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CPCS/CPMSM - Participant Guide Sample
Test Questions and Correct Answers
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.
Which of the following credentials must be tracked on an ongoing
basis? Ans: Licensure
According to NCQA standards, an organization that discovers
sanction information, complaints, or adverse events regarding a
practitioner must take what action? Ans: Determine if there is
evidence of poor quality that could affect the health and safety of
its members.
© 2025 All rights reserved
, 2 | Page
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? Ans: The National Practitioner Data Bank
When developing clinical privileging criteria, which of the
following is important to evaluate? Ans: Established standards of
practice such as, specialty board recommendations.
What is the main reason for periodically assessing appropriateness
of clinical privileges for each specialty? Ans: 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? Ans: Interventional Cardiologist
© 2025 All rights reserved
, 3 | Page
The Joint Commission hospital standards require that clinical
privileges are hospital specific and Ans: 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? Ans: Transesophageal Echocardiography
Which NCQA-required committee makes recommendations
regarding credentialing decisions? Ans: Credentialing Committee
HFAP standards require two medical staff committees to be
delineated in the medical staff structure. One of them is the
Medical Executive Committee. What is the other required medical
staff committee? Ans: 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? Ans: Sherman Anti-trust Act
© 2025 All rights reserved
, 4 | Page
Peer references should be obtained from: Ans: Practitioners in
the same professional discipline as the applicant
Patrick v. Burgett is an important case because it: Ans: 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: Ans: Provided due
process.
Access to credentials files should be: Ans: Described fully in an
access policy.
Which of the following bodies approves clinical privileges? Ans:
Governing Body or Board
What primary source verification is required by NCQA prior to
provisional credentialing? Ans: Licensure and 5-year malpractice
history or NPDB
© 2025 All rights reserved
CPCS/CPMSM - Participant Guide Sample
Test Questions and Correct Answers
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.
Which of the following credentials must be tracked on an ongoing
basis? Ans: Licensure
According to NCQA standards, an organization that discovers
sanction information, complaints, or adverse events regarding a
practitioner must take what action? Ans: Determine if there is
evidence of poor quality that could affect the health and safety of
its members.
© 2025 All rights reserved
, 2 | Page
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? Ans: The National Practitioner Data Bank
When developing clinical privileging criteria, which of the
following is important to evaluate? Ans: Established standards of
practice such as, specialty board recommendations.
What is the main reason for periodically assessing appropriateness
of clinical privileges for each specialty? Ans: 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? Ans: Interventional Cardiologist
© 2025 All rights reserved
, 3 | Page
The Joint Commission hospital standards require that clinical
privileges are hospital specific and Ans: 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? Ans: Transesophageal Echocardiography
Which NCQA-required committee makes recommendations
regarding credentialing decisions? Ans: Credentialing Committee
HFAP standards require two medical staff committees to be
delineated in the medical staff structure. One of them is the
Medical Executive Committee. What is the other required medical
staff committee? Ans: 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? Ans: Sherman Anti-trust Act
© 2025 All rights reserved
, 4 | Page
Peer references should be obtained from: Ans: Practitioners in
the same professional discipline as the applicant
Patrick v. Burgett is an important case because it: Ans: 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: Ans: Provided due
process.
Access to credentials files should be: Ans: Described fully in an
access policy.
Which of the following bodies approves clinical privileges? Ans:
Governing Body or Board
What primary source verification is required by NCQA prior to
provisional credentialing? Ans: Licensure and 5-year malpractice
history or NPDB
© 2025 All rights reserved
