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A case manager is advocating for a patient with a rare disease who requires an expensive experimental treatment not covered by their insurance. Which of the following actions best demonstrates the case manager's role as an advocate?
A
B
C
D
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2026 Statistics
Key Facts: CMGT-BC Exam
150
Total Questions
ANCC
3 hours
Exam Time
ANCC
$395
Exam Fee
ANCC
5 years
Certification Validity
ANCC
The CMGT-BC Nursing Case Management exam is a competency-based examination for registered nurses. It consists of 150 multiple-choice questions, with 125 scored and 25 unscored pretest questions. The exam duration is 3 hours. The certification is valid for 5 years.
Sample CMGT-BC Practice Questions
Try these sample questions to test your CMGT-BC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A case manager is advocating for a patient with a rare disease who requires an expensive experimental treatment not covered by their insurance. Which of the following actions best demonstrates the case manager's role as an advocate?
A.Informing the patient that the treatment is not covered and exploring alternative, less effective treatments.
B.Contacting the insurance company to appeal the denial and providing a detailed letter of medical necessity from the patient's physician.
C.Suggesting the patient start a crowdfunding campaign to pay for the treatment out-of-pocket.
D.Advising the patient to switch to a different insurance plan during the next open enrollment period.
Explanation: The primary role of a case manager as an advocate is to intervene on behalf of the patient to overcome barriers and ensure access to necessary care. Appealing the insurance denial with supporting medical documentation is a direct and appropriate advocacy action. The other options either do not fully support the patient's need for the specific treatment or shift the burden of finding a solution onto the patient.
2When coordinating a patient's discharge from the hospital to a skilled nursing facility, what is the most critical piece of information the case manager must communicate to the receiving facility?
A.The patient's preferred visiting hours.
B.A summary of the patient's dietary preferences.
C.The patient's complete medical history, current medication list, and recent clinical updates.
D.The contact information for the patient's family members.
Explanation: For a safe and effective transition of care, the receiving facility needs comprehensive clinical information to continue the patient's care without interruption. This includes medical history, a reconciled medication list, and a summary of their hospital stay. While other information is helpful, it is not as critical for immediate care planning.
3A case management department is reviewing its performance metrics and notes a high rate of hospital readmissions for patients with congestive heart failure (CHF). Which of the following interventions is the most appropriate next step?
A.Discharge all CHF patients with a referral to a cardiologist.
B.Implement a post-discharge follow-up call program for all CHF patients within 72 hours of discharge.
C.Provide all CHF patients with a standard brochure about the importance of a low-sodium diet.
D.Assume the data is flawed and re-run the report in three months.
Explanation: High readmission rates for a specific patient population indicate a need for a targeted intervention. Post-discharge follow-up calls are a proven strategy to identify and address patient issues early, reinforce education, and prevent complications that lead to readmission. The other options are either too generic, not targeted enough, or dismiss the data without investigation.
4A case manager is developing a health education plan for a patient with low health literacy and a new diagnosis of diabetes. Which strategy is most likely to be effective?
A.Providing the patient with a comprehensive, text-heavy booklet on diabetes management.
B.Using the 'teach-back' method to confirm the patient's understanding of key concepts after a verbal explanation.
C.Recommending the patient watch a series of lengthy online videos with medical terminology.
D.Advising the patient to ask their pharmacist if they have any questions about their new medications.
Explanation: The 'teach-back' method is an evidence-based strategy for ensuring patient understanding, especially for those with low health literacy. It involves asking the patient to explain in their own words what they need to know or do. This allows the case manager to assess comprehension and correct any misunderstandings immediately. The other options are not tailored to the needs of a patient with low health literacy.
5A case manager receives a phone call from a patient's adult child, who is requesting information about their parent's recent diagnosis. The patient has not signed a release of information for this family member. How should the case manager respond?
A.Provide the requested information, as the caller is an immediate family member.
B.Inform the caller that they cannot share any information due to patient privacy laws, and explain how the patient can provide consent.
C.Ask the caller to provide some personal details about the patient to verify their identity before sharing the information.
D.Put the patient on the phone to give verbal consent to share the information.
Explanation: Under HIPAA and other privacy laws, healthcare providers cannot share protected health information (PHI) without the patient's explicit consent. The correct and ethical response is to explain the privacy regulations and provide the family member with the steps to obtain a valid release of information from the patient. The other options are all violations of patient privacy.
6A utilization review case manager is assessing the medical necessity of a patient's continued hospital stay. Which of the following criteria would best support the decision to approve an additional day?
A.The patient's family is not yet ready for them to come home.
B.The patient requires an IV antibiotic that can only be administered in an acute care setting.
C.The patient is able to walk independently and perform all activities of daily living (ADLs).
D.The patient has a follow-up appointment with their primary care physician in two days.
Explanation: Utilization management decisions are based on the medical necessity of services in a particular setting. The need for a treatment that can only be safely and effectively provided in a hospital, such as a specific IV antibiotic, is a strong justification for continued stay. The other options are related to social factors, functional status, or outpatient care, and do not typically meet the criteria for an acute level of care.
