The Board of Governors Qualifying Examination consists of 230 multiple-choice questions (200 scored, 30 pretest) completed over 4 hours. ACHE reports a pass rate of approximately 80–85% for first-time candidates. Candidates with weaker healthcare finance backgrounds typically struggle most. Recommended preparation: 6–8 weeks of structured study using the ACHE study guide, a review of healthcare finance fundamentals (DRGs, operating margins, capital budgeting), and daily MCQ practice sets. BlitzGrok's adaptive question engine identifies your weakest domain and increases question frequency there automatically.