CPCS/CPMSM Exam UPDATED ACTUAL
Exam Questions and CORRECT Answers
Applicant completes an application that includes, reasons for inability to perform, las of present
illegal drug use, loss of license or felony convictions. Loss or limitation of privileges or
disciplinary actions. Current malpractice insurance coverage, current signed attestation
confirming the correctness and completeness of the application. If an application from an
external entity is used it must include the questions and attestations as identified above.
Signature stamps are not acceptable u - CORRECT ANSWER - NCQA Health Plan/CVO
Which type of agenda is used on a meeting agenda to group together non-controversial business
and reports that can be approved under one motion instead of individually approving each item?
- CORRECT ANSWER - Consent Agenda
According to NCQA under what circumstance would a Locum Tenens practitioner be exempt
from credentialing? - CORRECT ANSWER - Covering Practitioner
According to URAC, when developing a quality auditing process, prudent practice would be to
audit what percentage of completed credentialing files? - CORRECT ANSWER -
According to URAC, a complete credentials file should be reviewed by which professionals? -
CORRECT ANSWER -
According to NCQA, what must be included in the organization's right to appeal policies? -
CORRECT ANSWER - written notification when a professional review action has been
brought against a practitioner
reasons for the action
summary of the appeal rights and process
ability to request a hearing and the specific time period for submitting the request
allowing for at least 30 calendar days after the notification for practitioners to request a hearing
allowing representation by an attorney or another person
appointment of a hearing officer or a panel of individuals to review the appeal
,and written notification of the appeal decision that contains specific reasons for the decision.
Which Accrediting body requires an attestation to the practitioners identity? - CORRECT
ANSWER - The Joint Commission
According to HFAP, how often must a reappraisal of membership and privileges occur? -
CORRECT ANSWER - Every 24 months
Which Accrediting Agency requires all practitioners with clinical privileges to participate in
continuing education? - CORRECT ANSWER - DNV
According to CMS, what criteria are used by the governing board for the selection of medical
staff members? - CORRECT ANSWER - Character, competence, training, experience, and
judgment
Which agency requires peer recommendations be obtained at initial credentialing and
reappointment? - CORRECT ANSWER - AAAHC
Which regulatory agency standards must be followed for a hospital to bill for Medicare/Medicaid
services? - CORRECT ANSWER - CMS Conditions of Participation
Which Federal legislation created the National Practitioner Data Bank? - CORRECT
ANSWER - HCQIA
According to TJC, what is required to make a recommendation to the Governing Board? -
CORRECT ANSWER - Medical Executive Committee
According to NCQA, the application process is located in what document? - CORRECT
ANSWER -
,Why it is important to check that the practitioner is not currently excluded, suspended, debarred,
or ineligible to
participate in Federal health care programs? - CORRECT ANSWER - The facility won't
get paid for treating patients unless service is provided by authorized provider.
Which credential 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 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? - CORRECT ANSWER - NPDB
When developing clinical privileging criteria, what 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.
What type of 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.
What type of procedure 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. 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? - CORRECT ANSWER - Utilization Review
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 - 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
Exam Questions and CORRECT Answers
Applicant completes an application that includes, reasons for inability to perform, las of present
illegal drug use, loss of license or felony convictions. Loss or limitation of privileges or
disciplinary actions. Current malpractice insurance coverage, current signed attestation
confirming the correctness and completeness of the application. If an application from an
external entity is used it must include the questions and attestations as identified above.
Signature stamps are not acceptable u - CORRECT ANSWER - NCQA Health Plan/CVO
Which type of agenda is used on a meeting agenda to group together non-controversial business
and reports that can be approved under one motion instead of individually approving each item?
- CORRECT ANSWER - Consent Agenda
According to NCQA under what circumstance would a Locum Tenens practitioner be exempt
from credentialing? - CORRECT ANSWER - Covering Practitioner
According to URAC, when developing a quality auditing process, prudent practice would be to
audit what percentage of completed credentialing files? - CORRECT ANSWER -
According to URAC, a complete credentials file should be reviewed by which professionals? -
CORRECT ANSWER -
According to NCQA, what must be included in the organization's right to appeal policies? -
CORRECT ANSWER - written notification when a professional review action has been
brought against a practitioner
reasons for the action
summary of the appeal rights and process
ability to request a hearing and the specific time period for submitting the request
allowing for at least 30 calendar days after the notification for practitioners to request a hearing
allowing representation by an attorney or another person
appointment of a hearing officer or a panel of individuals to review the appeal
,and written notification of the appeal decision that contains specific reasons for the decision.
Which Accrediting body requires an attestation to the practitioners identity? - CORRECT
ANSWER - The Joint Commission
According to HFAP, how often must a reappraisal of membership and privileges occur? -
CORRECT ANSWER - Every 24 months
Which Accrediting Agency requires all practitioners with clinical privileges to participate in
continuing education? - CORRECT ANSWER - DNV
According to CMS, what criteria are used by the governing board for the selection of medical
staff members? - CORRECT ANSWER - Character, competence, training, experience, and
judgment
Which agency requires peer recommendations be obtained at initial credentialing and
reappointment? - CORRECT ANSWER - AAAHC
Which regulatory agency standards must be followed for a hospital to bill for Medicare/Medicaid
services? - CORRECT ANSWER - CMS Conditions of Participation
Which Federal legislation created the National Practitioner Data Bank? - CORRECT
ANSWER - HCQIA
According to TJC, what is required to make a recommendation to the Governing Board? -
CORRECT ANSWER - Medical Executive Committee
According to NCQA, the application process is located in what document? - CORRECT
ANSWER -
,Why it is important to check that the practitioner is not currently excluded, suspended, debarred,
or ineligible to
participate in Federal health care programs? - CORRECT ANSWER - The facility won't
get paid for treating patients unless service is provided by authorized provider.
Which credential 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 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? - CORRECT ANSWER - NPDB
When developing clinical privileging criteria, what 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.
What type of 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.
What type of procedure 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. 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? - CORRECT ANSWER - Utilization Review
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 - 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
