Credentialing Environment Overview (CPMSM) questions and answers graded A+ 2023/2024

Credentialing Environment Overview (CPMSM)Governing body - correct answer set the organization policy that supports quality patient care by developing the mission, vision, policies, and bylaws. Ultimate authority in the hospital organization. Governing body - correct answer They are legally responsible for everything that happens in the organization. Ensures the hospital is able to fulfill its mission and ensures resources are used efficiently and effectively. Governing body - correct answer This board of the hospital is responsible for appointment and evaluation of the CEO, performance improvement, risk management, patient safety, confidentiality of patient information, competence of hospital staff, financial oversight, compliance with law and regulations and establishment of mechanisms to ensure the quality of patient care. List the classifications of governing boards - correct answer philanthropic and corporate Philanthropic Governing Boards - correct answer board consist of non-paid individuals contributing their time and expertise in the interest of services to the facility or community. Usually associated with not-for-profit hospitals Corporate Governing Boards - correct answer board consist of paid business leaders who are selected to contribute due to their specific areas of expertise. CEO - correct answer individual selected by the governing body to accomplish the organization's mission and objectives. List all medical staff categories - correct answer active, associate/provisional, courtesy, consulting,honorary/emeritus, refer/follow, provisional, faculty, house, hospitalists CMS - correct answer this accreditor requires that medical staff bylaws include a statement on the duties and privileges related to each category of the medical staff. active staff - correct answer providers who routinely admit and treat patients and willing to participate in the work of the medical staff. Granted rights to vote, on-call list participation, serves on committees. failure to fulfill the documented responsibilities of an active staff appointment may automatically place the individual in another staff category. - correct answer TRUE Under the Federal HMO Act, an entity must have 3 characteristics to call itself an HMO - correct answer 1. an organized system for providing healthcare 2. an agreed upon basic and supplemental health maintenance and treatment services 3. a group of voluntarily enrolled people. What are the 4 HMO models? - correct answer Staff, group, network, IPA, direct contract Staff HMO model is - correct answer physicians working directly for and are paid by the organization. Group HMO model is - correct answer physicians are a separate corporation that contracts with the plan to provide services exclusively to members Network HMO Model - correct answer similar to group model but the plan contracts with several physician groups instead of one, to provide services exclusively to members. IPA HMO Model - correct answer plan that contracts with individual doctors on a per-person agreement. These doctors have their own practice and also see non-members. Direct contract HMO model - correct answer HMO contracts directly with individual physicians to provide physician services to their members. An IPA will often contract with this type of organization to provide services such as billing, credentialing, management, utilization, etc. - correct answer Medical Staff Organization