CPMSM STUDY GUIDE CORRECT
QUESTIONS & ANSWERS LATEST
UPDATE 2025 100% ACCURATE
Non-profit under religious/community control. - ANSWER Voluntary/Charitable Hospital
Non-profit under city, state, county. - ANSWER Govt (non-federal) hospital
Owned/operated by fed gov't, supported by fed funds, e.g., VA. Under direct supervision
of Surgeon General. - ANSWER Govt (federal) hospital
Owned by corporation, partnership. - ANSWER Proprietary for-profit hospital
Provides services typical of a doctor's office our outpatient clinic. - ANSWER First Level
Hospital
The average hospital. Provides short term/general acute care. - ANSWER Secondary
Care Hospital
Large urban teaching hospital with more complex care/specialized services. - ANSWER
Tertiary Care Hospital
Specializing in long term care, psychiatric care, cancer, pediatric, geriatric care etc. -
ANSWER Specialty Hospitals
Managed Care Organization - ANSWER MCO
Influenced by accreditation standards, fed/state regulations, policies/procedures,
standard of care, HEDIS/CAHPS. - ANSWER MCO Characteristics
Healthcare Effectiveness Data and Information Set - ANSWER HEDIS
Consumer Assessment of Healthcare Providers and Systems - ANSWER CAHPS
Health Maintenance Organization, provides healthcare to group of members who pre-
pay dues. - ANSWER HMO
1 Organized system for providing healthcare.
2 Agreed upon set of basic and supplemental health and treatment services.
3 A voluntarily enrolled group of people. - ANSWER HMO Three Characteristics
Staff model, group model, network model, independent practice association (IPA), direct
contract model. - ANSWER HMO Models
,Physicians work directly for and are paid by organization. - ANSWER HMO Staff Model
Physicians are a separate corporation that contracts with plan to provide services
exclusively to members. - ANSWER HMO Group Model
Physicians are separate corporation that contracts with plan to provide services. Plan
contracts with several physician groups (vs just one in a group model). - ANSWER
HMO Network Model
IPA, plan contracts with individual physicians in a per person agreement. These
physicians have their own practices and also see patients outside of the plan. IPAs
contract with Hospital MSO to provide services. HMSO charges a fee. The Plan
frequently drives reimbursement cost down for IPA. - ANSWER HMO Independent
Practice Association
HMO contracts directly with individual physicians to provide physician services to
members. - ANSWER HMO Direct Contract Model
PHO/HMSO joins forces as a negotiating team, at the Managed Care Plan's bargaining
table. PHO provides outpatient care and services for plan's members, and hospital
becomes the "preferred" hospital. PHO/hospital accepts full risk capitation. - ANSWER
Physician Hospital organization/Hospital Medical Staff Organization
. Network of doctors and hospitals created by insurance companies/employers.
Insurer/employer negotiates discounted rate. Care includes primary care gatekeepers,
second opinions for surgery etc. - ANSWER Preferred Provider Organization
MSO. Separate corporatinon set up to manage a medical group for a fee. - ANSWER
Management Services Organization
Section 2 - ANSWER Section 2
If you take on 100 pts you spread your risk over large amount. E.g., Kaiser/HMO model.
- ANSWER Full Risk Capitation
POS Plan. Combined features of HMO and indemity plans. Members can choose to use
in network physician or go with physiican out of network. In network physicans are paid
at discounted rate. Non-network physicians are paid by traditional fee-for service.
Financial incentive to stay in network. - ANSWER Point of Service Plan
CVO. Influenced by several factors, JCo, NCQA, fed/state regs. Two types of CVOs,
organization-specific and independent. - ANSWER Central Verification Organization
,Handles organization-specific credentialling, structured as part of non-profit
organization; may sometimes be for profit and have customers outside the org. -
ANSWER Organization-Specific CVO
Contracts with many outside organizations, for-profit. - ANSWER Independent CVO
Governing Body, CEO, Medical Director/VPMA/Chief Medical Officer, Med Staff Office,
Chief of Staff/Med Staff President, Dept/Service Chairs, MSP - ANSWER Key Leaders
with Responsibilities in Credentialing
Governing body/board supports quality pt care through mission, vision, policies, bylaws.
