CPMSM CORE EXAMS SET 2025/2026 QUESTIONS AND
ANSWERS GUARANTEE A+
✔✔NCQA has 6 standards that must be met in order for an org to use Delegated
Credentialing. Name the 6 standards that the written delegation document must have:
(P43)
[HANDSHAKE, PERSON DOING CHORES, PAPERWORK, STACK OF REPORTS,
TEACHER GRADING PAPER, MEDICINE SYMBOL] - ✔✔1. Be mutually agreed upon
2. Describe responsibilities of the org and the delegated entity
3. Describe the delegated activities
4. Require semi-annual reporting to the org
5. Describe the process of how the org evaluates the designated credentialing entity's
performance
6. Describe the remedies, if the delegated entity doesn't fulfill its duties
✔✔URAC'S requirements for using Delegated Credentialing require that every ____
years, the org. must conduct an on-site survey or there must be a process for randomly
selecting credentialing files for the org. to review. (p44) - ✔✔3
✔✔For a PSV collected via telephone, what info must you document in order for the
PSV to be valid? - ✔✔1. Name of the org called
2. date
3. Name of person contacted
4. The Questions asked
5. The responses
6. Name of the person receiving response
✔✔What information is given on an NPDB report? - ✔✔Malpractice payments, Adverse
actions to licensure and privileges; DEA actions, exclusion from Medicare
✔✔Who is allowed to query the NPDB site and receive the reports? (46) - ✔✔Hospitals,
healthcare entity that has a peer review process, Board of Medical Examiners, QI
Agency, Federal law enforcement, State Medicaid Fraud Unit
✔✔FSMB (will it include international licenses and sanctions?) - ✔✔Federation of State
Medical Boards
No, USA Only
✔✔CIN-BAD (48) - ✔✔Chiropractic Info Network- Board Action Data Bank
It's like the NPDB, but for chiropracters
, ✔✔What is the NTIS's CSA? (49) - ✔✔The National Technical Info Service of the US
Dept of COmmerce maintain the Controlled Substances Act Registration Database- info
about DEA registrations
✔✔What happens if your name is on the OIG list? (50) - ✔✔You are an excluded party.
No payment can be made to the person for any services under the Medicare, Medicaid,
etc.
✔✔Name the four elements of Negligence. (253) - ✔✔1. Duty to exercise a standard of
care
2. Breach of Duty (when duty not met, breach occurs)
3. Injury (if no injury, no liability)
4. Proximate cause (injury was caused by breach of duty)
✔✔Antitrust Law (253) - ✔✔federal and state government laws that regulates the
conduct and organization of business corporations, generally to promote competition for
the benefit of consumers.
✔✔What act offers conditional immunity to antitrust law? (253) - ✔✔Healthcare Quality
Improvement Act
✔✔what is the healthcare quality improvement act of 1986? (HQIA) - ✔✔Title I:
Promotion of Professional Review Activities - Provides protection from liability under
Federal and State laws for members of a professional review body and their staffs who,
in the reasonable belief that the action was in the furtherance of quality health care
✔✔Darling Vs. Charleston Memorial Community Hospital (253) - ✔✔set aside the
charitable immunity doctrine (doctrine that holds that a charitable organization is not
liable under tort law) and held that the hospital was guilty of negligent treatment that
resulted in amputation of teenage boy's leg- HOSPITAL CLAIMED THE DOCTRINE
LIMITED DAMAGES TO THEIR INSURANCE
✔✔Johnson Vs. Miseriacordia Community Hospital (254) - ✔✔Hospital held liable for
damages for a patient injured by a physician who failed to disclose pending malpractice
cases and lied about privs at other hospitals- HOSPITAL SHOULD HAVE VERIFIED
INFO
✔✔Elam Vs. College Park Hospital (254) - ✔✔Hospital liable for negligent credentialing,
it failed to obatin malpractice claims data on a DPM, even though Medical Records was
aware of claims.
