CMAC
CMAC - CASE MANAGEMENT ADMINISTRATOR CERTIFICATION | NEW
UPDATED EXAM QUESTIONS AND VERIFIED SOLUTIONS LATEST
2026/2027
CASE MANAGEMENT ADMINISTRATOR CERTIFICATION (CMAC)
1. A newly hired director of case management is asked to define the
primary purpose of hospital case management for the board. Which
statement best reflects that purpose?
A. Managing physician scheduling for admissions
B. Reducing nursing staff workload on inpatient units
C. Coordinating appropriate, cost-effective care across the continuum to
achieve quality outcomes
D. Ensuring every patient is discharged within the geometric mean length
of stay
ANSWER : C. Coordinating appropriate, cost-effective care across the
continuum to achieve quality outcomes
Case management balances quality, appropriate resource use and cost
across the continuum; it is not limited to throughput or staffing goals.
Page 1 of 63
, CMAC
2. Which professional organization publishes the Standards of Practice
for Case Management that administrators commonly use to build
departmental policy?
A. National Association of Social Workers (NASW) only
B. Centers for Disease Control and Prevention (CDC)
C. American Hospital Association (AHA)
D. Case Management Society of America (CMSA)
ANSWER : D. Case Management Society of America (CMSA)
CMSA's Standards of Practice describe core case management functions
and are widely used to shape departmental policy.
3. A department uses a model in which RN case managers handle
utilization review and care coordination while social workers handle
complex psychosocial needs. This is best described as:
A. A physician-led hospitalist model
B. A unit-based nursing model
C. A triad model with separate UR staff
D. A collaborative (dyad) case management model
ANSWER : D. A collaborative (dyad) case management model
The dyad pairs an RN case manager with a social worker, each working at
the top of their license.
4. In a triad case management model, which function is typically
separated out from the RN case manager role?
A. Utilization review
B. Discharge planning
C. Psychosocial assessment
D. Patient education
ANSWER : A. Utilization review
The triad adds a dedicated utilization review specialist alongside the RN
case manager and social worker.
Page 2 of 63
, CMAC
5. A case management administrator is calculating the department's
average length of stay. Which formula is correct?
A. Total admissions divided by total beds
B. Total discharges divided by total patient days
C. Total inpatient days divided by total discharges
D. Total observation hours divided by 24
ANSWER : C. Total inpatient days divided by total discharges
ALOS equals total inpatient days for discharged patients divided by the
number of discharges.
6. The case mix index (CMI) for a hospital rises over a quarter while
volume stays stable. What does this most likely indicate?
A. Payer mix has shifted toward Medicaid
B. Length of stay has decreased
C. Readmissions have fallen
D. The patient population is more clinically complex or documentation
better captures severity
ANSWER : D. The patient population is more clinically complex or
documentation better captures severity
CMI reflects the average relative weight of DRGs; a higher value signals
greater acuity or improved documentation capture.
7. Under Medicare's Inpatient Prospective Payment System, hospital
payment for an inpatient stay is primarily determined by:
A. The assigned MS-DRG
B. Itemized charges submitted on the claim
C. The total number of days the patient stayed
D. The attending physician's specialty
ANSWER : A. The assigned MS-DRG
IPPS pays a predetermined amount per discharge based on the MS-DRG,
adjusted by hospital-specific factors.
Page 3 of 63
, CMAC
8. Under the CMS Two-Midnight Rule, inpatient admission is generally
appropriate when the admitting practitioner:
A. Orders telemetry monitoring
B. Expects the stay to last more than 24 hours
C. Reasonably expects the patient to require medically necessary hospital
care spanning at least two midnights
D. Documents that the patient arrived before midnight
ANSWER : C. Reasonably expects the patient to require medically
necessary hospital care spanning at least two midnights
The benchmark rests on the practitioner's reasonable expectation,
documented in the record, of care crossing two midnights.
9. A Medicare patient has been in observation status for more than 24
hours. Which notice must the hospital deliver no later than 36 hours
after observation begins?
A. Advance Beneficiary Notice (ABN)
B. Hospital-Issued Notice of Noncoverage (HINN)
C. Medicare Outpatient Observation Notice (MOON)
D. Important Message from Medicare (IM)
ANSWER : C. Medicare Outpatient Observation Notice (MOON)
The NOTICE Act requires the MOON for beneficiaries receiving
observation services for more than 24 hours.
10. The Important Message from Medicare (IM) must be delivered
within two days of admission and again:
A. On the day of admission only
B. Within 30 days after discharge
C. Only if the patient requests an appeal
D. No more than two calendar days before discharge
ANSWER : D. No more than two calendar days before discharge
A follow-up copy of the IM is required within two calendar days before
discharge unless the initial delivery falls within that window.
