ANCC Nursing Case Management Certification Practice Test

CMGT-BC exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

Certification Name: Nursing Case Management Certification (CMGT-BC)
Credential Awarded: CMGT-BC (Case Management-Board Certified)
Administered By: American Nurses Credentialing Center (ANCC)
Eligibility: Open to registered nurses (RNs) who meet specific practice and education requirements.
Exam Format: Computer-based test (CBT)
Exam Length: 3.5 hours (including 15 minutes for a tutorial and 15 minutes for a post-exam survey)
Number of Questions: 175 questions (150 scored, 25 unscored pretest questions)
Question Types: Multiple-choice questions (MCQs)
Passing Score: Scaled score system (details on passing criteria are not publicly disclosed by ANCC)

- Foundations of Case Management
- Definition and Scope of Case Management:
- Understanding the role
- responsibilities
- goals of a case manager
- Case Management Models:
- Familiarity with various models such as the Collaborative Model
- Brokerage Model, and Clinical Case Management Model
- Standards of Practice:
- Knowledge of the Case Management Society of America (CMSA) Standards of Practice and the American Nurses Association (ANA) standards.
- Ethical and Legal Considerations:
- Understanding ethical principles
- confidentiality
- informed consent
- legal issues in case management
- Regulatory and Accreditation Requirements:
- Familiarity with regulations such as HIPAA
- Medicare/Medicaid guidelines
- accreditation standards (e.g., Joint Commission)

- Care Coordination and Transitions of Care
- Care Coordination Principles:
- Strategies for coordinating care across multiple providers and settings.
- Transition Planning:
- Ensuring smooth transitions between healthcare settings
- hospital to home
- acute care to long-term care
- Discharge Planning:
- Developing and implementing effective discharge plans to prevent readmissions.
- Interdisciplinary Collaboration:
- Working with healthcare teams
- including physicians
- social workers
- therapists
- optimize patient outcomes

- Patient-Centered Care
- Patient Advocacy:
- Ensuring the patient’s voice is heard and their preferences are respected.
- Cultural Competence:
- Providing care that is sensitive to the patient’s cultural
- religious
- social background
- Health Literacy:
- Assessing and addressing the patient’s ability to understand and act on health information.
- Patient Education:
- Educating patients and families about their conditions
- treatment options
- self-care strategies

- Utilization Management
- Resource Management:
- Efficient use of healthcare resources to achieve optimal patient outcomes.
- Cost-Effective Care:
- Balancing quality care with cost containment.
- Prior Authorization and Denial Management:
- Understanding insurance requirements and managing denials or appeals.
- Evidence-Based Practice:
Using research and clinical evidence to guide decision-making.

- Quality and Outcomes Management
- Quality Improvement:
- Implementing strategies to Boost healthcare quality and patient safety.
- Performance Metrics:
- Understanding key performance indicators (KPIs) such as readmission rates
- patient satisfaction scores
- length of stay.
- Outcome Measurement:
- Evaluating the effectiveness of case management interventions.
- Risk Management:
- Identifying and mitigating risks to patient safety and organizational liability.

- Healthcare Reimbursement and Financing
- Payment Models:
- Understanding fee-for-service
- value-based care
- bundled payments.
- Reimbursement Systems:
- Familiarity with Medicare
- Medicaid
- private insurance reimbursement processes.
- Cost-Benefit Analysis:
- Evaluating the financial impact of case management interventions.
- Budgeting and Financial Planning:
- Managing budgets and resources within a case management program.

- Population Health Management
- Health Promotion and Disease Prevention:
- Strategies for improving population health outcomes.
- Chronic Disease Management:
- Managing conditions such as diabetes
- heart disease
- COPD.
- Social Determinants of Health:
- Addressing factors such as housing
- education
- socioeconomic status that impact health outcomes.
- Community Resources:
- Connecting patients with community-based services and support.

- Technology in Case Management
- Health Information Systems:
- Using electronic health records (EHRs) and case management software.
- Telehealth:
- Leveraging telehealth for remote patient monitoring and consultations.
- Data Analytics:
- Using data to identify trends
- measure outcomes
- Boost care delivery.
- Privacy and Security:
- Ensuring the confidentiality and security of patient information.

