Credentialing Environment Overview
(CPMSM) UPDATED ACTUAL Exam
Questions and CORRECT Answers
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.
(CPMSM) UPDATED ACTUAL Exam
Questions and CORRECT Answers
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.