Ultimate authority of the hospital, and must act in hospital's best interests, exercise
oversight, incl appt/evaluation of CEO, cred issues, bylaws approval, fair-hearing. -
ANSWER Governing Body/Board and Cred Responsibilities
Philanthropic or Corporate Boards. Philanthropic are non-paid individuals. Corporate
boards are paid business leaders with a voting CEO. - ANSWER Governing Body Two
Types
Oversees day to day operations. CEO reports to governing body. - ANSWER Chief
Executive Officer
Acts as liaison btw medical staff and hospital administration. - ANSWER Medical
Director/VPMA/Chief Med Officer
MSO, formally organized, self-governing entity, must meet specific criteria. Medical staff
elects med staff leaders. Officers may be paid or volunteered. - ANSWER Medical Staff
Organization
Continuity of leadership with succession, treasury to vp, president elect, president. Chief
of Staff/Med Staff President is considered the CEO of the medical staff. Held
accountable for organization/administration of med staff. - ANSWER Chief of Staff/Med
Staff President
Accountable for clinical and administrative activities within department. - ANSWER
Dept/Service Chairpersons
Key person in support of Medical Staff Organization. Must work independently with little
supervision. - ANSWER Medical Services Professional
Enforcement of bylaws, policies, communication between stake holders. - ANSWER
Medical Staff Structure
LIPs provides pt care services and includes physicians, dentists, podiatrists, oral
surgeons, advanced practice clinicians (APCs). - ANSWER Licensed Independent
Practitioners
, E.g. Psychiatry hospital is small and non-departmentalized. Larger hospitals are
departmentalized and offer broader array of services. Depts are subdivided into
sections, e.g., cardiology, hospital medicine etc. - ANSWER Departmentalized vs Non-
Departmentalized Hospital
Smaller committees make recommendations to larger body. Several types of
committees, Peer Review, Leadership, Credentials, Pharmacy & Therapeutics, etc. -
ANSWER Committees
Surveys conducted annually or during reappt can identify those interested in serving on
committees. Appointments are one to two years typically, with the chair having higher
level of expertise. - ANSWER Committee Structure
Membership on a committee by virtue of a particular office or position. E.g., med staff
president may be ex-officio member of all committees. - ANSWER Ex-Officio
Standing committees - fulfills responsibilities on an ongoing basis, e.g. credentials. Ad
hoc committees, assembled and appointed to perform specific task, works
independently, reports to larger committee, and disbands after task is complete. Task
Force is composed of experts, formed to investigate a specific problem, and disbands
after problem is resolved. Continuous Quality Improvement Team is multidisciplinary
group to evaluate quality indicators. - ANSWER Four Types of Committees
Self governing entity, exists as extension of healthcare facility. Organizational structure
delineated by its bylaws, rules, regs. - ANSWER Medical staff
Must reflect current structure and operational practices of Med Staff org. Bylaws are
dynamic and annual review is recommended. Bylaws changes are adopted by majority
vote of the med staff and approved by the governing body. - ANSWER Bylaws
CoPs are intended to protect pt health and safety, and ensure quality care. - ANSWER
Medicare Conditions of Participation (CoPs)
Accreditation assists orgs in monitoring/improving quality of care. Orgs must credential
or else they lose accreditation. Accreditation is required for Medicare. Accredited orgs
are given "deemed status" which means they meet requirements for Centers for
Medicare and Medicaid's requirement for participation in Medicare, Medicaid. Meeting
requirements spares healthcare organizations from routine state surveys to assess
compliance. Healthcare org can be subject to state survey though. Accreditation is also
sought for marketing reasons, insurance premiums, maintain managed care
contractors, employer/union requirements. - ANSWER Why Get Accredited?
