The CPMSM exam addresses the following content. Candidates are required to demonstrate proficiency by answering exam questions that evaluate their knowledge of facts, concepts and processes required to complete the tasks described below. Additional information is available in the Candidate Handbook.
Credentialing and Privileging: Develop, Manage, Conduct, and Maintain Credentialing and Privileging Processes (38%)
- Dirrect the credentialing and privileging processes of practitioners/providers in accordance with regulatory requirements, accreditation standards, and organizational policies and procedures to mitigate organizational risk (e.g., negligent credentialing, discrimination) and promote the delivery of safe, quality patient care.
- Oversee the evaluation of credentialing/privileging requests and evidence of education, training, competence, and experience against established criteria for practitioners/providers to determine eligibility for requested privileges, membership, and/or plan participation.
- Collaborate with the organization’s medical staff to develop and maintain a facility-specific, criteria-based clinical privileging system for privileged practitioners/providers in accordance with regulatory requirements, accreditation standards, and organizational policies and procedures.
Ongoing Monitoring And Compliance: Ensure Continuous Adherence to Regulatory Requirements, Accreditation Standards, and Organizational Policies and Procedures (27%)
- Develop and/or maintain applicable governance documents (e.g., bylaws, credentialing policies and procedures, rules and regulations) that support and direct organizational practices and that comply with regulatory requirements, accreditation standards, managed care requirements, and organizational policies and procedures.
- Using a variety of tools, develop, review and prepare practitioner/provider performance improvement and peer review data in reports and presentations in order to facilitate analysis by the appropriate organizational leadership to enable evaluation of current/ongoing practitioner/provider competency.
- Facilitate efficient and timely due process that complies with an organization’s corrective action, fair hearing, and appeals policies as well as applicable legal and regulatory requirements by serving as an advisor to organizational leadership (e.g., medical staff, administration) in order to ensure consistency.
- Identify adverse actions (e.g., summary suspensions, privileging actions) taken against a practitioner/provider and appropriately report/notify the necessary authorized agencies, organizational staff, and external organizations in accordance with applicable law and contractual requirements.
- Monitor and report sanctions and complaints (e.g., OIG, state license) for practitioners/providers in order to recommend action by medical staff and/or organizational leadership to comply with internal and external requirements (e.g., state and federal agencies and health plans).
- Comply with internal and external requirements related to verifying the status of practitioner/provider expirables (e.g., licenses, certifications, insurance, vaccinations/immunizations) by querying approved sources and recommending action(s) to medical staff and/or organizational leadership based upon bylaws and policies/procedures (e.g., automatic suspension).
Department Operations Management: Ensure Effective Functioning of Departmental Operations (20%)
- Prepare, review, and manage operational budget and staffing plans, and perform human resources-related functions by evaluating financial and other internal and external resources to support departmental operations.
- Assess, implement, effectively utilize, and maintain products and information systems (e.g., files, reports, minutes, databases) by analyzing the needs and resources of the department in order to manage data with efficiency and integrity in a manner that complies with regulatory requirements, accreditation standards, and organizational policies and procedures.
- Oversee the preparation of materials for committees, boards, and other organizational groups in order to maintain an official record of proceedings and decisions and to identify and ensure follow-up on action items (e.g., scheduling, agendas, meeting materials, action plans).
System Management: Integrate and Collaborate with Others in the Facility on Interdisciplinary Responsibilities to Enhance Organizational Functions (15%)
- Work independently and/or with others to monitor educational activities offered by the organization to assist practitioners/providers in meeting their education requirements.
- Collaborate with others to create and implement orientation about programs, policies, and practices that support practitioner/provider compliance with regulatory requirements, accreditation standards, and organizational policies and procedures.
- Develop policies and applicable tools (e.g., confidentiality statements, audit tools, verifications, practitioner access) that govern the efficient management, sharing, and distribution of information to internal and external sources (e.g., managed care, hospitals, marketing, recruiting) in accordance with regulatory requirements, accreditation standards, and organizational policies and procedures.