom through several in one session. Other times, I spent a long time on only one domain.
If you are an auditory learner who learns better when hearing information, or if you feel that you have reviewed and understand the facts but you need help knowing how to apply them to the questions, I have created a course with Anne Llewellyn that will help you. Anne has been in case management for decades and has tons of knowledge and expertise that she shares in the course. Where the book gives you the facts, the course is done in a conversational style and puts things into perspective. It also helps you discover areas where you might want to dig a little deeper.
Since you have access to the course until you pass the test, I recommend getting and completing it early in your studies. Then you can go back and relisten to the sections that you feel you need to hear again. I have had people tell me “I heard Anne’s voice talking to me during the test.”
Whether you have a history of test anxiety or it is a result of not passing the CCM Exam the first time, test anxiety can be debilitating. Taking a practice test like Datachem while using relaxation techniques and biofeedback may be helpful. If it is truly severe, you may need to seek counseling to help you resolve this issue.
Remember, many people do not pass their first attempt and go on to pass later. Use this as a learning experience to find your weak areas and master them. If, however, after using the information in this article you are still unsuccessful in passing the CCM Exam, you may want to consider another certification exam. Look for our upcoming article and resource Stepping Up To Certification to review your case management certification options.
Wonder how your employer compares with others? How does your case management salary compare to the industry? Need a reference to show your employer standards for salary, benefits, caseload, education, certification and continuing education reimbursement?
We have you covered. The 2018 Salary and Trends Survey provides all this and more.
The survey was participated in by 1,000 case management professions. It collated valuable data on the case management industry that helps us understand who case managers are, the challenges they face, their salary potential, job satisfaction and the value they bring to consumers of healthcare and the organizations for which they work.
The industry is highly concentrated by women where ninety-seven percent (97%) are female. One-third of the case managers are forty-five (45) years of age and under, which means the majority of the workforce is over forty-five (45).
Although there is no education requirement for case management, almost half of the case managers surveyed have a bachelor’s degree, with just over a quarter holding an associate’s degree and just under a quarter holding a master’s.
More and more employers are requiring certification in case management from their staff. 70% of respondents stated that their employer requires certification in case management. If the case manager does not have this certification when hired most employers expect it within 4 years of hire.
As a benefit of their experience, responsibilities, and value, professional case managers report strong income levels and comprehensive benefits packages.
The 2018 Case Management Salary and Trends survey revealed over half (53%) of professional case managers surveyed make between $70,000 and $90,000 per year with nearly one-fifth (12%) earning over $100,000. Compensation has gone up since 2015 which was the last time the salary and trends survey was completed.
After salary, the next parameter to consider is required work hours and time off. Case managers also have flexibility in when they work with two-thirds of the case managers having three weeks or more of vacation, and only one-fourth of case managers surveyed work weekends and/or holidays. This is huge considering that most nurses are used to working 2-3 weekends a month and every other holiday, at a minimum!
Overall case managers are very satisfied with their career choice. The results showed that the majority (92%) of case managers surveyed are pleased with their case management career choice and see themselves staying in the industry for many years to come. This is very encouraging at a time when many nurses are reporting poor job satisfaction and leaving the workforce.
CCM Exam Eligibility
Knowledge of case management terminology and current practice are among the essential elements you’ll need to pass the Certified Case Manager® (CCM®) exam. But earning the CCM is about more than book knowledge—after all, it’s an exam based on what case managers do in daily practice.
Becoming a board-certified case manager requires you to have both the core education (which may be represented by licensure) and experience to practice case management before you even apply to take the test.
Why require education and experience to apply? Because the CCM is a professional certification, validating you have what it takes to grasp the big picture as well as the boots-on-the-ground know-how needed to practice case management.
The Commission expanded CCM exam eligibility requirements in March 2013. With a growing demand for case managers, we recognized the need to increase the ranks. We also acknowledged that case managers with education from across the allied health spectrum can demonstrate they have what it takes to become board certified.
The Commission’s Certification Guide goes into detail about eligibility, but we’ll cover the basics here. Let’s tackle the education requirement first. Applicants must have one (not both, just one) of the following two options to apply:
- License/certification option: A current, active and unrestricted licensure or certification in a health and human services discipline that allows you to conduct a client assessment independently. Some examples of licenses and certifications that meet this eligibility requirement are: RN, LCSW, LMSW, LPC, CRC and CDMS.
