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, Privileging, and Enrollment: Develop, manage, conduct, and maintain credentialing, privileging, and enrollment processes. (39%)
- Direct the credentialing, privileging, and enrollment processes of practitioners/providers in accordance with regulatory requirements, accreditation standards, and organizational policies and procedures to mitigate organizational risk and promote the delivery of safe, quality care.
- Oversee the evaluation of credentialing/privileging requests and evidence of education, training, competence, ability to perform, and experience against established criteria for practitioners/providers to determine eligibility for requested privileges, membership, and/or plan participation.
- Oversee the submission of complete and accurate applications and/or practitioner data/roster to ensure timely approval and maintenance of network 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. (37%)
- Develop and/or maintain applicable governance documents that support and direct organizational practices and that comply with regulatory requirements, accreditation standards, managed care requirements, and organizational policies and procedures.
- Identify, review and report practitioner performance data, complaints, sanctions, adverse actions, and quality of care issues in order to facilitate analysis by the appropriate organizational leadership to enable evaluation of current/ongoing practitioner competency or network participation.
- Facilitate consistent, efficient, and timely investigation, appeals, and due process to comply with an organization's corrective action, fair hearing, and appeals policies as well as applicable legal and regulatory requirements.
- Identify adverse 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.
- Comply with internal and external requirements related to verifying and reporting the status of practitioner/provider expirables by querying approved sources and recommending action(s) to medical staff and/or organizational leadership based upon bylaws and policies/procedures.
Operational Management: Ensure effective functioning of departmental operations (14%)
- Prepare, review, and manage operational budget and staffing plans by evaluating financial and performance data to support organizational initiatives.
- Assess, implement, and effectively utilize technology and resources by analyzing the needs of the department in order to manage data with efficiency and integrity to comply 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 facilitate follow-up on action items.
Organizational Management: Integrate and collaborate with others in the organization on interdisciplinary responsibilities to enhance effectiveness. (10%)
- Collaborate with others to implement programs, policies, and practices that support practitioner/provider status (e.g., onboarding, changes, off boarding) and compliance with regulatory requirements, accreditation standards, and organizational policies and procedures.
- Develop policies and procedures that govern the efficient management and distribution of practitioner/provider information to internal and external sources in accordance with regulatory requirements, accreditation standards, and organizational policies and procedures.
CPMSM® is registered in the U.S. Patent and Trademark Office as a service mark of National Association Medical Staff Services.