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2025 CPCS Certification Study Guide /
Newest Actual Exam Questions and
Correct Detailed Answers (Verified
Answers)
_____________Quiz____________? TJC (The Joint Commission) - relevant standards -
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Leadership, Medical Staff _____________Quiz____________? HFAP (Healthcare Facilities Accreditation Program) - relevant standards -
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Ch 3, Medical Staff _____________Quiz____________? DNV (Det Norske Veritas) - relevant standards -
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NIAHO Standards for Hospitals _____________Quiz____________? AAAHC (Accreditation Association for Ambulatory Health Care) - relevant standards -
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Governance _____________Quiz____________? Medicare CoPs (Conditions of Participation) - relevant standards -
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42 CFR Part 482 _____________Quiz____________? What does TJC accredit? -
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Healthcare organizations and programs in the U.S. _____________Quiz____________? What does NCQA accredit? -
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Health Plans and MCOs _____________Quiz____________? What does HFAP accredit? -
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Acute care hospitals
NCQA, URAC
_____________Quiz____________? Ambulatory care facility accreditor(s)? -
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AAAHC
_____________Quiz____________? MCA CoPs -
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Federal regulations that healthcare organizations must meet to participate in (bill) the Medicare program. _____________Quiz____________? "The Big Three" (accrediting bodies) -
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TJC, CMS, NCQA
_____________Quiz____________? Which accreditation body mostly aligns with MCA CoPs? -
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HFAP
_____________Quiz____________? Which accreditation body mostly aligns with NCQA requirements? -
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URAC
_____________Quiz____________? Which accreditation body mostly aligns with TJC requirements? -
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AAAHC
_____________Quiz____________? What is an 'Insurance Panel' -
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A group of practitioners who work with an insurance company to provide care for members enrolled with that insurance company. (In-network practitioners with an insurance company.) _____________Quiz____________? What is a 'Health Plan' -
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Health Insurance organization _____________Quiz____________?
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Director of Managed Healthcare _____________Quiz____________? What title or group is generally at the top of a CVO organizational structure? -
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Director _____________Quiz____________? In a hospital organizational structure, which group is generally at the top of the hierarchy? (Medical Staff Executive Committee or Board of Trustees) -
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Medical Staff Executive Committee _____________Quiz____________? What type of organization typically has a Board of Trustees? -
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Hospitals _____________Quiz____________? What type of organization typically has a Medical Staff Executive Committee (MSEC) -
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Hospitals
_____________Quiz____________? What type of organization typically has a Director of Managed Healthcare -
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HealthPlans/MCOs _____________Quiz____________? What type of organization is governed by AAAHC, HFAP, TJC, NCQA, URAC & CMS? -
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Ambulatory Clinic _____________Quiz____________? What type of CVO is for-profit and contracts with many outside organizations? -
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Independent CVOs _____________Quiz____________? What type of CVO is associated with a specific healthcare organization? -
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Organization Specific CVOs _____________Quiz____________?
State licensing regulations Accreditation standards TJC HFAP DNV Center for Improvement in Healthcare Quality (CIHQ) ISO 9001 Quality Management System (QMS) Standard of Care (legal aspect) -
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Hospitals _____________Quiz____________? What type of entity is implied by the below influences?
Accreditation Standards NCQA URAC Federal/state laws and restrictions Healthcare effectiveness Data and Information Set (HEDIS) Consumer Assessment of Healthcare Providers & Systems (CAHPS) Policies and Procedures Standard of Care (legal aspect) -
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Health Plans _____________Quiz____________? What type of entity is implied by the below influences?
Contracts Accreditation Standards AAAHC HFAP TJC DNV CIHQ NCQA URAC CMS Regulations Policies and Procedures Federal/state laws and regulations -
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CVOs _____________Quiz____________? What type of entity is implied by the below influences?
Is the medical staff a self-governing entity? -
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Yes! _____________Quiz____________? What is a self-governing entity that exists as an extension of the healthcare facility? -
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Medical Staff _____________Quiz____________? Where is the organization structure detailed for a hospital? -
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Bylaws _____________Quiz____________? What defines how medical staff appointees act and interact in hospital-related activities? -
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Bylaws _____________Quiz____________? Bylaws, Rules & Regulations and Policies of the medical staff establish -
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the roles and responsibilities and guide the behavior of the body and it's members.
_____________Quiz____________? Bylaws, Rules & Regulations and Policies of the medical staff protect medical staff appointees in legal proceedings: a) Individually b) as a whole c) both d) None of the above -
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C - individually and as a whole. _____________Quiz____________? What defines how medical staff appointees act and interact in hospital-related activities? -
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Bylaws _____________Quiz____________? The medical staff may delegate the authority for changing the Rules and Regulations to who/what? -
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MEC
a) a medical staff b) provider panel c) both d) neither -
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c) both