- The LPN and LVN licenses do not meet the independent assessment criteria, so those licenses don’t qualify candidates to apply for the CCM.
- If you aren’t sure that your license or certification allows you to practice independently, contact your state governing board to find out.
- If your license doesn’t qualify you to take the CCM, think about using your degree to apply instead.
- Just remember, your license needs to be active and current at the time you would take the exam.
- Higher education option: A bachelor’s or graduate degree in social work, nursing, or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of those being served.
- Your degree must be from an accredited institution.
- The degree, as part of the curriculum, must include supervised field experience in case management, health, or behavioral health. A great example of this is a bachelor’s degree in social work.
- Do you have a bachelor’s degree, but you’re unsure whether it’s among the many we accept for eligibility? Just call us at 856-380-6836 to find out.
If you have a qualified license AND a qualified degree, choose the option that will support your renewal in the future.
Second, comes the experience requirement. For all the options below, the Commission holds that only experience within the past five years should be considered, because health care changes so rapidly (and so does case management practice). Internships, preceptorships, practicum and volunteer experience are not accepted as employment experience.
Experience must be complete at the time you apply (not when you sit for the exam). The criteria are specific about the experience itself to ensure you’re doing comprehensive case management.
For all three options, your experience must include work in at least four of the five core components of case management. These align with the Knowledge Domains on the CCM exam:
- Care Delivery and Reimbursement Methods
- Psychosocial Concepts and Support Systems
- Quality and Outcomes Evaluation and Measurements
- Rehabilitation Concepts and Strategies
- Ethical, Legal, and Practice Standards.
Within each component, case managers must perform all eight essential activities with direct client contact (assess, plan, implement, coordinate, monitor, evaluate, outcomes, general tasks). Your experience must include providing services across the care continuum and interacting with others in the care system.
The Commission will ask you to provide the name and contact information for a supervisor in order to confirm your work experience. A current email—personal or professional—is required. This is simply the person that you report to (or have reported to) as a case manager, in contrast to the “supervision” required for some licenses, such as social work or licensed professional counselor.
How much qualified experience do you need? The Commission offers three ways for you to meet the requirement:
- 12 months of acceptable full-time case management employment, supervised by a board-certified case manager (CCM). Your Supervisor must be certified for at least one year at the time of your application.
- 24 months of acceptable full-time case management employment experience (no supervision by a CCM required under this option).
- 12 months of acceptable full-time case management employment experience as a supervisor of individuals who provide case management services. This must also fall in the last five years.
What if you work a part-time schedule? The Commission has a formula for that: We’ll pro-rate your experience based on a 37-hour work week (this is automatically calculated when you apply). Check the Certification Guide for details.
If it seems that eligibility criteria are a bit complicated, it’s because we try to ensure there are as many avenues open to qualified case managers as possible to apply for certification, while still ensuring the certification represents case manager excellence. Our goal is to certify and professionally support a qualified, ready workforce. And remember, we want to help, so don’t hesitate to call us at 856-380-6836.
Debby Formica has been with the Commission since 2010. She served previously as director of administration and operations, assistant vice president, and director of business development. In her new role as COO, Formica is responsible for oversight of certification services, management of volunteers, and implementation of the strategic direction provided by the Board of Commissioners. Formica has extensive experience in financial analysis, project management, and certification services. She began her career by spending eight years in healthcare financial consulting with CBIZ KA Consulting Services before moving to Johnson & Johnson as a manager in contract management and analysis. She holds a bachelor of science in accounting from Lehigh University and is a member of the Institute for Credentialing Excellence, the American Society of Association Executives and the Mid-Atlantic Society of Association Executives. Formica is also president and founder of Helpful Gifts from the Heart, a non-profit that benefits families dealing with pediatric cancer.
One of the most frequently asked questions we get is regarding CCM exam practice questions. We post a practice question each weekday in our FaceBook Group Case Managers Community, with the answer posted the following day. But many people are looking for more than this. So we began researching options.
I would like to first stress the fact that I do not feel practice questions/tests are necessary to successfully prepare for the CCM Exam. Many people, including myself, have passed without taking a practice test. That being said, I do understand that some people like to add practice questions to the tools that they use to study.
