CPMSM Preparation questions with 100% correct answers

CPMSM Preparation Why is it important to check that the practitioner is not currently exclude, suspended, debarred, or ineligible to participate in Federal health care programs? - correct answer The facility will not get paid for treating patients unless the service is provided by an authorized provider. Which of the following credentials must be tracked on an ongoing basis? - correct answer Licensure According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action? - correct answer Determine if there is evidence of poor quality that could affect the health and safety of its members. What is the name of the entity that was established thru the Health Care Quality Improvement Act of 1986 to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history? - correct answer The Nation Practitioner Data Bank When developing clinical privileging criteria, which of the following is important to evaluate? - correct answer Established standards of practice such as specialty board recommendations. What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty? - correct answer To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care. Which of the following specialists is most likely to perform a PTCA? - correct answer Interventional Cardiologist The Joint Commission hospital standards require that clinical privileges are hospital specific and - correct answer Based on the individual's demonstrated current competence and the procedures the hospital can support. Which of the following would be routinely performed by a cardiologist? - correct answer Transesophageal Echocardiography Which NCQA required committee makes recommendations regarding credentialing decisions? - correct answer Credentialing Committee HFAP standards require three medical staff committees to be delineated in the medical staff structure; what are they? - correct answer Medical Executive Committee, the Utilization Review Committee and the Utilization of Osteopathic Methods and Concepts Committee If you needed to find out about what the federal government requires in regards to anti-trust issues, what law would you consult? - correct answer The Sherman Anti-trust Act Peer references should be obtained from: - correct answer Practitioners in the same professional discipline as the applicant. Patrick v. Burgett is an important case because it: - correct answer Illustrates the potential for antitrust liability arising out of peer review activities. If a medical staff member has privileges and / or medical staff appointment revoked, he/she must be: - correct answer Provided due process Access to credentials files should be: - correct answer Described fully in an access policy Which of the following bodies approves clinical privileges? - correct answer The Governing body / Board Which primary source verification is required by NCQA prior to provisional credentialing? - correct answer Licensure and 5 years of malpractice history or NPDB According to TJC standards, initial appointments to the medical staff are made for a period of: - correct answer Not to exceed two years According to TJC, temporary privileges may be granted by: - correct answer The CEO on the recommendation of the medical staff president or authorized designee According to TJC, which of the following items must be verified with a primary source? - correct answer Licensure, training, experience and competence