CPCS QUIZ 2019 TEST PREPARATION |
COMPREHENSIVE PATIENT CARE
TECHNICIAN STUDY GUIDE 2026|
GRADED A+ | GUARANTEED SUCCESS
Updated 2026 Questions and Answers | 100% Verified
Exam Prep and Comprehensive Rationales Included
,What are the three reasons for credentialing? Patient Safety
Risk Management Concerns
Required by accrediting and Regulatory Agencies
Patient Safety can be accomplished by: By allowing only those providers who meets certain high standards to treat
patients.
Medicare Conditions of Participation (CoPs) Protect patient health and safety, and to ensure the quality of care for hospitalized
were created to? patients.
Per Medicare Conditions of Participation (CoPs) make recommendations to the governing body for new members who are
The Medical Staff must: specific to the type of appointment and extent of clinical privileges, and the
governing body takes the final appropriate action.
A separate credentials file must be maintained for each medical staff member or
applicant.
Deemed status means An accredited organization that meet the Centers for Medicare and Medicaid's
requirements for participation and other federal healthcare programs
Why get Accredited? Accreditation assists organizations in monitoring and improving quality of care.
Accreditation can be used to meet certain Medicare certification requirements,
organizations that are accredited are given "deemed status" meaning they meet
the Medicare and Medicaid requirements for participation.
Hospitals Accreditors that have been granted -The Joint Commission (TJC)
Deemed status are:
-American Osteopathic Association's Health
Facility Accreditation Program (AOA-HFAP)
-Det Norske Veritas Healthcare, Inc's (DNV GL)
National Integrated Accreditation for Healthcare
Organizations (NIAHO)
-Center for Improvement in Healthcare Quality (CIQH)
Managed Care Organizations accreditors are: The National Committee for Quality Assurance (NCQA)
Utilization Review Accreditation Commission (URAC)
Main accreditor for ambulatory care facilities? The Accreditation Association for Ambulatory Health Care (AAAHC)
,What are the functions of the Medical Staff Organization Provide Patient Care
(MSO)?
Evaluate the Quality of Patient Care
Maintenance of the MSO
The MSO formal structure and specific operational Medical Staff Organization and governing body of the Healthcare organization
mechanisms are the discretion of the?
Example of Medical Enviroments: Hospital
Ambulatory Care/ Surgery Center
CVO
Provider Organizations
Health Plan
Hospital Credentialing is driven by: Federal/State Laws and Regulations (Medicare CoPs, HQIA)
Accreditation Standards (TJC, ACHC/HFAP, DNV GL, NIAHO, CIHQ)
Governing Documents (Hospital and Medical Staff Bylaws, Medical Staff Rules &
Regulations, Hospital and Medical Staff Policies, and Procedures)
Standard of Care (Legal Aspect)
Health Plan Credentialing is Driven by: Federal/State Laws and Regulations
Accreditation Standards NCQA and URAC
Policies and Procedures
Standard of Care (Legal Aspect)
Healthcare Effectiveness Data and Information Set (HEDIS)
Consumer Assessment of Healthcare of Providers (CAHPS)
CMS
CVO Credentialing is Driven by: Contract
Policies and Procedures
Accreditation Standards (NCQA, URAC, The Joint Commission, DNV GL,
ACH/HFAP, CIQH)
An Independent CVO Contracts with many outside organizations
Typically for-profit company
Must satisfy the accreditation requirements/needs of customers
, In Ambulatory Care, Medical Office/Surgical Center Accreditation Standards (AAAHC, TJC, NCQA, URAC, ACHC/HFAP)
Credentialing is influenced by:
CMS regulations
State and Federal Law
Policies and Procedures
Contractual Agreements
Ambulatory Care Governance Documents (Policies and Procedures and Bylaws)
The Governing Body decides whether: The application will be approved
All or some of the requested privileges will be granted, or all of them will be
denied
There will be a change to the physician's medical staff category
The Centers for Medicare & Medicaid Services That privileging decisions rest with the
Conditions of Participation require governing board.
Department chairs, credentials committees, and MECs make only
recommendations; the board has the sole authority to grant or deny.
Who can evaluate and recommend in a Hospital setting? Department chairs
MEC
Credentials Committee
Who can deny or grant privileges in a Governing board or designated agent
Hospital setting?
Membership vs Privileging Membership is a political process. The medical staff category a physician belongs
to will determine whether a physician can vote, hold office, attend meetings, or
constitute a quorum.
Categories: Active, Associate, Courtesy, Emeritus staff, etc...
Privileges, on the other hand, are the clinical procedures that the hospital allows a
practitioner to do while treating patients.
