CPMSM - Study Guide Material Latest Update
CPMSM - Study Guide Material
Latest Update
What are four models of HMOs? - ✔✔✔-Staff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types of committees? - ✔✔✔-Standing
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - ✔✔✔-5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - ✔✔✔-5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? -
✔✔✔-3
At least three active medical staff
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,CPMSM - Study Guide Material Latest Update
How many medical staff members must serve on a Medical Records Committee? -
✔✔✔-1
At least one active medical staff
How often should the Medical Records committee meet? - ✔✔✔-At least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics
Committee? - ✔✔✔-5
At least five active medical staff
How often should the Pharmacy & Therapeutics committee meet? - ✔✔✔-At least
quarterly
How many medical staff members must serve on a Utilization Review Committee? -
✔✔✔-1
At least one active medical staff
How often should the Utilization Review Committee meet? - ✔✔✔-Every other
month
What is the process of obtaining, verifying, and assessing the qualifications of a
health care practitioner who seeks to provide patient care services in or for a
hospital? - ✔✔✔-Credentialing
What are the three reasons for credentialing? - ✔✔✔-Patient Safety
Risk Management
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,CPMSM - Study Guide Material Latest Update
Required by agencies
Which three accreditors have been granted "deemed status"? - ✔✔✔-TJC, HFAP,
DNV
Which two organizations offer accreditation for managed care organizations? -
✔✔✔-NCQA, URAC
Who is the main accreditor for ambulatory care facilities? - ✔✔✔-AAAHC
Physicians who are employees of a facility as hospitalists and who are not listed in
the provider directory are not included in the scope of the credentialing standards
with this accreditation? - ✔✔✔-URAC
For which accreditation, do the following practitioners need *not* to be
credentialed including:
-exclusively in the inpatient setting caring for organization members only in the
hospital setting
-practice exclusively in free-standing setting for members directed to facility
-pharmacists working for a PBM (pharmacy benefits management) organization for
UM functions
-locum tenens working less than 90 days
-rental network practitioners providing out of area care - ✔✔✔-NCQA
What are Medicare CoP's minimum criteria for appointment to the medical
staff/granting of medical staff privileges? - ✔✔✔-CCJET
character
competence
judgement
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, CPMSM - Study Guide Material Latest Update
experience
training
CMS regulations require that medical staff bylaws include what information
pertaining to each category of the medical staff? - ✔✔✔-duties and privileges
Do providers with refer and follow status have admitting privileges/ordering
privileges within the hospital? - ✔✔✔-No
For TJC, does "privileges" refer to duties and prerogatives of each category or the
clinical privileges to provide care? - ✔✔✔-Duties and prerogatives
Which accreditor requires an applicant to submit a statement that no health
problems exist which could affect his or her ability to provide care? - ✔✔✔-TJC
Which accreditor has *no* specific requirements for professional practice questions
on the application or reapp? - ✔✔✔-DNV
For Medicare deemed facilities, the delegation of credentialing agreement must
include what clause? - ✔✔✔-Adhere to Medicare regulations
How often must the delegate organization provide a report to Credentials for a
URAC facility? - ✔✔✔-Annually
What is the NCQA requirement for monitoring member complaints about providers?
- ✔✔✔-Continually monitoring member complaints for all practitioner sites
Performing a site visit within 60 days if a threshold was met
What is the only NCQA-required reporting for delegated credentialing? - ✔✔✔-The
names or files of practitioners or providers processed by the delegate
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CPMSM - Study Guide Material
Latest Update
What are four models of HMOs? - ✔✔✔-Staff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types of committees? - ✔✔✔-Standing
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - ✔✔✔-5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - ✔✔✔-5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? -
✔✔✔-3
At least three active medical staff
©®™ Page 1
,CPMSM - Study Guide Material Latest Update
How many medical staff members must serve on a Medical Records Committee? -
✔✔✔-1
At least one active medical staff
How often should the Medical Records committee meet? - ✔✔✔-At least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics
Committee? - ✔✔✔-5
At least five active medical staff
How often should the Pharmacy & Therapeutics committee meet? - ✔✔✔-At least
quarterly
How many medical staff members must serve on a Utilization Review Committee? -
✔✔✔-1
At least one active medical staff
How often should the Utilization Review Committee meet? - ✔✔✔-Every other
month
What is the process of obtaining, verifying, and assessing the qualifications of a
health care practitioner who seeks to provide patient care services in or for a
hospital? - ✔✔✔-Credentialing
What are the three reasons for credentialing? - ✔✔✔-Patient Safety
Risk Management
©®™ Page 2
,CPMSM - Study Guide Material Latest Update
Required by agencies
Which three accreditors have been granted "deemed status"? - ✔✔✔-TJC, HFAP,
DNV
Which two organizations offer accreditation for managed care organizations? -
✔✔✔-NCQA, URAC
Who is the main accreditor for ambulatory care facilities? - ✔✔✔-AAAHC
Physicians who are employees of a facility as hospitalists and who are not listed in
the provider directory are not included in the scope of the credentialing standards
with this accreditation? - ✔✔✔-URAC
For which accreditation, do the following practitioners need *not* to be
credentialed including:
-exclusively in the inpatient setting caring for organization members only in the
hospital setting
-practice exclusively in free-standing setting for members directed to facility
-pharmacists working for a PBM (pharmacy benefits management) organization for
UM functions
-locum tenens working less than 90 days
-rental network practitioners providing out of area care - ✔✔✔-NCQA
What are Medicare CoP's minimum criteria for appointment to the medical
staff/granting of medical staff privileges? - ✔✔✔-CCJET
character
competence
judgement
©®™ Page 3
, CPMSM - Study Guide Material Latest Update
experience
training
CMS regulations require that medical staff bylaws include what information
pertaining to each category of the medical staff? - ✔✔✔-duties and privileges
Do providers with refer and follow status have admitting privileges/ordering
privileges within the hospital? - ✔✔✔-No
For TJC, does "privileges" refer to duties and prerogatives of each category or the
clinical privileges to provide care? - ✔✔✔-Duties and prerogatives
Which accreditor requires an applicant to submit a statement that no health
problems exist which could affect his or her ability to provide care? - ✔✔✔-TJC
Which accreditor has *no* specific requirements for professional practice questions
on the application or reapp? - ✔✔✔-DNV
For Medicare deemed facilities, the delegation of credentialing agreement must
include what clause? - ✔✔✔-Adhere to Medicare regulations
How often must the delegate organization provide a report to Credentials for a
URAC facility? - ✔✔✔-Annually
What is the NCQA requirement for monitoring member complaints about providers?
- ✔✔✔-Continually monitoring member complaints for all practitioner sites
Performing a site visit within 60 days if a threshold was met
What is the only NCQA-required reporting for delegated credentialing? - ✔✔✔-The
names or files of practitioners or providers processed by the delegate
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