CPCS Study Guide Practice Test (2023/2024) Rated A+

CPCS Study Guide Practice Test (2023/2024) Rated A+ Why it is important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs? The facility won't get paid for treating patients unless service is provided by authorized provider. Which of the following credentials must be tracked on an ongoing basis? Licensure According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action? 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 through 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? The National Practitioner Data Bank When developing clinical privileging criteria, which of the following is important to evaluate? Established standards of practice, such as specialty board recommendations. What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty? It is required by the Medicare Conditions of Participation. Which of the following specialists is most likely to perform a PTCA? Interventional Cardiologist The Joint Commission hospital standards require that clinical privileges are hospital specific and 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? Transesophageal Echocardiography Which NCQA-required committee makes recommendations regarding credentialing decisions? Credentialing Committee HFAP standards require three medical staff committees to be delineated in the medical staff structure. Two of them are the Medical Executive Committee and the Utilization of Osteopathic Methods & Concepts Committee (required for hospitals with ten or more DOs who admit patients and provide direct patient care). What is the other required medical staff committee? Utilization Review Committee How often does NCQA require that delegation reports be evaluated by the health plan? Semi-Annually Peer references should be obtained from: Practitioners in the same professional discipline as the applicant NCQA recognizes which of the following as the final approval of an applicant who does not meet criteria for a clean file? Credentialing Committee If a medical staff member has privileges and/or medical staff appointment revoked, he/she must be: Provided due process. Access to credentials files should be: Described fully in an access policy. Which of the following bodies approves clinical privileges? Governing Body or Board What primary source verification is required by NCQA prior to provisional credentialing? Licensure and 5-year malpractice history or NPDB According to The Joint Commission standards, initial appointments to the medical staff are made for a period of: Not to exceed two years According to The Joint Commission standards, temporary privileges may be granted by: The CEO on the recommendation of the medical staff president or authorized designee According to The Joint Commission Standards, which of the following items must be verified with a primary source? Licensure, training, experience, and competence According to NCQA standards, a copy of which of the following is acceptable verification of the document? DEA certificate According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians? Federation of State Medical Boards According to The Joint Commission standards, which of following is considered a designated equivalent source for verification of board certification? The American Board of Medical Specialties Which of the following organizations have been recognized by The Joint Commission and NCQA to provide primary source verification of medical school graduation and residency training for U.S. graduates? American Medical Association Masterfile According to NCQA standards, the application attestation statement must affirm that the application Is correct and complete. According to The Joint Commission standards, medical staff bylaws should define The structure of the medical staff. According to The Joint Commission hospital standards, professional criteria for the granting of clinical privileges must include at least Relevant training or experience, ability to perform privileges requested, current licensure, and competence. The Joint Commission hospital standards require medical staff bylaws to include A mechanism for selection and removal of officers. According to NCQA standards, which of the following is an approved source for verification of board certification? State licensing agency if state agency conducts primary verification of board status According to The Joint Commission hospital standards, which of the following is a required component of the reappointment process? Documentation of the applicant's health status According to URAC's health network standards, each applicant within the scope of the credentialing program submits an application that includes at least which of the following: State licensure information, including current license(s) and history of licensure in all jurisdictions According to AAAHC, which must be monitored on an ongoing basis? Current licensure According to The Joint Commission, a nurse practitioner functioning independently and providing a medical level of care must: Be granted delineated clinical privileges. According to The Joint Commission, which of the following is an acceptable source for verification for medical education of an international graduate? Education Commission for Foreign Medical Graduates When evaluating compliance with the required time-frame for recredentialing, NCQA counts the recredentialing period to the: Month NCQA standards require the organization to verify board certification at recredentialing: In all cases. To whom does the AAAHC give the responsibility for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management? Governing body In order for a healthcare facility to participate in the Medicare and Medicaid programs it must comply with the: Medicare Conditions of Participation According to The Joint Commission hospital standards, which of the following is an element of a self-governing medical staff? The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges. Robert's Rules of order is an example of Parliamentary procedure. The medical staff application should provide a chronological history of The applicant's education, training, and work history. In order to participate in a health plan, a provider must be accepted to the plan's Provider panel In order for a physician to practice medicine in any state in the United States, he/she must possess Current state licensure. Which of the following is considered post-graduate education? Residency training Which of the following elements may not be used to evaluate credentials of applicants? Gender The release of liability statement signed by the applicant for medical staff appointment should include: A statement providing immunity to those who respond in good faith to requests for information. Primary source verification is: Receiving information directly from the issuing source. Unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice are examples of: Red flags. When documenting a telephone conversation regarding primary source verification what should be documented? Name of person and organization contacted, date of call, what was discussed and who conducted the interview. According to HFAP standards, when confirming malpractice coverage, the organization must: Have evidence of professional liability insurance, which includes certificate showing amounts of coverage Which of the following providers is considered a primary care physician (PCP)? Family medicine practitioner Which body has the obligation to the community to assure that only appropriately educated, trained and currently competent practitioners are granted medical staff membership and clinical privileges? Governing Body When credentialing and privileging practitioners it is appropriate to: Follow a routine process for each applicant. Medical liability insurance should be held in what limits? As specified by the medical staff and board of directors Which of the following would be an appropriate question to ask an applicant for medical staff? Do you have any medical conditions, treated or untreated, that would negatively affect your ability to provide the services or perform the privileges you are requesting? The governing body delegates the responsibility of credentialing, recredentialing, and privileging to: The medical staff Who should have access to medical staff meeting minutes? Personnel as documented in a records access policy and procedure In addition to conclusions, recommendations made, and actions taken, which of the following should always be documented in meeting minutes: Any required follow-up to occur. Active, Associate, Courtesy, Honorary, Consulting are all examples of: Membership categories Changes in medical staff bylaws are not final until formally approved by the: Governing body What is the only hospital medical staff committee required by The Joint Commission hospital standards? Medical Executive Committee The Healthcare Quality Improvement Act: Provides qualified immunity from antitrust liability arising out of peer review activities that are conducted in good faith. If you have a question regarding whether or not information regarding a practitioner should be released to a third party, which of the following would be the best person to ask? Organization's attorney Prior to releasing information to a third party regarding a practitioner, the organization should acquire A signed consent and release form You are working at an AAAHC accredited facility and you want to introduce the concept of utilizing a credentials verification organization. If the CVO is not accredited by a nationally recognized organization, you must: Perform an assessment of their turn-around times Under DNV-GL, what medical staff authority, in addition to the Chief Executive Officer, is required for granting temporary privileges? Member of the Executive Committee, President of the Medical Staff, or Medical Director According to the DNV, if the medical staff has an executive committee, who must attend the meetings? Medical Staff Members, CEO and CNO (or designee) on an ex-officio basis Automatic Suspension of clinical privileges may be considered at a DNV accredited hospital for which of the following instances? Revocation/restriction of professional license; non-compliance with completing medical records According to the DNV, a History and Physical completed within 30 days prior to admission or registration shall include an entry in the medical record which documents an examination for any change in the patient's current medical condition. Within what time frame must this be placed in the patient's medical record? Within 24 hours after admission or registration, and prior to surgery requiring anesthesia services or high-risk procedure