CPMSM questions with 100% correct answers

CPMSMAccording to URAC who should oversee the clinical aspects of the credentialing program within the organization? - correct answer Senior Clinical Staff Person Name 3 sources of verification of education of a dentist according to NCQA - correct answer Dental school, specialty board, state licensing board NCQA requires MCO's to recredential practitioners at least every - correct answer 3 years HFAP is commonly known as - correct answer AOA, an osteopathic organization T/F No accreditation body requires verification of malpractice insurance - correct answer True What six criteria are observed in an initial site visit by NCQA - correct answer 1. Physical accessibility 2. Physical appearance 3. Adequacy of waiting and exam rooms 4. Appointment availability 5. Adequacy of treatment 6. Record keeping processes According to TJC which of the following should be used to verify current competence? 1. Board Certification 2. Malpractice Face Sheet 3. Hospital Verification 4. Patient complaint record - correct answer Hospital verification According to NCQA, who has ultimate authority in credentialing decision? - correct answer Credentials committee of medical director if it is a clean file What two entities does EMTALA not apply - correct answer Military and Shriners Name the six general competencies according to ACGME and ABMS - correct answer 1. Patient Care 2. Medical/clinical knowledge 3. Practice based learning and improvement 4. Interpersonal and communication skills 5.Professionalism 6. System based practice The medical staff is actively involved in measuring, assessing and improving what? - correct answer Patient safety data If a hospital loses accreditation for providing falsified information to the joint commission, it may not participate in the accreditation process again for a period of how long? - correct answer 1 year What does the NCQA use for public reporting of survey results? - correct answer Health Plan Report Card Areas of an organization's system, structure and process that are most relevant to the organization's patient safety & quality of care, AND most at rick for negative outcomes are referred to as what according to the Joint Commission? - correct answer Critical focus areas According to NCQA what must be included in the organizations rights to appeal policies? - correct answer Written notification of the action including the reasons for the action If a CVO wishes to request reconsideration of denial of its certification it must do so within how many days? - correct answer 30 days An MCO may appeal the accreditation decision by NCQA within how many days - correct answer 30 days T/F Negligence is considered a standard of care violation - correct answer True If a hospital changes ownership/control/change in capacity, it must notify TJC in writing not less than how many days after he change? - correct answer 30 days Cancer Registry programs may be accredited for up to - correct answer 3 years In order for an organization to apply for NCQA survey, they must have been in operation for how long? - correct answer 18 months In order to apply for NCQA certification the CVO must have been under contract to provide verification services at least - correct answer Six months