CMS gives "deemed status". TJC, "American Osteopathic Association's Health Facilities
Accreditation Program and Det Norske Veritas Healthcare are also granted "deemed
QUESTIONS & ANSWERS LATEST
UPDATE 2025 100% ACCURATE
Non-profit under religious/community control. - ANSWER Voluntary/Charitable Hospital
Non-profit under city, state, county. - ANSWER Govt (non-federal) hospital
Owned/operated by fed gov't, supported by fed funds, e.g., VA. Under direct supervision
of Surgeon General. - ANSWER Govt (federal) hospital
Owned by corporation, partnership. - ANSWER Proprietary for-profit hospital
Provides services typical of a doctor's office our outpatient clinic. - ANSWER First Level
Hospital
The average hospital. Provides short term/general acute care. - ANSWER Secondary
Care Hospital
Large urban teaching hospital with more complex care/specialized services. - ANSWER
Tertiary Care Hospital
Specializing in long term care, psychiatric care, cancer, pediatric, geriatric care etc. -
ANSWER Specialty Hospitals
Managed Care Organization - ANSWER MCO
Influenced by accreditation standards, fed/state regulations, policies/procedures,
standard of care, HEDIS/CAHPS. - ANSWER MCO Characteristics
Healthcare Effectiveness Data and Information Set - ANSWER HEDIS
Consumer Assessment of Healthcare Providers and Systems - ANSWER CAHPS
Health Maintenance Organization, provides healthcare to group of members who pre-
pay dues. - ANSWER HMO
1 Organized system for providing healthcare.
2 Agreed upon set of basic and supplemental health and treatment services.
3 A voluntarily enrolled group of people. - ANSWER HMO Three Characteristics
Staff model, group model, network model, independent practice association (IPA), direct
contract model. - ANSWER HMO Models
,Physicians work directly for and are paid by organization. - ANSWER HMO Staff Model
Physicians are a separate corporation that contracts with plan to provide services
exclusively to members. - ANSWER HMO Group Model
Physicians are separate corporation that contracts with plan to provide services. Plan
contracts with several physician groups (vs just one in a group model). - ANSWER
HMO Network Model
IPA, plan contracts with individual physicians in a per person agreement. These
physicians have their own practices and also see patients outside of the plan. IPAs
contract with Hospital MSO to provide services. HMSO charges a fee. The Plan
frequently drives reimbursement cost down for IPA. - ANSWER HMO Independent
Practice Association
HMO contracts directly with individual physicians to provide physician services to
members. - ANSWER HMO Direct Contract Model
PHO/HMSO joins forces as a negotiating team, at the Managed Care Plan's bargaining
table. PHO provides outpatient care and services for plan's members, and hospital
becomes the "preferred" hospital. PHO/hospital accepts full risk capitation. - ANSWER
Physician Hospital organization/Hospital Medical Staff Organization
. Network of doctors and hospitals created by insurance companies/employers.
Insurer/employer negotiates discounted rate. Care includes primary care gatekeepers,
second opinions for surgery etc. - ANSWER Preferred Provider Organization
MSO. Separate corporatinon set up to manage a medical group for a fee. - ANSWER
Management Services Organization
Section 2 - ANSWER Section 2
If you take on 100 pts you spread your risk over large amount. E.g., Kaiser/HMO model.
- ANSWER Full Risk Capitation
POS Plan. Combined features of HMO and indemity plans. Members can choose to use
in network physician or go with physiican out of network. In network physicans are paid
at discounted rate. Non-network physicians are paid by traditional fee-for service.
Financial incentive to stay in network. - ANSWER Point of Service Plan
CVO. Influenced by several factors, JCo, NCQA, fed/state regs. Two types of CVOs,
organization-specific and independent. - ANSWER Central Verification Organization
,Handles organization-specific credentialling, structured as part of non-profit
organization; may sometimes be for profit and have customers outside the org. -
ANSWER Organization-Specific CVO
Contracts with many outside organizations, for-profit. - ANSWER Independent CVO
Governing Body, CEO, Medical Director/VPMA/Chief Medical Officer, Med Staff Office,
Chief of Staff/Med Staff President, Dept/Service Chairs, MSP - ANSWER Key Leaders
with Responsibilities in Credentialing
Governing body/board supports quality pt care through mission, vision, policies, bylaws.