- Professional Practice
- Leadership and Advocacy:
- Leading case management teams and advocating for policy changes.
- Professional Development:
- Engaging in continuing education and staying current with best practices.
- Certification and Licensure:
- Understanding the requirements for maintaining CMGT-BC certification and state licensure.
- Interprofessional Collaboration:
- Building effective relationships with other healthcare professionals.
- Case Management Process:
- Assessment
- planning
- implementation
- coordination
- monitoring
- evaluation.
- Care Plan:
- A documented plan outlining the patient’s goals and interventions.
- Continuity of Care:
- Ensuring seamless care across different providers and settings.

- Determinants of Health:
- Factors that influence health outcomes
- genetics
- behavior
- environment.
- Health Equity:
- Ensuring fair and equal access to healthcare resources.
- Patient-Centered Medical Home (PCMH):
- A care delivery model focused on comprehensive
- patient-centered care.
- Value-Based Care:
- A healthcare delivery model that rewards quality and outcomes rather than volume of services.

- ANA Code of Ethics for Nurses with Interpretive Statements
- CMSA Standards of Practice for Case Management (eg, patient advocacy)
- Concepts of nursing case management
- Nursing scope and standards of practice
- Utilization management (eg, authorizations, denials and appeals)

- Benefit management (eg, payor reimbursement, cost sharing, coordination of benefits)
- Resource coordination (eg, providers, community)
- Transition of care management (eg, planning, facilitation, evaluation)
- Data management (eg, collection, analysis, benchmarking)
- Performance improvement (eg, outcome measurement and evaluation)

- Patient education (eg, readiness for change, motivational interviewing, health literacy, medication reconciliation, safety, therapeutic communication, advanced care planning)
- Population health initiatives (eg, screenings/risk stratifications, risk-reduction strategies, health equity, social drivers/determinants of health)

