CPCS CPMSM Exam Questions with correct
answers 54pg
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
|u |- |VERIFIED |ANSWER✔✔-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 |approved |under |one |motion |instead |of |individually |approving |each |item? |-
|VERIFIED |ANSWER✔✔-Consent |Agenda
According |to |NCQA |under |what |circumstance |would |a |Locum |Tenens |practitioner |be |exempt |from
|credentialing? |- |VERIFIED |ANSWER✔✔-Covering |Practitioner
According |to |URAC, |when |developing |a |quality |auditing |process, |prudent |practice |would |be |to |audit
|what |percentage |of |completed |credentialing |files? |- |VERIFIED |ANSWER✔✔-
According |to |URAC, |a |complete |credentials |file |should |be |reviewed |by |which |professionals? |-
|VERIFIED |ANSWER✔✔-
According |to |NCQA, |what |must |be |included |in |the |organization's |right |to |appeal |policies? |- |VERIFIED
|ANSWER✔✔-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
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? |- |VERIFIED |ANSWER✔✔-
The |Joint |Commission
According |to |HFAP, |how |often |must |a |reappraisal |of |membership |and |privileges |occur? |- |VERIFIED
|ANSWER✔✔-Every |24 |months
Which |Accrediting |Agency |requires |all |practitioners |with |clinical |privileges |to |participate |in |continuing
|education? |- |VERIFIED |ANSWER✔✔-DNV
According |to |CMS, |what |criteria |are |used |by |the |governing |board |for |the |selection |of |medical |staff
|members? |- |VERIFIED |ANSWER✔✔-Character, |competence, |training, |experience, |and |judgment
Which |agency |requires |peer |recommendations |be |obtained |at |initial |credentialing |and
|reappointment? |- |VERIFIED |ANSWER✔✔-AAAHC
Which |regulatory |agency |standards |must |be |followed |for |a |hospital |to |bill |for |Medicare/Medicaid
|services? |- |VERIFIED |ANSWER✔✔-CMS |Conditions |of |Participation
Which |Federal |legislation |created |the |National |Practitioner |Data |Bank? |- |VERIFIED |ANSWER✔✔-HCQIA
According |to |TJC, |what |is |required |to |make |a |recommendation |to |the |Governing |Board? |- |VERIFIED
|ANSWER✔✔-Medical |Executive |Committee
According |to |NCQA, |the |application |process |is |located |in |what |document? |- |VERIFIED |ANSWER✔✔-
Why |it |is |important |to |check |that |the |practitioner |is |not |currently |excluded, |suspended, |debarred, |or
|ineligible |to
participate |in |Federal |health |care |programs? |- |VERIFIED |ANSWER✔✔-The |facility |won't |get |paid |for
|treating |patients |unless |service |is |provided |by |authorized |provider.
,Which |credential |must |be |tracked |on |an |ongoing |basis? |- |VERIFIED |ANSWER✔✔-Licensure
According |to |NCQA |standards, |an |organization |that |discovers |sanction |information, |complaints, |or
|adverse
events |regarding |a |practitioner |must |take |what |action? |- |VERIFIED |ANSWER✔✔-Determine |if |there |is
|evidence |of |poor |quality |that |could |affect |the |health |and |safety |of |its |members.
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? |- |VERIFIED |ANSWER✔✔-NPDB
When |developing |clinical |privileging |criteria, |what |is |important |to |evaluate? |- |VERIFIED |ANSWER✔✔-
Established |standards |of |practice |such |as, |specialty |board |recommendations.
What |is |the |main |reason |for |periodically |assessing |appropriateness |of |clinical |privileges |for |each
|specialty? |- |VERIFIED |ANSWER✔✔-To |protect |patient |safety |by |ensuring |current |competency,
|relevance |to |the |facility, |and |accepted |standards
of |care.
