Credentialing Environment Overview (CPMSM) With Complete
Solutions 100% Verified
Governing body- ANSWER establish the organization's policy that promotes quality
patient care by developing the mission, vision, policies, and bylaws. Ultimate authority
in the hospital organization.
Governing body- ANSWER They are legally responsible for everything that takes place
within the organization. Ensures the hospital is capable of carrying out its mission and
ensures resources are utilized effectively and efficiently.
Governing body - 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 - ANSWER philanthropic and corporate
Philanthropic Governing Boards - 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 - ANSWER board consist of paid business leaders who are
selected to contribute due to their specific areas of expertise.
CEO - ANSWER individual selected by the governing body to accomplish the
organization's mission and objectives.
List all medical staff categories - ANSWER active, associate/provisional, courtesy,
consulting,honorary/emeritus, refer/follow, provisional, faculty, house, hospitalists
, CMS - 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 - 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. - ANSWER TRUE
Under the Federal HMO Act, a thing that calls itself an HMO must be an organization that
has all 3 of the following characteristics - 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? - ANSWER Staff, group, network, IPA, direct contract
Staff HMO model is - ANSWER physicians working directly for and are paid by the
organization.
Group HMO model is - ANSWER physicians are a separate corporation that contracts
with the plan to provide services exclusively to members
Network HMO Model - 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 - ANSWER plan that contracts with individual doctors on a per-person
agreement. These doctors have their own practice and also see non-members.
Solutions 100% Verified
Governing body- ANSWER establish the organization's policy that promotes quality
patient care by developing the mission, vision, policies, and bylaws. Ultimate authority
in the hospital organization.
Governing body- ANSWER They are legally responsible for everything that takes place
within the organization. Ensures the hospital is capable of carrying out its mission and
ensures resources are utilized effectively and efficiently.
Governing body - 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 - ANSWER philanthropic and corporate
Philanthropic Governing Boards - 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 - ANSWER board consist of paid business leaders who are
selected to contribute due to their specific areas of expertise.
CEO - ANSWER individual selected by the governing body to accomplish the
organization's mission and objectives.
List all medical staff categories - ANSWER active, associate/provisional, courtesy,
consulting,honorary/emeritus, refer/follow, provisional, faculty, house, hospitalists
, CMS - 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 - 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. - ANSWER TRUE
Under the Federal HMO Act, a thing that calls itself an HMO must be an organization that
has all 3 of the following characteristics - 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? - ANSWER Staff, group, network, IPA, direct contract
Staff HMO model is - ANSWER physicians working directly for and are paid by the
organization.
Group HMO model is - ANSWER physicians are a separate corporation that contracts
with the plan to provide services exclusively to members
Network HMO Model - 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 - ANSWER plan that contracts with individual doctors on a per-person
agreement. These doctors have their own practice and also see non-members.
