CPCS / CPMSM Sample Questions | Questions with 100% Correct Answers | Latest Update 2024 | Verified

CPCS / CPMSM Sample Questions | Questions with 100% Correct Answers | Latest Update 2024 | Verified Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - Yes According to the Joint Commission, who may amend the medical staff bylaws? - Governing Body Failure to meet the established qualifications and criteria for appointment should be reported to whom? - The applicant NCQA requires the MCO to obtain a minimum of ???? years of work history? - 5 years According to NCQA what policy must an organization have in place to obtain approval to enter into a delegated agreement? - Credentialing policies How often does the OIG report to the NPDB? - Monthly Hospitals must query the NPDB when: - Initial appt, granting of privileges, every two years NCQA requires verifications must be less than how many days old? - 180 days What is the verification time limit on malpractice history according to the NCQA? - 180 days Time limited credential must be verified by the CVO within how many days prior to submission to the client? - 120 days According to AAAHC, for initial appointments, in addition to licensure and education, what verification is required? - Experience and hospital affiliation What accreditation body states "the NPDB is an acceptable source for sanctions or limitations on licensure, Medicaid/Medicare sanctions and malpractice history? - NCQA Who is required to query the NPDB? - Hospitals Is disciplinary action taken against the license of a dentist reportable to the NPDB? - Yes Under HCQIA, a hospital failure to report an adverse privilege action lasting longer than 30 days may cause the organization to lose HCQIA immunity for how many years? - 3 years According to NCQA, verification of Medicare/Medicaid sanctions can be queried by any of what sources? - AMA, FSMB, HIPDB, OIG, Sanctions Report, NPDB, Sate Agency According to NCQA, how often must an organization conduct an audit of the credentialing process delegated to another organization? - Annually How far back does the Joint Commission require evaluation of malpractice history? What source may be used? - Back to medical school. NPDB. Is an internet verification from a website not contracted by the primary source that attests to the accuracy and timeliness of the information considered a complete verification by NCQA? - No What accreditation bodies require privileges to be distributed to essential department personnel? - Joint Commission/CMS T/F - The Joint Commission and NCQA do not require criminal background checks. - True - the only organization that requires background checks is HFAP. Is a payment made by an insurance company reportable to the NPDB? - Yes Who is the best person to consult when releasing adverse information in a verification request from another organization? - Legal Counsel According to CMS, who in the organization may make decisions regarding approval of credentialing applications? - Governing Board What are the six elements of a written delegation agreement? - 1. Mutually agreed upon 2. Describes responsibilities of organization and delegated entity 3. Describes delegated activities 4. Requires semi-annual reporting to the organization 5. Describes the process by which the organization evaluates the delegated entities performance 6. Describes remedies available to the organization if the delegated entity does not fulfil its obligations including revocation of delegated agreement According to NCQA, what providers are NOT required to be credentialed when working in an independent relationship? - Locums Tenens, Hospital based practitioners (i.e. Anesthesia, Pathology, Radiology, etc.) How many peer references does HFAP require at initial appointment? - 1 T/F - Denial of a medical license application by a state medical board is not reportable to the NPDB? - True What two accreditors state: a hospital may not rely solely on board certification when considering practitioner for medical staff membership? - HFAP, CMS According to the Joint commission & HFAP, name four approved sources for PSV for medical education. - Medical School, AMA, ECFMG, AOA According to NCQA, practitioners must be notified of credentialing decision within how many days? - 60 days The DHHS mails a copy of the NPDB report to the names provider. If the provider wishes to dispute the reports accuracy, the provider has how many days to do so? - 60 days According to URAQ, within how many days must the practitioner be notified of credentialing decisions? - 10 days How many days does a practitioner have to dispute an NPDB report accuracy? - 60 days Which accrediting body requires five year verification of malpractice history? - NCQA What is the commonly used source for verifying malpractice history? - NPDB According to the Joint Commission, a fair hearing and appeals process as described in the medical staff bylaws is available to whom? - Medical staff members and non-members holding clinical privileges T/F - Only the highest of training must be verified according to the NCQA. - True According to the Joint Commission, a peer recommendation should address what six competencies? - Medical knowledge, technical and clinical skills, clinical judgment, interpersonal skills, communication skills, and professionalism. Telemedicine - according to TJC what two options are available for credentialing at the originating site? - Full credentialing, use of the distant sites credentialing According to TJC, what is included in the process of planning and implementing privileges? - 1. Developing and approving a procedure list 2. Processing the application 3. Evaluate applicant specific information 4. Submit recommendations to the governing body for applicant specific delineated privileges 5. Notify the applicant, relevant personnel 6. Monitor the use of privileges Are payments made by a physician in a malpractice claim reportable to the NPDB? - No A hospital that does not query the databank as required by HCQIA is: - Legally liable for knowledge of any information reported. According to TJC, OPPE should be performed on whom? - All privileges practitioners According to TJC who can provide confirmation of an applicant's health status - Director of post graduate training program, chief of another hospital where applicant holds privileges. According to NCQA any gap in personal history greater than __ must be clarified in writing. - One year According to TJC what two verifications must be performed before granting privileges to satisfy an urgent patient care need? - Current licensure, current competence According to TJC what committee is required to review and make recommendation regarding credentialing applications? - MEC