✔✔Bell Vs. Sharp Cabrillo Hospital (254) - ✔✔Hospital liable for a reappointment
physician's actions due to failure to request data from other hospital about a
suspension- HOSPITAL SHOULD HAVE OBTAINED MORE INFO
ANSWERS GUARANTEE A+
✔✔NCQA has 6 standards that must be met in order for an org to use Delegated
Credentialing. Name the 6 standards that the written delegation document must have:
(P43)
[HANDSHAKE, PERSON DOING CHORES, PAPERWORK, STACK OF REPORTS,
TEACHER GRADING PAPER, MEDICINE SYMBOL] - ✔✔1. Be mutually agreed upon
2. Describe responsibilities of the org and the delegated entity
3. Describe the delegated activities
4. Require semi-annual reporting to the org
5. Describe the process of how the org evaluates the designated credentialing entity's
performance
6. Describe the remedies, if the delegated entity doesn't fulfill its duties
✔✔URAC'S requirements for using Delegated Credentialing require that every ____
years, the org. must conduct an on-site survey or there must be a process for randomly
selecting credentialing files for the org. to review. (p44) - ✔✔3
✔✔For a PSV collected via telephone, what info must you document in order for the
PSV to be valid? - ✔✔1. Name of the org called
2. date
3. Name of person contacted
4. The Questions asked
5. The responses
6. Name of the person receiving response
✔✔What information is given on an NPDB report? - ✔✔Malpractice payments, Adverse
actions to licensure and privileges; DEA actions, exclusion from Medicare
✔✔Who is allowed to query the NPDB site and receive the reports? (46) - ✔✔Hospitals,
healthcare entity that has a peer review process, Board of Medical Examiners, QI
Agency, Federal law enforcement, State Medicaid Fraud Unit
✔✔FSMB (will it include international licenses and sanctions?) - ✔✔Federation of State
Medical Boards
No, USA Only
✔✔CIN-BAD (48) - ✔✔Chiropractic Info Network- Board Action Data Bank
It's like the NPDB, but for chiropracters
, ✔✔What is the NTIS's CSA? (49) - ✔✔The National Technical Info Service of the US
Dept of COmmerce maintain the Controlled Substances Act Registration Database- info
about DEA registrations
✔✔What happens if your name is on the OIG list? (50) - ✔✔You are an excluded party.
No payment can be made to the person for any services under the Medicare, Medicaid,
etc.
✔✔Name the four elements of Negligence. (253) - ✔✔1. Duty to exercise a standard of
care
2. Breach of Duty (when duty not met, breach occurs)
3. Injury (if no injury, no liability)
4. Proximate cause (injury was caused by breach of duty)
✔✔Antitrust Law (253) - ✔✔federal and state government laws that regulates the
conduct and organization of business corporations, generally to promote competition for
the benefit of consumers.
✔✔What act offers conditional immunity to antitrust law? (253) - ✔✔Healthcare Quality
Improvement Act
✔✔what is the healthcare quality improvement act of 1986? (HQIA) - ✔✔Title I:
Promotion of Professional Review Activities - Provides protection from liability under
Federal and State laws for members of a professional review body and their staffs who,
in the reasonable belief that the action was in the furtherance of quality health care
✔✔Darling Vs. Charleston Memorial Community Hospital (253) - ✔✔set aside the
charitable immunity doctrine (doctrine that holds that a charitable organization is not
liable under tort law) and held that the hospital was guilty of negligent treatment that
resulted in amputation of teenage boy's leg- HOSPITAL CLAIMED THE DOCTRINE
LIMITED DAMAGES TO THEIR INSURANCE
✔✔Johnson Vs. Miseriacordia Community Hospital (254) - ✔✔Hospital held liable for
damages for a patient injured by a physician who failed to disclose pending malpractice
cases and lied about privs at other hospitals- HOSPITAL SHOULD HAVE VERIFIED
INFO
✔✔Elam Vs. College Park Hospital (254) - ✔✔Hospital liable for negligent credentialing,
it failed to obatin malpractice claims data on a DPM, even though Medical Records was
aware of claims.
✔✔Bell Vs. Sharp Cabrillo Hospital (254) - ✔✔Hospital liable for a reappointment
physician's actions due to failure to request data from other hospital about a
suspension- HOSPITAL SHOULD HAVE OBTAINED MORE INFO