I would recommend that anyone who has test anxiety use a practice test that simulates the CCM exam as much as possible. They should use the practice test in conjunction with relaxation techniques and biofeedback to learn how to cope with and overcome their test anxiety.
Practice questions/tests are also useful to gauge where you need to focus your study time. A good practice test will have questions in each of the Domains that CCMC will test you on and break down your results according to those domains so that you know where your strengths and weaknesses are.
I do not recommend practice questions/tests be the only study tools used. You still have to learn the material. “Guessing” at answers and reviewing the rationale to the ones you miss is really not studying, it’s learning to pass the practice test. Remember, mastering the practice test is not the same as mastering the information you need to know to pass the actual test. The actual test will have different questions and answer choices.
So what should you look for in a good practice test?
There are 2 things that are crucial. First, you want to know who wrote it. The person who wrote it should have passed the exam! Be skeptical of any practice questions whether in a book or digital format that do not list the names and credentials of the authors. It is also important that the rational, and when appropriate references, are listed along with the correct answer.
We were able to find a practice test we are proud to recommend: DataChem. DataChem met our minimum criteria stated in the last paragraph and also had additional features we feel are important.
DataChem has a practice test mode that allows you to determine the amount of time, the number of questions and the domains to include in your practice test. You have an unlimited number of times to use the practice test mode and can adjust the time, number of questions, and included domains each time.
In addition to the practice test mode, DataChem also has a study mode where you can read and answer one question at a time. You can also mark questions you are having trouble with and review them again at a later time.
DataChem has a large number of questions in its question pool. This means that you will not get the same questions over and over.
You have unlimited use of DataChem for the amount of time you purchase it for. The minimum is 60 days and the longest is 270. This is great because it gives you enough time to really use it to its fullest and not try to cram in all of your learning. You can use it as one of your study tools at regular intervals through your studies.
I have created a demo video to walk you through some of the features of The Datachem CCM Practice Test Software. Click the link below to view the video and get additional information.
When taking a practice test you will find information that is new to you. Don’t freak out! Use this as an opportunity to use your critical thinking and reasoning skills. You will come across questions on the actual test that you do not know the answer to. You have to know how to use the information provided and your knowledge base to answer these questions.
Please see our Affiliate disclosure at the following link Affiliate Disclosure
Have you ever thought about starting your own Case Management or Patient Advocacy business?
Do you currently have a business you would like to grow?
Anne Llewellyn and I will be conducting a Pre-Conference Workshop on this subject at this year’s National Nurses in Business Association National Conference in Las Vegas, Nevada October 12-14. This nurse entrepreneurship and careers alternative conference is the #1 business conference for nurses!
In our pre-conference workshop, we will look at the emerging roles of case management and patient advocacy for nurse entrepreneurs. We will teach you how to break into independent practice and develop a business plan for success so that you can establish a profitable business. If this is something that would interest you we would love to see you there. You can get more information by clicking this link…
Case Management and Patient Advocacy: Career Paths for Nurses Who Want to Move Beyond the Bedside
During this pre-conference seminar, you will learn:
- The similarities and differences between patient advocacy and case management
- The skills and competencies needed to be successful
- How to reach and maintain prospective clients
The National Nurses In Business Association Conference is designed for nurses who are thinking about starting a business, those already in business, and those looking for career alternatives. Nationally acclaimed speakers and business experts will provide nurses with the information, tools and actionable take-a-ways you need to start your own nursing business—or to make your current business even more successful, as well as exposing you to a wealth of alternative career options. In addition, the seven pre-conference workshops will give you in depth, how–to information, resources, and dozens of tips whether you are a novice or a seasoned pro.
Now, more than ever, there are unlimited opportunities in nursing to achieve autonomy and take the lead in re-framing nurse’s role in the delivery of healthcare services and programs. Thousands of nurses nationwide have already accomplished this by starting their own business and are enjoying independence, professional respect, and increased financial rewards.
We would love to see you there! Click the button for more information…
National Nurses In Business Association Conference 2018
Have you ever wondered how the CCM certification exam is created? Where do those questions come from and who writes them? We were curious too! CCMC was very gracious and gave us a behind-the-scenes look at how the CCM Exam & Question Development occurs to share with you. We are sure you will find the following article by Debby Formica very interesting and informative!