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Question: 658
A case manager is assessing the effectiveness of a new patient navigation program. If the program costs
$100,000 and results in a 25% increase in preventive care utilization among 400 patients, what is the estimated financial benefit if preventive care saves $500 per patient annually?
A. $80,000 B. $100,000 C. $200,000 D. $50,000
er: D
nation: A 25% increase means 100 more patients are utilizing preventive care. The total savin he increased utilization is 100 patients x $500 = $50,000, which does not cover the program
ion: 659
manager is evaluating a patient's eligibility for Medicare coverage for therapy services. Wh lowing conditions must be met for the patient to qualify for these services?
patient must demonstrate a significant improvement in their condition within 30 days patient must require therapy services for a minimum of 60 days
therapy must be deemed medically necessary and prescribed by a physician patient must attend therapy sessions at least three times a week
er: C
nation: For Medicare coverage, therapy services must be deemed medically necessary and bed by a physician, ensuring compliance with coverage criteria.
ion: 660
manager is analyzing the financial outcomes of a community health initiative that required of $250,000. If the initiative resulted in a 30% decrease in smoking rates among 1,000 pants, what is the potential financial benefit if the average cost of smoking-related healthcar
Answ
Expla gs
from t cost.
Quest
A case ich of
the fol
1. The
2. The
3. The
4. The Answ
Expla prescri
Quest
A case a
budget
partici e is
$3,000 per person?
A. $600,000 B. $700,000 C. $900,000 D. $800,000
Answer: C
Explanation: A 30% reduction means 300 fewer individuals smoking. The financial benefit is calculated
as 300 x $3,000 = $900,000.
Question: 661
While coordinating care for a patient transitioning from an acute care setting to home health services, the case manager discovers a discrepancy in medication lists between the hospital discharge summary and the outpatient pharmacy. What action should the case manager take first to resolve this issue?
1. Assume the outpatient pharmacy is correct and update the care plan accordingly
2. Instruct the patient to use the medications listed by the outpatient pharmacy
ntact the hospital's pharmacy to verify the discharge medications er: D
nation: Contacting the hospital's pharmacy to verify the discharge medications is the first ste safe and accurate medication management, which is critical for patient safety during transiti
ion: 662
manager is tasked with developing a care plan for a patient with a history of substance use er. According to the Case Management Society of America (CMSA) Standards of Practice, w ollowing principles should take precedence when creating this plan?
oritizing the patient's immediate medical needs over psychosocial factors
uring the plan is strictly confidential and only shared with the healthcare team using on compliance with treatment protocols to minimize relapse risk
olving the patient and their family in the decision-making process er: D
nation: Involving the patient and their family in the decision-making process is essential as it collaboration and ensures that the care plan aligns with the patient's values and preferences, re principle of the CMSA Standards.
Schedule a follow-up appointment to review the medications with the patient
3. Co
Answ
Expla p to
ensure ons of
care.
Quest
A case
disord hich
of the f
1. Pri
2. Ens
3. Foc
4. Inv Answ
Expla
fosters which
is a co
Question: 663
A case manager is tasked with evaluating the effectiveness of a newly implemented care coordination program. Which method would provide the most comprehensive data regarding the program's impact on patient outcomes?
1. Reviewing hospital readmission rates alongside patient feedback and health outcomes
2. Conducting a patient satisfaction survey only
3. Analyzing staff workload and efficiency metrics only
4. Gathering anecdotal evidence from case managers involved in the program
Answer: A
Explanation: Combining multiple data sources, including readmission rates and patient feedback, provides a holistic view of the program�s effectiveness and its impact on patient outcomes.
Question: 664
A case manager is reviewing a discharge plan for a patient with chronic kidney disease. Which component is essential to include in the plan to prevent complications?
neric information about kidney disease
ist of medications without dosage instructions
chedule for follow-up appointments without specific timings eferral for nutritional counseling focused on renal diet
er: D
nation: A referral for nutritional counseling focused on a renal diet is essential for managing disease and preventing complications related to dietary indiscretions.
ion: 665
year-old woman with multiple chronic conditions is experiencing difficulty managing her he cognitive decline. What is the most appropriate intervention for the case manager to imple uation?
hedule more frequent follow-up appointments to monitor her conditions er her to a geriatric specialist for comprehensive assessment
olve a caregiver or family member in her care planning and management vide written instructions for self-management without follow-up
er: C
nation: Involving a caregiver or family member in her care planning provides essential suppo that her health management is sustained and effective, especially in the context of cognitiv
Ge
A l
A s
A r
Answ
Expla chronic
kidney
Quest
A 65- alth
due to ment in
this sit
1. Sc
2. Ref
3. Inv
4. Pro Answ
Expla rt and
ensures e
decline.
Question: 666
A case manager is assessing a patient's understanding of their chronic illness. What approach is best to ensure that the patient comprehends their health status and treatment plan?
1. Use medical jargon to explain
2. Encourage questions and provide clear explanations
3. Provide written materials only
4. Assume the patient understands without confirmation Answer: B
Explanation: Encouraging questions and providing clear explanations fosters understanding and empowers the patient in their care management.
Question: 667
entation of informed consent for treatment. What is the best course of action to rectify this i
date the documentation without notifying the providers involved ore the oversight as it is a minor issue
in staff on the importance of informed consent and implement a checklist cument the oversight in the compliance report without further action
er: C
nation: Training staff on the importance of informed consent and implementing a checklist is ure compliance moving forward.
