CPMSM - Study Guide Material 100%
latest update 2025
,What are four models of HMOs? - ANSWERStaff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types of committees? - ANSWERStanding
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - ANSWER5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - ANSWER5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? -
ANSWER3
At least three active medical staff
How many medical staff members must serve on a Medical Records Committee? -
ANSWER1
At least one active medical staff
How often should the Medical Records committee meet? - ANSWERAt least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics
Committee? - ANSWER5
At least five active medical staff
How often should the Pharmacy & Therapeutics committee meet? - ANSWERAt least
quarterly
How many medical staff members must serve on a Utilization Review Committee? -
ANSWER1
At least one active medical staff
, How often should the Utilization Review Committee meet? - ANSWEREvery other
month
What is the process of obtaining, verifying, and assessing the qualifications of a health
care practitioner who seeks to provide patient care services in or for a hospital? -
ANSWERCredentialing
What are the three reasons for credentialing? - ANSWERPatient Safety
Risk Management
Required by agencies
Which three accreditors have been granted "deemed status"? - ANSWERTJC, HFAP,
DNV
Which two organizations offer accreditation for managed care organizations? -
ANSWERNCQA, URAC
Who is the main accreditor for ambulatory care facilities? - ANSWERAAAHC
Physicians who are employees of a facility as hospitalists and who are not listed in the
provider directory are not included in the scope of the credentialing standards with this
accreditation? - ANSWERURAC
For which accreditation, do the following practitioners need *not* to be credentialed
including:
-exclusively in the inpatient setting caring for organization members only in the hospital
setting
-practice exclusively in free-standing setting for members directed to facility
-pharmacists working for a PBM (pharmacy benefits management) organization for UM
functions
-locum tenens working less than 90 days
-rental network practitioners providing out of area care - ANSWERNCQA
What are Medicare CoP's minimum criteria for appointment to the medical staff/granting
of medical staff privileges? - ANSWERCCJET
character
competence
judgement
experience
training
CMS regulations require that medical staff bylaws include what information pertaining to
each category of the medical staff? - ANSWERduties and privileges
Do providers with refer and follow status have admitting privileges/ordering privileges
within the hospital? - ANSWERNo
latest update 2025
,What are four models of HMOs? - ANSWERStaff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types of committees? - ANSWERStanding
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - ANSWER5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - ANSWER5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? -
ANSWER3
At least three active medical staff
How many medical staff members must serve on a Medical Records Committee? -
ANSWER1
At least one active medical staff
How often should the Medical Records committee meet? - ANSWERAt least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics
Committee? - ANSWER5
At least five active medical staff
How often should the Pharmacy & Therapeutics committee meet? - ANSWERAt least
quarterly
How many medical staff members must serve on a Utilization Review Committee? -
ANSWER1
At least one active medical staff
, How often should the Utilization Review Committee meet? - ANSWEREvery other
month
What is the process of obtaining, verifying, and assessing the qualifications of a health
care practitioner who seeks to provide patient care services in or for a hospital? -
ANSWERCredentialing
What are the three reasons for credentialing? - ANSWERPatient Safety
Risk Management
Required by agencies
Which three accreditors have been granted "deemed status"? - ANSWERTJC, HFAP,
DNV
Which two organizations offer accreditation for managed care organizations? -
ANSWERNCQA, URAC
Who is the main accreditor for ambulatory care facilities? - ANSWERAAAHC
Physicians who are employees of a facility as hospitalists and who are not listed in the
provider directory are not included in the scope of the credentialing standards with this
accreditation? - ANSWERURAC
For which accreditation, do the following practitioners need *not* to be credentialed
including:
-exclusively in the inpatient setting caring for organization members only in the hospital
setting
-practice exclusively in free-standing setting for members directed to facility
-pharmacists working for a PBM (pharmacy benefits management) organization for UM
functions
-locum tenens working less than 90 days
-rental network practitioners providing out of area care - ANSWERNCQA
What are Medicare CoP's minimum criteria for appointment to the medical staff/granting
of medical staff privileges? - ANSWERCCJET
character
competence
judgement
experience
training
CMS regulations require that medical staff bylaws include what information pertaining to
each category of the medical staff? - ANSWERduties and privileges
Do providers with refer and follow status have admitting privileges/ordering privileges
within the hospital? - ANSWERNo