Behind the Scenes with CCM Exam Development
By Debby Formica COO, Commission for Case Manager Certification
It seems so simple, right? A multiple-choice exam, just 180 questions long. How hard could it be to create and manage?
Probably harder than you think.
Many case managers are curious about test questions we use for the exam. If you’ve ever wondered where they come from, keep reading for your virtual behind-the-scenes look at test development.
Recently, we welcomed about a dozen subject matter experts into a room with tables heaped high with reference books and materials for a question development session (in test development language, it’s called an item development workshop). Volunteers from across all practice settings spent the next two days with test development experts, carefully weighing the exam criteria, crafting questions and reviewing question drafts for accuracy, clarity, and validity. They compared wording and answer possibilities against established case management definitions and resources. (CCM exam pro tip: The references used during item development workshops are the same as those on the CCM Suggested References list. They make great study materials.)
Because the Commission field-tests 30 questions on the exam to gauge performance (only 150 previously validated questions are considered in the candidate’s score), the data from the field tests are also examined and assessed during follow up item-review sessions. In fact, every question that eventually becomes a scored exam question has survived a multi-step process: writing, review, pre-testing and additional review.
Items are regularly updated and retired so the exam remains current and representative of the case management profession. CCMC maintains a pool of items representing a comprehensive selection of statistically validated test questions. Case management subject matter experts are charged with continually adding to and upgrading this “test question (item) pool.”
The CCM exam is practice-based, meaning all questions are grounded in the knowledge that an experienced case manager should know and understand. Test experts—psychometricians—apply a statistical procedure (called equating) to adjust for any differences in the level of difficulty among examinations. We go to these lengths to ensure that each exam candidate demonstrates the same level of ability in order to pass the examination.
A participant once told me that volunteering for item development is a remarkable professional stretch—a truly eye-opening and complete immersion into case management knowledge. I know that when I finish an item development workshop, my brain is tired! CCM exam development is a rigorous, on-going, and fascinating process. The dedication of the subject matter experts who volunteer their time and knowledge is phenomenal. They’re an important part of what makes the CCM the gold standard credential for the case management profession.
Here’s another question we often hear: What do we mean by an “evidence-based” exam?
Every CCM exam—for a quarter century now—has been based on research delving into the work case managers do every day. The Commission fields the Case Manager Role and Function Study—a job task analysis—every five years. That independent research forms the basis for refinements to the exam blueprint, or the knowledge domains that are tested on the exam.
When you think about it, the Role and Function Study results reflect the changes occurring in real-world case management practice—and that evolution is reflected in the exam blueprint and questions.
As part of this case manager community, you’ve probably heard that it takes time and determination to prepare for the Certified Case Manager® (CCM®) exam—and that’s 100 percent by design. Employers count on the Commission to validate the competency of case managers—through eligibility criteria and an evidence-based exam. That rigor is what makes the CCM so valuable in today’s health care marketplace for more than 45,000 CCMs.
The exam research, review and refresh process is critically important to the Commission. It’s part of our charge to uphold the CCM as the industry standard for excellence in case management; it’s the only cross-setting, cross-discipline case manager credential for health care and related fields that are accredited by the National Commission for Certifying Agencies. As an aside, it just seems right that we at the Commission know what it feels like to go through the certification process, too—we do it regularly to maintain our NCCA status.
CCMs expect the Commission to proactively track trends and current case management practice to ensure the credential sustains its value. That’s what makes all the studying and preparation worth the effort. The CCM is not just a credential for today. It’s a credential that will add value to your professional development across the span of your career.
Last call to those who want to take the CCM exam this April 2018! It’s less than a month to go before the April 2018 application window closes on January 31. So, if one of your goals this 2018 is to add CCM to your name, then this is your opportunity! Act now while you still have time!
You will have 3 opportunities to take the CCM Exam in 2018, April, August, and December. We all know how fast time flies, and with only 3 testing periods per year, it is easy to miss out.
Personally, I think April is the best time to take the CCM, what better way to spend a cold winter day than studying!
Wondering if you’re eligible to take the exam? Let’s go over the details of eligibility.
According to the CCM Certification Guide, there are 3 areas of qualification you must meet to be eligible to take the exam.
- Meet the specified licensure or education qualifications.
- Qualify within one of CCMC’s employment category experience categories.
