CPMSM Preparation UPDATED ACTUAL
Exam Questions and CORRECT Answers
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
According to NCQA standards, a copy of which is an acceptable verification of the document? -
CORRECT ANSWER - DEA certificate
According to NCQA standards, which is an acceptable source for primary source verification of
Medicare and Medicaid sanction activity against physicians? - CORRECT ANSWER -
Federation State Medical Boards
According to TJC standards, which of following is considered a designated equivalent source for
verification of board certification? - CORRECT ANSWER - The American Board of
Medical Specialties
Which of the following organizations have been recognized by TJC and NCQA to provide
primary source verification of medical school graduation and residency training for US
graduates? - CORRECT ANSWER - American Medical Association Master file
According to NCQA standards, the application attestation statement must affirm that the
application - CORRECT ANSWER - Is correct and complete
Exam Questions and CORRECT Answers
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
According to NCQA standards, a copy of which is an acceptable verification of the document? -
CORRECT ANSWER - DEA certificate
According to NCQA standards, which is an acceptable source for primary source verification of
Medicare and Medicaid sanction activity against physicians? - CORRECT ANSWER -
Federation State Medical Boards
According to TJC standards, which of following is considered a designated equivalent source for
verification of board certification? - CORRECT ANSWER - The American Board of
Medical Specialties
Which of the following organizations have been recognized by TJC and NCQA to provide
primary source verification of medical school graduation and residency training for US
graduates? - CORRECT ANSWER - American Medical Association Master file
According to NCQA standards, the application attestation statement must affirm that the
application - CORRECT ANSWER - Is correct and complete
