CPMSM END OF COURSE 2025/2026 QUESTIONS AND
ANSWERS GUARANTEE A+
✔✔Disaster Plan - ✔✔TJC, HFAP, AAAHC require groups/organizations to have the
plan documented and in place.
✔✔DEA Verification - ✔✔Copies can be accepted, ensure there are no challenges to
the certificate.
✔✔Licensure - ✔✔Medicare: does not specifically address sanctions URAC: states that
it has to be verified in a 6 month time frame.
NCQA: Verified within 180 days (or 120 for CVO)
All organizations require that the monitoring of licensure be ongoing.
✔✔Malpractice - ✔✔AAAHC, TJC, Medicare: Not fully addressed but states if bylaws
require verification or proof of coverage, documentation must be obtained. All other
organizations require proof and verification.
✔✔Malpractice History - ✔✔NCQA: Pulled and verified with in the correct time frames
(180 days or 120 days if CVO)
URAC: 6 month time frame
All require at minimum to verify history for the last 5 years.
✔✔Accountable Care Organization - ✔✔Pt Centered and includes offices, hospitals,
nursing homes. The healthcare organization is characterized by a payment and care
delivery model that seeks to tie provider reimbursements to quality metrics and
reductions in the total cost of care for patients. Patients are assigned to specific
providers.
✔✔EMTALA - ✔✔Emergency Medical Treatment and Active Labor Act -Must be an
emergency
-Must screen to see if it is a true emergency
-Stabilize pt prior to transfer
-Must have "on call" list. (Medicare does not specify hoe many days must be covered)
✔✔Security Rule - ✔✔The Security Standards for the Protection of Electronic Protected
Health Information, commonly known as the HIPAA. Security Rule, establishes national
standards for securing patient data that is stored or transferred electronically.
✔✔Sherman Antitrust Act (1980) - ✔✔Known as "competition law" states
-Can not monopolize services
-Must have exclusive contract to limit practitioners
-Can not pay practitioners for using your services, or "incentivizing" provider to use your
facilities or services.
,✔✔PSQIP - ✔✔The Patient Safety and Quality Improvement Act of 2005: Pub.L. 109-
41, 42 U.S.C. ch. 6A subch. VII part C, established a system of patient safety
organizations and a national patient safety database. To encourage reporting and broad
discussion of adverse events, near misses, and dangerous conditions, it also
established privilege and confidentiality protections for Patient Safety Work Product.
The PSQIA was introduced by Sen. Jim Jeffords. It passed in the Senate July 21, 2005
by unanimous consent, and passed the House of Representatives on July 27, 2005 with
428 Ayes, 3 Nays, and 2 Present/Not Voting
✔✔CVO Audits - ✔✔-10 credentialing and 10 re-credentialing
-Pre-delegation Audit
-look at files, policies, and procedures
-Must provide semi annual reports
✔✔Meeting Management - ✔✔Parliamentary procedures and Robert's Rules of Order
✔✔Standing Committee - ✔✔Meets regularly and has ongoing responsibilites
✔✔Adhok Committee - ✔✔Works on a specific task or duty, works independently, and
reports back to group. Once task is complete the committee is disbanded.
✔✔Task Force - ✔✔Committee comprised of experts used to analyze or solve a
problem
✔✔Continuous Quality Committee - ✔✔Meets regularly to address specific quality
indicators.
✔✔Meeting Minutes must include - ✔✔conclusions, recommendations, and actions
taken.
✔✔President - ✔✔Has same voting rights as other group members
✔✔Ex Officio - ✔✔Member by virtue of some other office they hold/held and have same
voting rights as rest of the group.
✔✔Once a Motion is stated it becomes part of the - ✔✔Assembly
✔✔Proxy - ✔✔Can allow if allowed by state, federal laws, and bylaws.
✔✔Board Meetings - ✔✔Can be held electronically as long as bylaws allow.
✔✔Privileged Motions - ✔✔Are used to set aside the (main) pending motion to give
immediate attention to an item/topic.
