Exam (elaborations)
CREDENTIALING ENVIRONMENT OVERVIEW CPMSM EXAM
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CREDENTIALING ENVIRONMENT OVERVIEWCPMSM EXAM
The governing body, ANSWER, develops the organization's goal, vision, policies,
and bylaws to enhance great patient care. The highest authority in the hospital
organization.
Governing body: ANSWER They are legally liable for everything that occurs
within the organization. Ensures the hospital's ability to execute its objective while
also ensuring that resources are spent efficiently.
Governing body: ANSWER This hospital board is in charge of appointing and
evaluating the CEO, improving performance, risk management, patient safety,
confidentiality of patient information, hospital staff competence, financial
oversight, compliance with law and regulations, and establishing mechanisms to
ensure the quality of patient care.
List the classifications of governing boards: philanthropic and corporate.
Philanthropic Governing Boards - ANSWER boards are made up of unpaid persons
who volunteer their time and expertise in the sake of providing services to an
institution or community. Usually linked with non-profit hospitals.
Corporate Governing Boards - The ANSWER board is made up of compensated
business executives who are chosen to contribute based on their areas of
competence.
CEO – ANSWER individual chosen by the governing board to carry out the
organization's mission and objectives.
, List of medical staff classifications, including active, associate/provisional,
courtesy, consultant, honorary/emeritus, refer/follow, provisional, faculty, house,
and hospitalists.
CMS - ANSWER This accreditor mandates that medical staff bylaws include a
statement outlining the tasks and privileges assigned to each category of medical
staff.
Active staff - ANSWER providers who admit and treat patients regularly and are
willing to participate in medical staff duties. Voting rights are granted, as is
membership on the on-call list and committee service.
Failure to meet the stipulated responsibilities of an active staff appointment may
result in the individual being placed in another staff category. - The answer is true.
According to the Federal HMO Act, a company must exhibit three characteristics to
declare itself an HMO: ANSWER 1. A structured system for providing healthcare
2. agreed upon basic and supplementary health maintenance and treatment services.
3. A group of individuals who have freely enrolled.
What are the four HMO models? - ANSWER Staff, group, network, IPA, or direct
contact
Staff HMO is a model in which physicians work directly for and are paid by the
organization.
The group HMO concept is: ANSWER physicians are a separate organization that
contracts with the plan to deliver services only to members.
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