COMPREHENSIVE PATIENT CARE
TECHNICIAN STUDY GUIDE 2026|
GRADED A+ | GUARANTEED SUCCESS
Updated 2026 Questions and Answers | 100% Verified
Exam Prep and Comprehensive Rationales Included
,What are the three reasons for credentialing? Patient Safety
Risk Management Concerns
Required by accrediting and Regulatory Agencies
Patient Safety can be accomplished by: By allowing only those providers who meets certain high standards to treat
patients.
Medicare Conditions of Participation (CoPs) Protect patient health and safety, and to ensure the quality of care for hospitalized
were created to? patients.
Per Medicare Conditions of Participation (CoPs) make recommendations to the governing body for new members who are
The Medical Staff must: specific to the type of appointment and extent of clinical privileges, and the
governing body takes the final appropriate action.
A separate credentials file must be maintained for each medical staff member or
applicant.
Deemed status means An accredited organization that meet the Centers for Medicare and Medicaid's
requirements for participation and other federal healthcare programs
Why get Accredited? Accreditation assists organizations in monitoring and improving quality of care.
Accreditation can be used to meet certain Medicare certification requirements,
organizations that are accredited are given "deemed status" meaning they meet
the Medicare and Medicaid requirements for participation.
Hospitals Accreditors that have been granted -The Joint Commission (TJC)
Deemed status are:
-American Osteopathic Association's Health
Facility Accreditation Program (AOA-HFAP)
-Det Norske Veritas Healthcare, Inc's (DNV GL)
National Integrated Accreditation for Healthcare
Organizations (NIAHO)
-Center for Improvement in Healthcare Quality (CIQH)
Managed Care Organizations accreditors are: The National Committee for Quality Assurance (NCQA)
Utilization Review Accreditation Commission (URAC)
Main accreditor for ambulatory care facilities? The Accreditation Association for Ambulatory Health Care (AAAHC)
,What are the functions of the Medical Staff Organization Provide Patient Care
(MSO)?
Evaluate the Quality of Patient Care
Maintenance of the MSO
The MSO formal structure and specific operational Medical Staff Organization and governing body of the Healthcare organization
mechanisms are the discretion of the?
Example of Medical Enviroments: Hospital
Ambulatory Care/ Surgery Center
CVO
Provider Organizations
Health Plan
Hospital Credentialing is driven by: Federal/State Laws and Regulations (Medicare CoPs, HQIA)
Accreditation Standards (TJC, ACHC/HFAP, DNV GL, NIAHO, CIHQ)
Governing Documents (Hospital and Medical Staff Bylaws, Medical Staff Rules &
Regulations, Hospital and Medical Staff Policies, and Procedures)
Standard of Care (Legal Aspect)
Health Plan Credentialing is Driven by: Federal/State Laws and Regulations
Accreditation Standards NCQA and URAC
Policies and Procedures
Standard of Care (Legal Aspect)
Healthcare Effectiveness Data and Information Set (HEDIS)
Consumer Assessment of Healthcare of Providers (CAHPS)
CMS
CVO Credentialing is Driven by: Contract
Policies and Procedures
Accreditation Standards (NCQA, URAC, The Joint Commission, DNV GL,
ACH/HFAP, CIQH)
An Independent CVO Contracts with many outside organizations
Typically for-profit company
Must satisfy the accreditation requirements/needs of customers
, In Ambulatory Care, Medical Office/Surgical Center Accreditation Standards (AAAHC, TJC, NCQA, URAC, ACHC/HFAP)
Credentialing is influenced by:
CMS regulations
State and Federal Law
Policies and Procedures
Contractual Agreements
Ambulatory Care Governance Documents (Policies and Procedures and Bylaws)
The Governing Body decides whether: The application will be approved
All or some of the requested privileges will be granted, or all of them will be
denied
There will be a change to the physician's medical staff category
The Centers for Medicare & Medicaid Services That privileging decisions rest with the
Conditions of Participation require governing board.
Department chairs, credentials committees, and MECs make only
recommendations; the board has the sole authority to grant or deny.
Who can evaluate and recommend in a Hospital setting? Department chairs
MEC
Credentials Committee
Who can deny or grant privileges in a Governing board or designated agent
Hospital setting?
Membership vs Privileging Membership is a political process. The medical staff category a physician belongs
to will determine whether a physician can vote, hold office, attend meetings, or
constitute a quorum.
Categories: Active, Associate, Courtesy, Emeritus staff, etc...
Privileges, on the other hand, are the clinical procedures that the hospital allows a
practitioner to do while treating patients.