- Be of good moral character, consistent with the CCMC Code of Professional Conduct.
Licensure and Education Qualification Information
To qualify for the CCM Exam, you must hold a: (more…)
A healthcare CRM system can streamline case management processes to improve patient outcomes, reduce payer denials and support revenue cycle and a great Go-To Tool for Case Managers
Being complex and collaborative, case management implies not only care coordination from admission to discharge, but also advocating for options and services to meet patients’ health needs and achieve improved health outcomes.
Handling this process without any dedicated tools or (even) with outdated technology is troublesome, at best. Sometimes, case managers even have to resort to paper to document patient data or draft a care plan. Accordingly, using ineffective and inconvenient technology for case management can cause business problems.
When case management goes wrong
The main pitfall of using inappropriate technology is that case managers don’t have a single system to handle case management plans. This results in poor visibility, segmented and inefficient case plans along with frequent scheduling issues. The diffusion of information between different systems can lead to duplication and data inconsistency across facilities within a healthcare organization, and, accordingly, to the lack of patient case tracking.
Moreover, the system in use may be not tuned to fit all workflows of particular case managers, making them manually handle some part of processes (e.g., invoicing), which is time-consuming and ineffective.
How to fix case management with CRM
Among different technologies capable of supporting case management, we suggest considering implementing a CRM. Hospitals are using healthcare CRM systems in multiple ways, including case management. There are four main reasons for that.
Detailed and expandable patient profiles
A CRM system integrates with the EHR, PMS, and hospital invoicing systems to enable a 360-degree view of a patient’s preferences, care needs, treatment plan, and inquiries. Case managers will have all information required to be on the same page with their patients’ current status (health, services, billing, etc.) and any significant changes.
The hospital CRM, on the one hand, provides case managers with a set of standard tools to organize their workflows and build standardized and trackable processes. On the other hand, it is a human- and management-friendly system, allowing thorough customization and flexibility. Let’s check the possible features:
- Service planning and outcome management
- Patient document management with e-signature for all documents
- Dashboards for case managers and supervisors
- Custom reporting and analytics
With these features, the hospital CRM can help providers to optimize resource-intensive case management processes by deploying technology around patient-centered care. There can be multiple examples, let’s name a few.
For instance, case managers will be able to detect any barriers to care plan fulfillment quickly via custom analytics. Moreover, if some post-discharge services require authorization, it can be requested within the system. The case manager can also create a checklist for patient goals and send them to the patient and the family for discussion during daily reassessments.
We are highlighting the ability to set up automated and configurable alerts for important events because timely notifications are crucial for a smooth case management process. For example, case managers will be aware of any delays or denials in services and can initiate the appeal process or other activities right away.
PHI safety is critical, so the system for case management needs to respond to high demand in patient data protection. Healthcare CRM enables role-based security to comply with HIPAA requirements.
How CRM-driven case management supports revenue cycle and clinical outcomes
Apart from patient outcomes, case management activities across pre-admission, admission, treatment, discharge and post-discharge phases impact the revenue cycle. СRM can assist case managers in yielding positive clinical and financial outcomes. Let’s see a few examples for each phase.
ED screening for admission. Case managers will be able to monitor new admissions within their CRM accounts and make sure that patients are provided with the adequate level of care. In other cases, care services are most likely to be denied by payers.
ED review for relevant patient classification. The CRM allows automatic matching of new patients with the Medicare “inpatient only” list to help the organization avoid delay or denial of payment as well as unneeded staff resource utilization.
Sending clinical reviews to payers for emergent admissions. Case managers can forward the clinical admission reviews required according to contracts with each particular health plan in a more automated way. All applicable forms will be already filled in with available information and offered to the case manager for reviewing, changing and e-signing right in the CRM.
Early discharge planning. Speaking of the revenue cycle, timely discharge planning helps to avoid extended inpatient days and length of stay as well as payer denials. Case managers can use the analytic capabilities of hospital CRM to find similar cases and base their identification of discharge timeline on previous experience.
Care plan implementation and evaluation:
Provide timely care plan reviews. Case managers need to check a patient’s health status and treatment progress, identifying arising barriers and handling them time to ensure a seamless care cycle. CRM has multiple features to support the managers’ efficiency – from step-by-step process flows and checklists (e.g., expected outcomes for the hospital day) to automated alerts.
