The exam tests five domains: (1) Governance and Organizational Structure — board responsibilities, medical staff relations, organizational models, accreditation (Joint Commission, CMS Conditions of Participation); (2) Healthcare Finance — capital budgeting, operating budgets, revenue cycle, DRGs, value-based reimbursement; (3) Quality and Performance Improvement — PDCA, Lean/Six Sigma, patient safety, regulatory compliance, risk management; (4) Human Resources — employment law, union relations, workforce planning, leadership development; (5) Healthcare Law and Ethics — HIPAA, Stark Law, anti-kickback statute, informed consent, bioethical frameworks. Finance and quality are historically the highest-weight domains.