What |type |of |specialists |is |most |likely |to |perform |a |PTCA? |- |VERIFIED |ANSWER✔✔-Interventional
|Cardiologist
The |Joint |Commission |hospital |standards |require |that |clinical |privileges |are |hospital-specific |and |-
|VERIFIED |ANSWER✔✔-Based |on |the |individual's |demonstrated |current |competence |and |the
|procedures |the |hospital |can |support.
What |type |of |procedure |would |be |routinely |performed |by |a |cardiologist? |- |VERIFIED |ANSWER✔✔-
Transesophageal |Echocardiography
, Which |NCQA-required |committee |makes |recommendations |regarding |credentialing |decisions? |-
|VERIFIED |ANSWER✔✔-Credentialing |Committee
HFAP |standards |require |three |medical |staff |committees |to |be |delineated |in |the |medical |staff
|structure. |Two |of
them |are |the |Medical |Executive |Committee |and |the |Utilization |of |Osteopathic |Methods |& |Concepts
|Committee
(required |for |hospitals |with |ten |or |more |DOs |who |admit |patients |and |provide |direct |patient |care).
|What |is |the
other |required |medical |staff |committee? |- |VERIFIED |ANSWER✔✔-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? |- |VERIFIED |ANSWER✔✔-Sherman |Anti-trust |Act
Peer |references |should |be |obtained |from |- |VERIFIED |ANSWER✔✔-Practitioners |in |the |same
|professional |discipline |as |the |applicant
Patrick |v. |Burgett |is |an |important |case |because |it: |- |VERIFIED |ANSWER✔✔-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:
|- |VERIFIED |ANSWER✔✔-Provided |due |process
Access |to |credentials |files |should |be: |- |VERIFIED |ANSWER✔✔-Described |fully |in |an |access |policy
What |body |approves |clinical |privileges? |- |VERIFIED |ANSWER✔✔-Governing |Body |or |Board
What |primary |source |verification |is |required |by |NCQA |prior |to |provisional |credentialing? |- |VERIFIED
|ANSWER✔✔-Licensure |and |5 |year |malpractice |history |or |NPDB
answers 54pg
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
|u |- |VERIFIED |ANSWER✔✔-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 |approved |under |one |motion |instead |of |individually |approving |each |item? |-
|VERIFIED |ANSWER✔✔-Consent |Agenda
According |to |NCQA |under |what |circumstance |would |a |Locum |Tenens |practitioner |be |exempt |from
|credentialing? |- |VERIFIED |ANSWER✔✔-Covering |Practitioner
According |to |URAC, |when |developing |a |quality |auditing |process, |prudent |practice |would |be |to |audit
|what |percentage |of |completed |credentialing |files? |- |VERIFIED |ANSWER✔✔-
According |to |URAC, |a |complete |credentials |file |should |be |reviewed |by |which |professionals? |-
|VERIFIED |ANSWER✔✔-
According |to |NCQA, |what |must |be |included |in |the |organization's |right |to |appeal |policies? |- |VERIFIED
|ANSWER✔✔-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
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? |- |VERIFIED |ANSWER✔✔-
The |Joint |Commission
According |to |HFAP, |how |often |must |a |reappraisal |of |membership |and |privileges |occur? |- |VERIFIED
|ANSWER✔✔-Every |24 |months
Which |Accrediting |Agency |requires |all |practitioners |with |clinical |privileges |to |participate |in |continuing
|education? |- |VERIFIED |ANSWER✔✔-DNV
According |to |CMS, |what |criteria |are |used |by |the |governing |board |for |the |selection |of |medical |staff
|members? |- |VERIFIED |ANSWER✔✔-Character, |competence, |training, |experience, |and |judgment
Which |agency |requires |peer |recommendations |be |obtained |at |initial |credentialing |and
|reappointment? |- |VERIFIED |ANSWER✔✔-AAAHC
Which |regulatory |agency |standards |must |be |followed |for |a |hospital |to |bill |for |Medicare/Medicaid
|services? |- |VERIFIED |ANSWER✔✔-CMS |Conditions |of |Participation
Which |Federal |legislation |created |the |National |Practitioner |Data |Bank? |- |VERIFIED |ANSWER✔✔-HCQIA
According |to |TJC, |what |is |required |to |make |a |recommendation |to |the |Governing |Board? |- |VERIFIED
|ANSWER✔✔-Medical |Executive |Committee
According |to |NCQA, |the |application |process |is |located |in |what |document? |- |VERIFIED |ANSWER✔✔-
Why |it |is |important |to |check |that |the |practitioner |is |not |currently |excluded, |suspended, |debarred, |or
|ineligible |to
participate |in |Federal |health |care |programs? |- |VERIFIED |ANSWER✔✔-The |facility |won't |get |paid |for
|treating |patients |unless |service |is |provided |by |authorized |provider.
