Credentialing

Examination Outline

Blueprint Changes for August 2013

200 Questions
KNOWLEDGE AREA PERCENTAGE NO. OF QUESTIONS
Governance and Organizational Structure Knowledge 5% 10
  1. Knowledge of governance theory (e.g., mission and values, relationships with board of directors, roles of governing board and management)
  2. Knowledge of governance structure (e.g., bylaws articles of incorporation, fiduciary responsibilities)
  3. Knowledge of medical staff structure and its relationship to governing body and facility operation (e.g., credentialing, privileging and disciplinary process)
  4. Knowledge of public policy matters and legislative and advocacy processes
Human Resources Knowledge 11% 22
  1. Knowledge of performance management systems (e.g., performance-based evaluation, rewards systems, disciplinary policies and procedures)
  2. Knowledge of recruitment techniques
  3. Knowledge of selection techniques
  4. Knowledge of labor relations strategies and tactics
  5. Knowledge of staffing methodologies and productivity management (e.g., acuity-based staffing, flexible staffing, fixed staffing)
  6. Knowledge of employee satisfaction measurement and improvement techniques
  7. Knowledge of motivational techniques
  8. Knowledge of compensation and benefits and practices
  9. Knowledge of worker safety, security and employee health issues (e.g., OSHA; workplace violence)
  10. Knowledge of conflict resolution and grievance procedure
Financial Knowledge 10% 20
  1. Knowledge of basic accounting principles (e.g., accounts receivable, cash flow, chart of accounts, GAAP)
  2. Knowledge of financial management and financial analysis principles (e.g., balance sheets, income and cash flow statements, ratio analysis)
  3. Knowledge of operating budget principles (e.g., fixed vs. flexible, zero based, variance analysis)
  4. Knowledge of capital budgeting principles
  5. Knowledge of reimbursement methodologies and ramifications
  6. Knowledge of fundamental productivity measures (e.g., hours per patient day, cost per patient day, units of service per man hour)
  7. Knowledge of financial controls and auditing principles
  8. Knowledge of capital funding sources
  9. Knowledge of revenue generation
  10. Knowledge of asset management, including facilities equipment, etc.
Healthcare Technology and Information Management Knowledge 5% 10
  1. Knowledge of the role and function of information technology in operations
  2. Knowledge of technology trends and clinical applications
  3. Knowledge of technology security requirements (re: HIPAA, local governmental and organizational policies)
  4. Knowledge of health information (e.g., data equipment, interoperability standards, decision support)
  5. Knowledge of information systems continuity (e.g., disaster planning, recovery, backup sabotage, natural disasters)
  6. Knowledge of information systems planning and implementation (e.g., service architecture, technology lifecycles, obsolescence
Quality and Performance Improvement Knowledge 10% 20
  1. Knowledge of benchmarking techniques
  2. Knowledge of medical staff peer review
  3. Knowledge of risk management principles and programs (e.g., insurance, education, safety, injury management, patient complaint, patient and staff security)
  4. Knowledge of performance and process improvement
  5. Knowledge of customer satisfaction principles and tools
  6. Knowledge of clinical methodologies (e.g., clinical pathways, evidence-based medicine, population health, pay for performance)
  7. Knowledge of utilization review
  8. Knowledge of national quality initiatives including patient safety
Laws and Regulations 8% 16
  1. Knowledge of human resources laws and regulations (e.g., labor law, wage and hour, FMLA, FLSA, EEOC,) ERISA, workers compensation)
  2. Knowledge of confidentiality principles and laws
  3. Knowledge of corporate compliance laws and regulations (e.g., physician contracts, billing and coding practices, antitrust, conflict of interest, EMTALA, Stark, fraud and abuse, antikickback, tax status)
  4. Knowledge of Medicare/Medicaid/third party payment regulations
  5. Knowledge of inspection and accrediting standards, regulations and organizations (e.g., The Joint Commission/NCQA, OSHA, FDA, NRC, CDC
  6. Knowledge of patient rights laws and regulations (e.g., organ donation, HIPPA, medical records, access to care, advance directives, durable power of attorney, involuntary commitments)
Professionalism and Ethical Knowledge 8% 16
  1. Knowledge of professional codes of ethical behavior (e.g., ACHE, Hippocratic Oath, AMA)
  2. Knowledge of patients’ rights and responsibilities
  3. Knowledge of ethics committee’s roles, structure and functions
  4. Knowledge of cultural and spiritual diversity for patients and staff as they relate to healthcare needs
  5. Knowledge of conflict of interest situations as defined by organizational bylaws, policies and procedures
  6. Knowledge of professional norms and behaviors
  7. Knowledge of the consequences of unethical actions
  8. Knowledge of ethical implications of human-subject research
Healthcare Knowledge 18% 36
  1. Knowledge of healthcare and medical terminology
  2. Knowledge of healthcare trends
  3. Knowledge of managed care models, structures and environment (e.g., group, staff, IPA, PPO)
  4. Knowledge of the ambulatory-care sector (acute-care, ambulatory care, post-acute, public health, long-term)
  5. Knowledge of the interdependency, integration and competition among healthcare sectors
  6. Knowledge of ancillary services (e.g., lab, radiology, therapies)
  7. Knowledge of physicians’ roles
  8. Knowledge of implications of community standards of care
  9. Knowledge of evidence-based management practice
  10. Knowledge of staff perspective in organizational settings (e.g., frame of reference by discipline and role; orientation)
  11. Knowledge of healthcare economics
  12. Knowledge of the interrelationships among access, quality, cost, resources allocation, accountability and community
  13. Knowledge of nurse and allied health professionals scope of practice
  14. Knowledge of support services (e.g., plant operations, materials management, supply chain management, hospitality services)
  15. Knowledge of patient perspective (e.g., cultural differences, expectations)
Management Knowledge 15% 30
  1. Knowledge of implementation planning (e.g., operational plan, management plan)
  2. Knowledge of contingency planning (e.g., emergency preparedness and response)
  3. Knowledge of organizational systems theory and structuring (e.g., span of control, chain of command, interrelationships of organizational units)
  4. Knowledge of management functions (e.g., planning, organizing, directing, controlling)
  5. Knowledge of leadership theory and situational applications
  6. Knowledge of team-building techniques
  7. Knowledge of mediation, negotiation and dispute resolving techniques
  8. Knowledge of potential impacts and consequences of decision making in situations both internal and external
  9. Knowledge of how an organization’s culture impacts its effectiveness
  10. Ability to analyze and evaluate information to support a decision or recommendation
  11. Ability to distinguish relevant from irrelevant information
  12. Ability to integrate information from various sources to make decisions or recommendations
Business Knowledge 10% 20
  1. Knowledge of strategic planning principles (e.g., scenario planning, forecasting, etc)
  2. Knowledge of basic business contracts (e.g., legal and financial implications)
  3. Knowledge of marketing principles and tools (e.g., market analysis, market research, sales, advertising)
  4. Knowledge of techniques for business plan development, implementation and assessment
  5. Knowledge of principles of public affairs and community relations
  6. Knowledge of the functions of organizational policies and procedures
  7. Knowledge of socioeconomic environment in which the organizations function