, ✔✔Subsidiary Motion - ✔✔applies to pending motions and is lower ranking.
✔✔Incidental Motion - ✔✔arise out of questions to Main/Pending Motion and normally
must be addressed or answered to continue on with Main Motion.
✔✔Rescind (Unclassified Motion) - ✔✔To take from the table, revoke, cancel, or repeal.
✔✔Ratify (Unclassified Motion) - ✔✔Sign or give formal consent to, making it officially
valid.
✔✔Medical Executive Committee (MEC) - ✔✔Receives and acts upon reports and
recommendations from the other Medical Staff Committees, special committees and
officers of the staff concerning performance improvement and quality assessments.
MEC reports results and recommendations to the Medical Staff and Board of Directors.
✔✔Bylaws - ✔✔Documents approved by the Medical Staff and Governing Board that
set the laws and guidelines for the governance of the Medical Staff.
✔✔Credentials Committee - ✔✔This committee reviews and evaluates the training,
scope of practice, competency, ability to perform privileges requested of each initial
appointment, reappointment, and modifications of clinical privileges and makes
recommendations to the Medical Executive Committee. This committee provides
oversight for FPPE and OPPE. Should meet regularly.
✔✔Utilization Management or Utilization Review Committee - ✔✔Ensures that all of the
patient care given by the facility/providers is appropriate and provided effectively.
Normally monitors topics such as: appropriateness of admission to the Hospital, delays
in use of, or over use of ancillary services, delays in consultations and referrals, lengths
of stay, and discharge planning.
✔✔It is important to check that the practitioner is not currently excluded, suspended,
debarred, or ineligible to participate in Federal healthcare programs - ✔✔because the
facility will not get paid for treating patients unless service is provided by an authorized
provider.
✔✔According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must - ✔✔first determine if there
is evidence of poor quality that could affect the health and safety of its members.
✔✔Health Care Quality Improvement Act of 1986 - ✔✔Created the National Provider
Data Bank to restrict the ability of incompetent providers to move from state to state
without disclosure or discovery of previous medical malpractice payment and adverse
action history.
ANSWERS GUARANTEE A+
✔✔Disaster Plan - ✔✔TJC, HFAP, AAAHC require groups/organizations to have the
plan documented and in place.
✔✔DEA Verification - ✔✔Copies can be accepted, ensure there are no challenges to
the certificate.
✔✔Licensure - ✔✔Medicare: does not specifically address sanctions URAC: states that
it has to be verified in a 6 month time frame.
NCQA: Verified within 180 days (or 120 for CVO)
All organizations require that the monitoring of licensure be ongoing.
✔✔Malpractice - ✔✔AAAHC, TJC, Medicare: Not fully addressed but states if bylaws
require verification or proof of coverage, documentation must be obtained. All other
organizations require proof and verification.
✔✔Malpractice History - ✔✔NCQA: Pulled and verified with in the correct time frames
(180 days or 120 days if CVO)
URAC: 6 month time frame
All require at minimum to verify history for the last 5 years.
✔✔Accountable Care Organization - ✔✔Pt Centered and includes offices, hospitals,
nursing homes. The healthcare organization is characterized by a payment and care
delivery model that seeks to tie provider reimbursements to quality metrics and
reductions in the total cost of care for patients. Patients are assigned to specific
providers.
✔✔EMTALA - ✔✔Emergency Medical Treatment and Active Labor Act -Must be an
emergency
-Must screen to see if it is a true emergency
-Stabilize pt prior to transfer
-Must have "on call" list. (Medicare does not specify hoe many days must be covered)
✔✔Security Rule - ✔✔The Security Standards for the Protection of Electronic Protected
Health Information, commonly known as the HIPAA. Security Rule, establishes national
standards for securing patient data that is stored or transferred electronically.
✔✔Sherman Antitrust Act (1980) - ✔✔Known as "competition law" states
-Can not monopolize services
-Must have exclusive contract to limit practitioners
-Can not pay practitioners for using your services, or "incentivizing" provider to use your
facilities or services.
