CPMSM WITH COMPLETE SOLUTIONS 100% VERIFIED
What is a quorum? - ANSWER The number of members that must be present at a
meeting to transact business
What is credentialing as defined by TJC? - ANSWER Process of Obtaining, Verifying, and
Assessing the qualifications of a practitioner to provide healthcare services for an org.
What does it mean for an org. to have "deemed status? "- ANSWER Means that they
meet the Centers for Medicare/Medicaid requirements for participation in Medicare +
other federal programs.
CIHQ - ANSWER Center for Improvement in Healthcare Quality
DNV GL - ANSWER Det Norske Veritas Healthcare Inc.
TJC - ANSWER The Joint Commission
HFAP - ANSWER Health Facilities Accreditation Program
NCQA - ANSWER National Committee for Quality Assurance
AAAHC - Accreditation Association for Ambulatory Health Care
Name 2 accreditors that accredit MCOs. - ANSWER URAC and NCQA
Name the accreditor that accredites ambulatory care facilities. - ANSWER AAAHC
, CoPs - ANSWER Medicare Conditions of Participation
According to NCQA standards, under what circumstance is it NOT necessary to
credential a practitioner? Remember: NCQA accredits MCOs. (p.21) - ANSWER Those
who practice exclusively in the inpatient setting and provide care for the org's members
due to the members being directed to the hospital (PRANER= Pathologist, Radiologists,
Anesthesiologists, Neonates, ER docs). EX: a PVH only physician that has to care for
PHC's patient via the ER (PHC doesn't need to credential him).
Pharmacists
Covering locum tenens-unless working for longer than 90 days
Internal Criteria (p22) - ANSWER factors defined by the hospital or MCO's governing
board-ex: board certification, minimum insurance amount
External Criteria (p 22) - ANSWER Requirements set by others outside of the org. like
TJC, NCQZ and CoPs.
Medicare CoPs require that __________ describe the qualifications of a candidate in
order for them to be recommended an appointment by the governing body. - ANSWER
Bylaws
What does the "Interpretive Guidelines 482.12(a)(2)" state from CoPs? (p23) - ANSWER
[The governing body must] appoint members of the medical staff after considering the
recommendations of the existing members of the medical staff-ie.gov body decides
whether to grant, deny, continue, revise, discontinue, limit revoke privs, after
considering the rec of the medical staff
What is the "Interpretive Guidelines 482.12(a)(6) from CoPs (p23)? - ANSWER [The
governing body must] ensure the criteria for selection are individual character,
competence training, experience, and judgement. [IC,CT,E,J]
What is a quorum? - ANSWER The number of members that must be present at a
meeting to transact business
What is credentialing as defined by TJC? - ANSWER Process of Obtaining, Verifying, and
Assessing the qualifications of a practitioner to provide healthcare services for an org.
What does it mean for an org. to have "deemed status? "- ANSWER Means that they
meet the Centers for Medicare/Medicaid requirements for participation in Medicare +
other federal programs.
CIHQ - ANSWER Center for Improvement in Healthcare Quality
DNV GL - ANSWER Det Norske Veritas Healthcare Inc.
TJC - ANSWER The Joint Commission
HFAP - ANSWER Health Facilities Accreditation Program
NCQA - ANSWER National Committee for Quality Assurance
AAAHC - Accreditation Association for Ambulatory Health Care
Name 2 accreditors that accredit MCOs. - ANSWER URAC and NCQA
Name the accreditor that accredites ambulatory care facilities. - ANSWER AAAHC
, CoPs - ANSWER Medicare Conditions of Participation
According to NCQA standards, under what circumstance is it NOT necessary to
credential a practitioner? Remember: NCQA accredits MCOs. (p.21) - ANSWER Those
who practice exclusively in the inpatient setting and provide care for the org's members
due to the members being directed to the hospital (PRANER= Pathologist, Radiologists,
Anesthesiologists, Neonates, ER docs). EX: a PVH only physician that has to care for
PHC's patient via the ER (PHC doesn't need to credential him).
Pharmacists
Covering locum tenens-unless working for longer than 90 days
Internal Criteria (p22) - ANSWER factors defined by the hospital or MCO's governing
board-ex: board certification, minimum insurance amount
External Criteria (p 22) - ANSWER Requirements set by others outside of the org. like
TJC, NCQZ and CoPs.
Medicare CoPs require that __________ describe the qualifications of a candidate in
order for them to be recommended an appointment by the governing body. - ANSWER
Bylaws
What does the "Interpretive Guidelines 482.12(a)(2)" state from CoPs? (p23) - ANSWER
[The governing body must] appoint members of the medical staff after considering the
recommendations of the existing members of the medical staff-ie.gov body decides
whether to grant, deny, continue, revise, discontinue, limit revoke privs, after
considering the rec of the medical staff
What is the "Interpretive Guidelines 482.12(a)(6) from CoPs (p23)? - ANSWER [The
governing body must] ensure the criteria for selection are individual character,
competence training, experience, and judgement. [IC,CT,E,J]