,Which |credential |must |be |tracked |on |an |ongoing |basis? |- |VERIFIED |ANSWER✔✔-Licensure
According |to |NCQA |standards, |an |organization |that |discovers |sanction |information, |complaints, |or
|adverse
events |regarding |a |practitioner |must |take |what |action? |- |VERIFIED |ANSWER✔✔-Determine |if |there |is
|evidence |of |poor |quality |that |could |affect |the |health |and |safety |of |its |members.
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? |- |VERIFIED |ANSWER✔✔-NPDB
When |developing |clinical |privileging |criteria, |what |is |important |to |evaluate? |- |VERIFIED |ANSWER✔✔-
Established |standards |of |practice |such |as, |specialty |board |recommendations.
What |is |the |main |reason |for |periodically |assessing |appropriateness |of |clinical |privileges |for |each
|specialty? |- |VERIFIED |ANSWER✔✔-To |protect |patient |safety |by |ensuring |current |competency,
|relevance |to |the |facility, |and |accepted |standards
of |care.
What |type |of |specialists |is |most |likely |to |perform |a |PTCA? |- |VERIFIED |ANSWER✔✔-Interventional
|Cardiologist
The |Joint |Commission |hospital |standards |require |that |clinical |privileges |are |hospital-specific |and |-
|VERIFIED |ANSWER✔✔-Based |on |the |individual's |demonstrated |current |competence |and |the
|procedures |the |hospital |can |support.
What |type |of |procedure |would |be |routinely |performed |by |a |cardiologist? |- |VERIFIED |ANSWER✔✔-
Transesophageal |Echocardiography
, Which |NCQA-required |committee |makes |recommendations |regarding |credentialing |decisions? |-
|VERIFIED |ANSWER✔✔-Credentialing |Committee
HFAP |standards |require |three |medical |staff |committees |to |be |delineated |in |the |medical |staff
|structure. |Two |of
them |are |the |Medical |Executive |Committee |and |the |Utilization |of |Osteopathic |Methods |& |Concepts
|Committee
(required |for |hospitals |with |ten |or |more |DOs |who |admit |patients |and |provide |direct |patient |care).
|What |is |the
other |required |medical |staff |committee? |- |VERIFIED |ANSWER✔✔-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? |- |VERIFIED |ANSWER✔✔-Sherman |Anti-trust |Act
Peer |references |should |be |obtained |from |- |VERIFIED |ANSWER✔✔-Practitioners |in |the |same
|professional |discipline |as |the |applicant
Patrick |v. |Burgett |is |an |important |case |because |it: |- |VERIFIED |ANSWER✔✔-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:
|- |VERIFIED |ANSWER✔✔-Provided |due |process
Access |to |credentials |files |should |be: |- |VERIFIED |ANSWER✔✔-Described |fully |in |an |access |policy
What |body |approves |clinical |privileges? |- |VERIFIED |ANSWER✔✔-Governing |Body |or |Board
What |primary |source |verification |is |required |by |NCQA |prior |to |provisional |credentialing? |- |VERIFIED
|ANSWER✔✔-Licensure |and |5 |year |malpractice |history |or |NPDB