11. A physician admits a Medicare patient as inpatient, but the UR
committee determines inpatient criteria were not met before
Page 4 of 63
CMAC - CASE MANAGEMENT ADMINISTRATOR CERTIFICATION | NEW
UPDATED EXAM QUESTIONS AND VERIFIED SOLUTIONS LATEST
2026/2027
CASE MANAGEMENT ADMINISTRATOR CERTIFICATION (CMAC)
1. A newly hired director of case management is asked to define the
primary purpose of hospital case management for the board. Which
statement best reflects that purpose?
A. Managing physician scheduling for admissions
B. Reducing nursing staff workload on inpatient units
C. Coordinating appropriate, cost-effective care across the continuum to
achieve quality outcomes
D. Ensuring every patient is discharged within the geometric mean length
of stay
ANSWER : C. Coordinating appropriate, cost-effective care across the
continuum to achieve quality outcomes
Case management balances quality, appropriate resource use and cost
across the continuum; it is not limited to throughput or staffing goals.
Page 1 of 63
, CMAC
2. Which professional organization publishes the Standards of Practice
for Case Management that administrators commonly use to build
departmental policy?
A. National Association of Social Workers (NASW) only
B. Centers for Disease Control and Prevention (CDC)
C. American Hospital Association (AHA)
D. Case Management Society of America (CMSA)
ANSWER : D. Case Management Society of America (CMSA)
CMSA's Standards of Practice describe core case management functions
and are widely used to shape departmental policy.
3. A department uses a model in which RN case managers handle
utilization review and care coordination while social workers handle
complex psychosocial needs. This is best described as:
A. A physician-led hospitalist model
B. A unit-based nursing model
C. A triad model with separate UR staff
D. A collaborative (dyad) case management model
ANSWER : D. A collaborative (dyad) case management model
The dyad pairs an RN case manager with a social worker, each working at
the top of their license.
4. In a triad case management model, which function is typically
separated out from the RN case manager role?
A. Utilization review
B. Discharge planning
C. Psychosocial assessment
D. Patient education
ANSWER : A. Utilization review
The triad adds a dedicated utilization review specialist alongside the RN
case manager and social worker.
Page 2 of 63
, CMAC
5. A case management administrator is calculating the department's
average length of stay. Which formula is correct?
A. Total admissions divided by total beds
B. Total discharges divided by total patient days
C. Total inpatient days divided by total discharges
D. Total observation hours divided by 24
ANSWER : C. Total inpatient days divided by total discharges
ALOS equals total inpatient days for discharged patients divided by the
number of discharges.
6. The case mix index (CMI) for a hospital rises over a quarter while
volume stays stable. What does this most likely indicate?
A. Payer mix has shifted toward Medicaid
B. Length of stay has decreased
C. Readmissions have fallen
D. The patient population is more clinically complex or documentation
better captures severity
ANSWER : D. The patient population is more clinically complex or
documentation better captures severity
CMI reflects the average relative weight of DRGs; a higher value signals
greater acuity or improved documentation capture.
7. Under Medicare's Inpatient Prospective Payment System, hospital
payment for an inpatient stay is primarily determined by:
A. The assigned MS-DRG
B. Itemized charges submitted on the claim
C. The total number of days the patient stayed
D. The attending physician's specialty
ANSWER : A. The assigned MS-DRG
IPPS pays a predetermined amount per discharge based on the MS-DRG,
adjusted by hospital-specific factors.
Page 3 of 63
, CMAC
8. Under the CMS Two-Midnight Rule, inpatient admission is generally
appropriate when the admitting practitioner:
A. Orders telemetry monitoring
B. Expects the stay to last more than 24 hours
C. Reasonably expects the patient to require medically necessary hospital
care spanning at least two midnights
D. Documents that the patient arrived before midnight
ANSWER : C. Reasonably expects the patient to require medically
necessary hospital care spanning at least two midnights
The benchmark rests on the practitioner's reasonable expectation,
documented in the record, of care crossing two midnights.
9. A Medicare patient has been in observation status for more than 24
hours. Which notice must the hospital deliver no later than 36 hours
after observation begins?
A. Advance Beneficiary Notice (ABN)
B. Hospital-Issued Notice of Noncoverage (HINN)
C. Medicare Outpatient Observation Notice (MOON)
D. Important Message from Medicare (IM)
ANSWER : C. Medicare Outpatient Observation Notice (MOON)
The NOTICE Act requires the MOON for beneficiaries receiving
observation services for more than 24 hours.
10. The Important Message from Medicare (IM) must be delivered
within two days of admission and again:
A. On the day of admission only
B. Within 30 days after discharge
C. Only if the patient requests an appeal
D. No more than two calendar days before discharge
ANSWER : D. No more than two calendar days before discharge
A follow-up copy of the IM is required within two calendar days before
discharge unless the initial delivery falls within that window.
11. A physician admits a Medicare patient as inpatient, but the UR
committee determines inpatient criteria were not met before
Page 4 of 63
