CPMSM - STUDY GUIDE MATERIAL
COMPLETE QUESTIONS &
SOLUTIONS(RATED A+)
What are four models of HMOs? - ANSWER Staff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types of committees? - ANSWER Standing
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - ANSWER 5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - ANSWER 5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? -
ANSWER 3
At least three active medical staff
How many medical staff members must serve on a Medical Records Committee? -
ANSWER 1
At least one active medical staff
How often should the Medical Records committee meet? - ANSWER At least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics
Committee? - ANSWER 5
At least five active medical staff
How often should the Pharmacy & Therapeutics committee meet? - ANSWER At least
quarterly
,How many medical staff members must serve on a Utilization Review Committee? -
ANSWER 1
At least one active medical staff
How often should the Utilization Review Committee meet? - ANSWER Every other
month
Which accreditor requires an applicant to submit a statement that no health problems
exist which could affect his or her ability to provide care? - ANSWER TJC
Which accreditor has *no* specific requirements for professional practice questions on
the application or reapp? - ANSWER DNV
For Medicare deemed facilities, the delegation of credentialing agreement must include
what clause? - ANSWER Adhere to Medicare regulations
How often must the delegate organization provide a report to Credentials for a URAC
facility? - ANSWER Annually
What is the NCQA requirement for monitoring member complaints about providers? -
ANSWER Continually monitoring member complaints for all practitioner sites
Performing a site visit within 60 days if a threshold was met
What is the only NCQA-required reporting for delegated credentialing? - ANSWER The
names or files of practitioners or providers processed by the delegate
What is the credentialing timeframe for URAC? - ANSWER 6 months
No credentialing application is submitted for initial review if it is signed and dated more
than 180 days prior to credentialing committee review or if it contains primary or
secondary source verification information collected more than six months prior to
review.
What are the two requirements for verification at reappointment for DNV? - ANSWER
Licensure
Current Competence
What is verification of a practitioner's credentials based upon evidence obtains by
means other than direct contact with the issuing source of the credential? (e.g. copies of
licenses/certifications or database queries) - ANSWER Secondary Source
What year was HIPAA established? - ANSWER 1996
, Which two entities can report to HIPDB? - ANSWER Federal/state government
agencies
Health Plans
Which agency was established to combat fraud and abuse in health insurance and
health care delivery and to promote quality care by HIPAA? - ANSWER HIPDB
What year did reporting to HIPDB begin? - ANSWER 1999
What is a national non-profit organization representing the 70+ medical and osteopathic
boards? - ANSWER FSMB
Federation of State Medical Boards
What is the name of the source for demographic, educational, and practice information
for all US physicians with MDs? - ANSWER AMA Physician Masterfile
What year was the AMA Master File started? - ANSWER 1906
What is CIN-BAD? - ANSWER Chiropractic Information Network - Board Action
Databank
What year was CIN-BAD started? - ANSWER 1993
What is the CSA registration database? - ANSWER Controlled Substances Act
DEA
Who maintains a database of individuals and entities excluded from federal programs
including Medicare and Medicaid? - ANSWER OIG
Office of the Inspector General
Who maintains the list of people and organizations excluded from doing business with
the Federal Government? - ANSWER SAM
System for Award Management
What is the former name of SAM? - ANSWER EPLS
Excluded parties list system
What four systems are included in SAM? - ANSWER CCR (Central Contractor Registry)
Fedreg (Federal Agency Registration)
ORCA - Online Representations and Certifications Applicaction
EPLS - Excluded Parties List System
In the managed care setting, how many levels of training must be verified? - ANSWER
Only the highest level (residency) or board certification
COMPLETE QUESTIONS &
SOLUTIONS(RATED A+)
What are four models of HMOs? - ANSWER Staff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types of committees? - ANSWER Standing
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - ANSWER 5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - ANSWER 5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? -
ANSWER 3
At least three active medical staff
How many medical staff members must serve on a Medical Records Committee? -
ANSWER 1
At least one active medical staff
How often should the Medical Records committee meet? - ANSWER At least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics
Committee? - ANSWER 5
At least five active medical staff
How often should the Pharmacy & Therapeutics committee meet? - ANSWER At least
quarterly
,How many medical staff members must serve on a Utilization Review Committee? -
ANSWER 1
At least one active medical staff
How often should the Utilization Review Committee meet? - ANSWER Every other
month
Which accreditor requires an applicant to submit a statement that no health problems
exist which could affect his or her ability to provide care? - ANSWER TJC
Which accreditor has *no* specific requirements for professional practice questions on
the application or reapp? - ANSWER DNV
For Medicare deemed facilities, the delegation of credentialing agreement must include
what clause? - ANSWER Adhere to Medicare regulations
How often must the delegate organization provide a report to Credentials for a URAC
facility? - ANSWER Annually
What is the NCQA requirement for monitoring member complaints about providers? -
ANSWER Continually monitoring member complaints for all practitioner sites
Performing a site visit within 60 days if a threshold was met
What is the only NCQA-required reporting for delegated credentialing? - ANSWER The
names or files of practitioners or providers processed by the delegate
What is the credentialing timeframe for URAC? - ANSWER 6 months
No credentialing application is submitted for initial review if it is signed and dated more
than 180 days prior to credentialing committee review or if it contains primary or
secondary source verification information collected more than six months prior to
review.
What are the two requirements for verification at reappointment for DNV? - ANSWER
Licensure
Current Competence
What is verification of a practitioner's credentials based upon evidence obtains by
means other than direct contact with the issuing source of the credential? (e.g. copies of
licenses/certifications or database queries) - ANSWER Secondary Source
What year was HIPAA established? - ANSWER 1996
, Which two entities can report to HIPDB? - ANSWER Federal/state government
agencies
Health Plans
Which agency was established to combat fraud and abuse in health insurance and
health care delivery and to promote quality care by HIPAA? - ANSWER HIPDB
What year did reporting to HIPDB begin? - ANSWER 1999
What is a national non-profit organization representing the 70+ medical and osteopathic
boards? - ANSWER FSMB
Federation of State Medical Boards
What is the name of the source for demographic, educational, and practice information
for all US physicians with MDs? - ANSWER AMA Physician Masterfile
What year was the AMA Master File started? - ANSWER 1906
What is CIN-BAD? - ANSWER Chiropractic Information Network - Board Action
Databank
What year was CIN-BAD started? - ANSWER 1993
What is the CSA registration database? - ANSWER Controlled Substances Act
DEA
Who maintains a database of individuals and entities excluded from federal programs
including Medicare and Medicaid? - ANSWER OIG
Office of the Inspector General
Who maintains the list of people and organizations excluded from doing business with
the Federal Government? - ANSWER SAM
System for Award Management
What is the former name of SAM? - ANSWER EPLS
Excluded parties list system
What four systems are included in SAM? - ANSWER CCR (Central Contractor Registry)
Fedreg (Federal Agency Registration)
ORCA - Online Representations and Certifications Applicaction
EPLS - Excluded Parties List System
In the managed care setting, how many levels of training must be verified? - ANSWER
Only the highest level (residency) or board certification