7A managed care organization is preparing for an NCQA (National Committee for Quality Assurance) accreditation survey. Which of the following case management activities would be most important to demonstrate compliance with NCQA standards?
A.Documenting all patient interactions in a non-standardized format.
B.Having a robust process for complex case management, including a comprehensive assessment, care plan, and interdisciplinary team collaboration.
C.Focusing case management services exclusively on the lowest-risk, healthiest members.
D.Conducting patient satisfaction surveys on an ad-hoc basis.
Explanation: NCQA standards emphasize structured, comprehensive, and patient-centered case management for members with complex needs. A well-documented process that includes assessment, a personalized care plan, and collaboration with an interdisciplinary team is a core component of NCQA's requirements for case management programs. The other options are inconsistent with NCQA principles.
8A case manager is working with a patient who is ambivalent about quitting smoking. The patient says, 'I know I should quit, but I've been smoking for 20 years and I enjoy it.' Which of the following responses uses the principles of motivational interviewing?
A.'You must quit smoking immediately, or you will have a heart attack.'
B.'It sounds like you're feeling torn. On one hand, you enjoy smoking, and on the other, you're concerned about your health.'
C.'I'll sign you up for a smoking cessation class next week. You can do it!'
D.'If you don't quit smoking, your insurance premiums will go up.'
Explanation: Motivational interviewing is a collaborative, person-centered approach to elicit and strengthen motivation for change. The correct response uses reflective listening to acknowledge the patient's ambivalence without judgment. This helps build rapport and allows the patient to explore their own motivations for change. The other options are confrontational, directive, or use scare tactics, which are counterproductive in motivational interviewing.
9Which of the following best defines the primary goal of nursing case management?
A.To reduce healthcare costs for the insurance company.
B.To provide direct nursing care to patients with complex needs.
C.To help patients navigate the healthcare system and achieve optimal health outcomes in a cost-effective manner.
D.To ensure patients are discharged from the hospital as quickly as possible.
Explanation: The primary goal of nursing case management is to coordinate care and advocate for patients to help them achieve their health goals. This involves a holistic approach that considers both quality of care and resource utilization. While cost-effectiveness is a component, the ultimate goal is patient-centered and focused on health outcomes. Case managers coordinate care, but do not typically provide direct, hands-on nursing care.
10A case manager is leading an interdisciplinary team meeting for a patient with multiple chronic conditions. The team includes a physician, a social worker, a physical therapist, and a pharmacist. What is the case manager's primary role in this meeting?
A.To make all final decisions about the patient's care plan.
B.To take notes and distribute the meeting minutes to the team.
C.To facilitate communication and collaboration among team members to create a unified, patient-centered care plan.
D.To represent the interests of the insurance company and limit the services provided.
Explanation: In an interdisciplinary team setting, the case manager's key role is to act as a facilitator and coordinator. They ensure that all team members have an opportunity to share their expertise, that communication is clear, and that the resulting care plan is integrated and aligned with the patient's goals. The case manager does not make unilateral decisions but rather builds consensus among the team.
About the CMGT-BC Exam
The Nursing Case Management board certification (CMGT-BC™) from the American Nurses Credentialing Center (ANCC) is for registered nurses who want to demonstrate their expertise in the case management specialty. The exam assesses entry-level clinical knowledge and skills after initial RN licensure.
Questions
150 scored questions
Time Limit
3 hours
Passing Score
N/A
Exam Fee
$395 (ANCC)
CMGT-BC Exam Content Outline
22%
Professional Foundation
Concepts of nursing case management, legal and ethical issues, reimbursement methodologies, and professional development.
30%
Care Coordination
Assessment, care planning, interdisciplinary collaboration, transition of care management, and resource management.
26%
Quality Management
Accreditation and regulatory requirements, data analysis, patient safety, and outcomes management.
23%
Health Promotion
Patient education, health and wellness coaching, self-management support, and cultural competence.
How to Pass the CMGT-BC Exam
What You Need to Know
- Passing score: N/A
- Exam length: 150 questions
- Time limit: 3 hours
- Exam fee: $395
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
CMGT-BC Study Tips from Top Performers
1Focus on Care Coordination (30% of exam) - master the concepts of assessment, care planning, and transition of care.
2Understand the principles of Quality Management (26% of exam) - be familiar with patient safety, outcomes management, and regulatory requirements.
3Review Health Promotion topics (23% of exam) - patient education, self-management support, and cultural competence are key areas.
4Don't neglect the Professional Foundation (22% of exam) - know the legal, ethical, and reimbursement aspects of case management.
Frequently Asked Questions
How many questions are on the CMGT-BC exam?
The CMGT-BC exam has 150 multiple-choice questions. 125 are scored, and 25 are unscored pretest questions used for future exam development.
How long is the CMGT-BC exam?
You will have 3 hours to complete the exam.
What is the passing score for the CMGT-BC exam?
The passing score is not published by the ANCC. The exam is criterion-referenced, meaning the passing score is determined by a panel of experts.
How much does the CMGT-BC exam cost?
The exam fee is $395 for non-members of the American Nurses Association (ANA).