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CPCS/CPMSM 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 unless the
practitioner is physically impaired and the disability is
documented in the practitioners file. Ans: 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
© 2025 All rights reserved
, 2 | Page
approved under one motion instead of individually approving each
item? Ans: Consent Agenda
According to NCQA under what circumstance would a Locum
Tenens practitioner be exempt from credentialing? Ans: Covering
Practitioner
According to NCQA, what must be included in the organization's
right to appeal policies? Ans: 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
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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? Ans: The Joint Commission
According to HFAP, how often must a reappraisal of membership
and privileges occur? Ans: Every 24 months
Which Accrediting Agency requires all practitioners with clinical
privileges to participate in continuing education? Ans: DNV
According to CMS, what criteria are used by the governing board
for the selection of medical staff members? Ans: Character,
competence, training, experience, and judgment
© 2025 All rights reserved
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Which agency requires peer recommendations be obtained at
initial credentialing and reappointment? Ans: AAAHC
Which regulatory agency standards must be followed for a hospital
to bill for Medicare/Medicaid services? Ans: CMS Conditions of
Participation
Which Federal legislation created the National Practitioner Data
Bank? Ans: HCQIA
According to TJC, what is required to make a recommendation to
the Governing Board? Ans: Medical Executive Committee
Why it is important to check that the practitioner is not currently
excluded, suspended, debarred, or ineligible to
participate in Federal health care programs? Ans: The facility
won't get paid for treating patients unless service is provided by
authorized provider.
© 2025 All rights reserved
CPCS/CPMSM 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 unless the
practitioner is physically impaired and the disability is
documented in the practitioners file. Ans: 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
© 2025 All rights reserved
, 2 | Page
approved under one motion instead of individually approving each
item? Ans: Consent Agenda
According to NCQA under what circumstance would a Locum
Tenens practitioner be exempt from credentialing? Ans: Covering
Practitioner
According to NCQA, what must be included in the organization's
right to appeal policies? Ans: 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
© 2025 All rights reserved
, 3 | Page
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? Ans: The Joint Commission
According to HFAP, how often must a reappraisal of membership
and privileges occur? Ans: Every 24 months
Which Accrediting Agency requires all practitioners with clinical
privileges to participate in continuing education? Ans: DNV
According to CMS, what criteria are used by the governing board
for the selection of medical staff members? Ans: Character,
competence, training, experience, and judgment
© 2025 All rights reserved
, 4 | Page
Which agency requires peer recommendations be obtained at
initial credentialing and reappointment? Ans: AAAHC
Which regulatory agency standards must be followed for a hospital
to bill for Medicare/Medicaid services? Ans: CMS Conditions of
Participation
Which Federal legislation created the National Practitioner Data
Bank? Ans: HCQIA
According to TJC, what is required to make a recommendation to
the Governing Board? Ans: Medical Executive Committee
Why it is important to check that the practitioner is not currently
excluded, suspended, debarred, or ineligible to
participate in Federal health care programs? Ans: The facility
won't get paid for treating patients unless service is provided by
authorized provider.
© 2025 All rights reserved