,✔✔PSQIP - ✔✔The Patient Safety and Quality Improvement Act of 2005: Pub.L. 109-
41, 42 U.S.C. ch. 6A subch. VII part C, established a system of patient safety
organizations and a national patient safety database. To encourage reporting and broad
discussion of adverse events, near misses, and dangerous conditions, it also
established privilege and confidentiality protections for Patient Safety Work Product.
The PSQIA was introduced by Sen. Jim Jeffords. It passed in the Senate July 21, 2005
by unanimous consent, and passed the House of Representatives on July 27, 2005 with
428 Ayes, 3 Nays, and 2 Present/Not Voting
✔✔CVO Audits - ✔✔-10 credentialing and 10 re-credentialing
-Pre-delegation Audit
-look at files, policies, and procedures
-Must provide semi annual reports
✔✔Meeting Management - ✔✔Parliamentary procedures and Robert's Rules of Order
✔✔Standing Committee - ✔✔Meets regularly and has ongoing responsibilites
✔✔Adhok Committee - ✔✔Works on a specific task or duty, works independently, and
reports back to group. Once task is complete the committee is disbanded.
✔✔Task Force - ✔✔Committee comprised of experts used to analyze or solve a
problem
✔✔Continuous Quality Committee - ✔✔Meets regularly to address specific quality
indicators.
✔✔Meeting Minutes must include - ✔✔conclusions, recommendations, and actions
taken.
✔✔President - ✔✔Has same voting rights as other group members
✔✔Ex Officio - ✔✔Member by virtue of some other office they hold/held and have same
voting rights as rest of the group.
✔✔Once a Motion is stated it becomes part of the - ✔✔Assembly
✔✔Proxy - ✔✔Can allow if allowed by state, federal laws, and bylaws.
✔✔Board Meetings - ✔✔Can be held electronically as long as bylaws allow.
✔✔Privileged Motions - ✔✔Are used to set aside the (main) pending motion to give
immediate attention to an item/topic.
, ✔✔Subsidiary Motion - ✔✔applies to pending motions and is lower ranking.
✔✔Incidental Motion - ✔✔arise out of questions to Main/Pending Motion and normally
must be addressed or answered to continue on with Main Motion.
✔✔Rescind (Unclassified Motion) - ✔✔To take from the table, revoke, cancel, or repeal.
✔✔Ratify (Unclassified Motion) - ✔✔Sign or give formal consent to, making it officially
valid.
✔✔Medical Executive Committee (MEC) - ✔✔Receives and acts upon reports and
recommendations from the other Medical Staff Committees, special committees and
officers of the staff concerning performance improvement and quality assessments.
MEC reports results and recommendations to the Medical Staff and Board of Directors.
✔✔Bylaws - ✔✔Documents approved by the Medical Staff and Governing Board that
set the laws and guidelines for the governance of the Medical Staff.
✔✔Credentials Committee - ✔✔This committee reviews and evaluates the training,
scope of practice, competency, ability to perform privileges requested of each initial
appointment, reappointment, and modifications of clinical privileges and makes
recommendations to the Medical Executive Committee. This committee provides
oversight for FPPE and OPPE. Should meet regularly.
✔✔Utilization Management or Utilization Review Committee - ✔✔Ensures that all of the
patient care given by the facility/providers is appropriate and provided effectively.
Normally monitors topics such as: appropriateness of admission to the Hospital, delays
in use of, or over use of ancillary services, delays in consultations and referrals, lengths
of stay, and discharge planning.
✔✔It is important to check that the practitioner is not currently excluded, suspended,
debarred, or ineligible to participate in Federal healthcare programs - ✔✔because the
facility will not get paid for treating patients unless service is provided by an authorized
provider.
✔✔According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must - ✔✔first determine if there
is evidence of poor quality that could affect the health and safety of its members.
✔✔Health Care Quality Improvement Act of 1986 - ✔✔Created the National Provider
Data Bank to restrict the ability of incompetent providers to move from state to state
without disclosure or discovery of previous medical malpractice payment and adverse
action history.