ion: 668
ospital setting, a case manager identifies that patients with chronic pain are frequently readmi the best strategy for addressing this issue?
rease the use of pain medications for all patients
laborate with pain management specialists to create individualized care plans charge patients with chronic pain after a set number of days
cus solely on physical therapy as a treatment modality er: B
nation: Collaborating with pain management specialists allows for tailored care plans that ad
During a compliance audit, a case manager identifies that certain patient records lack proper
docum ssue?
1. Up
2. Ign
3. Tra
4. Do
Answ
Expla crucial
to ens
Quest
In a h tted.
What is
1. Inc
2. Col
3. Dis
4. Fo
Answ
Expla dress
the multifaceted nature of chronic pain, potentially reducing readmissions.
Question: 669
In a case where a patient has limited understanding of their treatment options, which approach should the case manager take to ensure informed consent is obtained?
1. Use complex medical terminology to explain options
2. Rely solely on the physician's explanation of treatment
3. Allow family members to make decisions on behalf of the patient
4. Provide clear, simplified information and check for understanding Answer: D
Explanation: Providing clear, simplified information and checking for understanding is crucial for ensuring that the patient can make an informed decision regarding their treatment options.
Question: 670
ucate the patient about the healthcare system without considering their culture. ess the cultural factors influencing the patient's healthcare experience. commend that the patient follow the standard protocols.
cument the cultural barriers and move on to the next case. er: B
nation: Assessing cultural factors is essential for tailoring communication and interventions t ient's unique needs and enhance understanding.
ion: 671
ent recently discharged after heart surgery reports difficulty understanding follow-up care tions. What is the most appropriate action for the nurse to take to Boost the patient�s ehension?
vide all instructions verbally to avoid confusion teach-back methods to confirm understanding
Give the patient a list of resources to read
sume the patient will remember the information discussed er: B
nation: Using teach-back methods allows the nurse to verify the patient's understanding and
In a case management scenario, a patient is experiencing barriers due to cultural differences and misunderstanding of the healthcare system. What is the case manager's most effective initial response?
1. Ed
2. Ass
3. Re
4. Do
Answ
Expla o meet
the pat
Quest
A pati instruc compr
1. Pro
2. Use C.
D. As
Answ Expla
reinforces the information in a patient-centered manner.
Question: 672
During a multidisciplinary team meeting, a case manager identifies a gap in services for a patient transitioning from hospital to home care. Which strategy should the case manager prioritize to advocate for policy changes that address this issue within the healthcare system?
1. Develop a budget proposal for new services
2. Collaborate with local legislators to influence policy reform
3. Organize a community awareness campaign
4. Conduct a survey to assess patient needs Answer: B
Explanation: Collaborating with local legislators to influence policy reform is essential for addressing systemic gaps in services. This approach can lead to legislative changes that provide better support for patients transitioning from hospital to home care.
Question: 673
manager is developing a care plan for a patient with a latest knee replacement who is encing significant pain and limited mobility. Which of the following interventions would bes
the patient's recovery process?
commend bed rest to minimize pain
courage gradual increase in physical activity and coordinate with physical therapy us only on pain management with medications
ggest the patient avoid any movement to prevent further injury er: B
nation: Encouraging gradual physical activity and coordinating with physical therapy is essen ry post-surgery, promoting healing and improving mobility.
ion: 674
manager is tasked with coordinating care for a patient with complex needs. Which accredit rd should guide the care coordination process to ensure compliance with best practices?
facility must maintain a minimum occupancy rate
facility must implement a patient-centered approach to care facility must prioritize cost-effective treatment options
facility must limit the number of specialists involved in the patient's care
er: B
A case
experi t
support
1. Re
2. En
3. Foc
4. Su
Answ
Expla tial for
recove
Quest
A case ation
standa
1. The
2. The
3. The
4. The Answ
Explanation: Implementing a patient-centered approach to care is a fundamental accreditation standard that guides effective care coordination and ensures compliance with best practices.
Question: 675
A case manager is tasked with developing a budget for a new mental health outreach program. If the program costs $350,000 and is expected to prevent $1 million in costs associated with untreated mental health issues, what is the overall financial benefit?
A. $700,000 B. $500,000 C. $600,000 D. $650,000
Answer: D
Explanation: The overall financial benefit is calculated as the savings minus the costs: $1,000,000 -
$350,000 = $650,000.
manager is tasked with improving care coordination for patients with multiple chronic cond payment model would best support this initiative by incentivizing comprehensive care ement?
-for-service pitation
ndled payments ue-based care
er: D
nation: Value-based care models incentivize comprehensive care management by linking ursement to patient outcomes, making it an ideal choice for improving care coordination for
with multiple chronic conditions.
ion: 677
ansition from hospital care to a home-based care model, which of the following practices sho se manager implement to ensure patient safety and effective communication?
vide the patient with a brochure about home care services only
pend solely on the patient to relay information to home health providers mit follow-up communication to email correspondence
ablish a communication protocol between the hospital and home health providers to share up
Question: 676
A case itions.
Which manag
1. Fee
2. Ca
3. Bu
4. Val Answ
Expla reimb patients
Quest
In a tr uld
the ca
1. Pro
2. De
3. Li
4. Est dates
on the patient�s condition Answer: D
Explanation: Establishing a communication protocol between the hospital and home health providers is critical for ensuring that all parties are updated on the patient�s condition and needs.

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