Ultimate authority of the hospital, and must act in hospital's best interests, exercise
oversight, incl appt/evaluation of CEO, cred issues, bylaws approval, fair-hearing. -
ANSWER Governing Body/Board and Cred Responsibilities
Philanthropic or Corporate Boards. Philanthropic are non-paid individuals. Corporate
boards are paid business leaders with a voting CEO. - ANSWER Governing Body Two
Types
Oversees day to day operations. CEO reports to governing body. - ANSWER Chief
Executive Officer
Acts as liaison btw medical staff and hospital administration. - ANSWER Medical
Director/VPMA/Chief Med Officer
MSO, formally organized, self-governing entity, must meet specific criteria. Medical staff
elects med staff leaders. Officers may be paid or volunteered. - ANSWER Medical Staff
Organization
Continuity of leadership with succession, treasury to vp, president elect, president. Chief
of Staff/Med Staff President is considered the CEO of the medical staff. Held
accountable for organization/administration of med staff. - ANSWER Chief of Staff/Med
Staff President
Accountable for clinical and administrative activities within department. - ANSWER
Dept/Service Chairpersons
Key person in support of Medical Staff Organization. Must work independently with little
supervision. - ANSWER Medical Services Professional
Enforcement of bylaws, policies, communication between stake holders. - ANSWER
Medical Staff Structure
LIPs provides pt care services and includes physicians, dentists, podiatrists, oral
surgeons, advanced practice clinicians (APCs). - ANSWER Licensed Independent
Practitioners
, E.g. Psychiatry hospital is small and non-departmentalized. Larger hospitals are
departmentalized and offer broader array of services. Depts are subdivided into
sections, e.g., cardiology, hospital medicine etc. - ANSWER Departmentalized vs Non-
Departmentalized Hospital
Smaller committees make recommendations to larger body. Several types of
committees, Peer Review, Leadership, Credentials, Pharmacy & Therapeutics, etc. -
ANSWER Committees
Surveys conducted annually or during reappt can identify those interested in serving on
committees. Appointments are one to two years typically, with the chair having higher
level of expertise. - ANSWER Committee Structure
Membership on a committee by virtue of a particular office or position. E.g., med staff
president may be ex-officio member of all committees. - ANSWER Ex-Officio
Standing committees - fulfills responsibilities on an ongoing basis, e.g. credentials. Ad
hoc committees, assembled and appointed to perform specific task, works
independently, reports to larger committee, and disbands after task is complete. Task
Force is composed of experts, formed to investigate a specific problem, and disbands
after problem is resolved. Continuous Quality Improvement Team is multidisciplinary
group to evaluate quality indicators. - ANSWER Four Types of Committees
Self governing entity, exists as extension of healthcare facility. Organizational structure
delineated by its bylaws, rules, regs. - ANSWER Medical staff
Must reflect current structure and operational practices of Med Staff org. Bylaws are
dynamic and annual review is recommended. Bylaws changes are adopted by majority
vote of the med staff and approved by the governing body. - ANSWER Bylaws
CoPs are intended to protect pt health and safety, and ensure quality care. - ANSWER
Medicare Conditions of Participation (CoPs)
Accreditation assists orgs in monitoring/improving quality of care. Orgs must credential
or else they lose accreditation. Accreditation is required for Medicare. Accredited orgs
are given "deemed status" which means they meet requirements for Centers for
Medicare and Medicaid's requirement for participation in Medicare, Medicaid. Meeting
requirements spares healthcare organizations from routine state surveys to assess
compliance. Healthcare org can be subject to state survey though. Accreditation is also
sought for marketing reasons, insurance premiums, maintain managed care
contractors, employer/union requirements. - ANSWER Why Get Accredited?
CMS gives "deemed status". TJC, "American Osteopathic Association's Health Facilities
Accreditation Program and Det Norske Veritas Healthcare are also granted "deemed