Reviewing authorized days. To avoid delays in payment, case managers need to reassure that claims submitted for hospital stay have all the days authorized for medical necessity. Since all documents and case plan details are already in the hospital CRM, this process won’t be tedious.
Fulfilling the discharge plan. Incomprehensive discharge plans that don’t incorporate experience-based best practice bear a risk of readmissions. By keeping all case plan parts in one place, case managers can safeguard consistency. Moreover, the organized case plan helps in reducing delays and denials in services, which allows upholding the revenue cycle.
Denial management. The CRM provides case managers with the tools to effectively manage denials, response to post-billing denials and outstanding reviews. Each claim’s status will be tracked, and alerts will notify managers about any issues with case Billings. Moreover, a semi-automated appeal algorithm can be enabled to streamline denial management even further, decrease delays and thus enhance revenue.
Following up with patients. Case managers will be able to communicate with patients via emails or text messages on their post-discharge plans, including home care, treatment details, and durable medical equipment. Be it instructions, self-check lists or surveys, established contact with patients allows to track their health outcomes outside the facility and prevent readmissions.
CRM against the rising caseloads and financial pressure
Case management departments should bridge clinical and financial goals, escaping inadequate care levels, unauthorized days, readmissions, billing delays and payer denials.
CRM can be the system that helps to withstand external financial pressures by reducing internal case management inefficiencies. By allowing case managers to handle daily activities in utilization management, discharge planning, and care coordination within one access point, providers are improving health outcomes and supporting the clinical revenue cycle.
With 5 years of writing on business and technology, Lola is a Healthcare Industry Analyst at ScienceSoft, an IT consulting company headquartered in McKinney, Texas. Being an HIMSS member, she focuses on Healthcare IT, highlighting the industry challenges and technology solutions that tackle them. Lola’s articles explore chronic disease management, mHealth, healthcare data analytics, value-based care delivery, CMS regulations and more.
If one of your goals for 2017 is to pass the CCM Exam, this is your last chance!
The application window for the August 2017 exam is closed, but the December exam window is now open. You can sign up to take the December CCM exam that will move your career to the next level until September 30, 2017.
Completing your application is easier than ever. The entire application can be done online where you will find everything you need to complete your application.
In order to sit for the CCM exam, you must meet eligibility criteria. Take a look at this post for specific eligibility information.
Qualified applicants will be provided with information via email regarding how to register for the exam and how to make a special accommodations request.
The CCM Exam is an 180-question multiple choice exam which you have 3 hours to complete.
The content of the CCM examination is based on an ongoing, nationwide validation research project. The research has identified five knowledge domains.
- Psychosocial Concepts and Support Systems
- Quality and Outcomes Evaluation and Measurements
- Rehabilitation Concepts and Strategies
- Care Delivery and Reimbursements Methods
- Ethical, Legal and Practice Standards
Additionally, each of the five domains is further defined into sub-domains
Application & Examination Fee
When applying for the exam, I would love it if you would type my name in the “promo code” field found in the Education and License section of the application. This really helps CCMC recognize the work we at The Stay At Home Nurse, LLC are doing to promote case management certification. Doing this will also enter you in a drawing to be held after the application window closes where one lucky CCM and their referred candidate will be randomly chosen by CCMC to each win a $345 American Express Gift Card! Gives you the chance to take the exam for much less! The application fee is $200 and the exam fee is $185, a total of $385 will be paid when you apply.
Qualified applicants can take the exam in over 8,000 locations in 160 countries. Exams are conducted at Prometric Testing Centers, take a look and see where your nearest testing center is.
Now that you’re ready to sign up for the exam, you’ll ask yourself, “How do I study for the exam?”
Take a moment to check out CCM Certification Made Easy which is a test prep book to help you master the knowledge you need to pass. If an online course is a better study option for you, we have the CCM Certification Review Course, which is a 12 module course designed to help you understand the role case managers play in today’s modern complex healthcare systems and how this information is vital to preparing and passing the CCM exam.
You may check out this post for more study tips to help you feel confident and ready to take the exam.
To get more information and to sign up for the exam, head over to CCMCertification.org and click on “Get Certified” or call CCMC Customer Service at 856-380-6836 for assistance.
Remember, if you plan on taking the exam in the month of December, be sure to apply before the September 30th deadline!