CPMSM STUDY QUESTIONS WITH
COMPLETE SOLUTIONS
Why is it important to check that the practitioner is not currently excluded, suspended,
debarred, or ineligible to participate in Federal health care programs? - ANSWER-The
facility will not get paid for treating patients unless service is provided by an authorized
provider
Which of the following credentials must be tracked on an ongoing basis? - ANSWER-
Licensure
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
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 an adverse action history? -
ANSWER-National Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to
evaluate? - 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? - ANSWER-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? - ANSWER-
Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital
specific and: - ANSWER-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? - ANSWER-
Transesophageal Echocardiography
Which NCQA required committee makes recommendations regarding credentialing
decisions? - ANSWER-Credentials 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 and Concepts Committee (required for hospitals with 10 or more
DOs who admit patients and provide direct patient care). What is the other required
medical staff committee? - 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? - ANSWER-Sherman Anti-trust Act
Peer references should be obtained from: - ANSWER-Practitioners in the same
professional discipline as the applicant
Patrick v. Burgett is an important case because it: - 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: - ANSWER-Provided due process
Access to credentials files should be: - ANSWER-Described fully in an access policy
Which of the following bodies approves clinical privileges? - ANSWER-Governing body
of Board
What primary source verification is required by NCQA prior to provisional credentialing?
- ANSWER-Licensure and 5 year malpractice history or NPDB
According to The Joint Commission standards, initial appointments to the medical staff
are made for a period of: - ANSWER-Not to exceed two years
According to The Joint Commission standards, temporary privileges may be granted by:
- ANSWER-The CEO on recommendation of the medical staff president or authorized
designee
According to URAC's health network standards, each applicant within the scope of the
credentialing program submits an application that includes at least which of the
following: - ANSWER-State licensure information, including current license(s) and
history of licensure in all jurisdictions
According to AAAHC, which must be monitored on an ongoing basis? - ANSWER-
Current licensure
According to The Joint Commission, a nurse practitioner functioning independently and
providing a medical level of care must: - ANSWER-Be granted delineated clinical
privileges
COMPLETE SOLUTIONS
Why is it important to check that the practitioner is not currently excluded, suspended,
debarred, or ineligible to participate in Federal health care programs? - ANSWER-The
facility will not get paid for treating patients unless service is provided by an authorized
provider
Which of the following credentials must be tracked on an ongoing basis? - ANSWER-
Licensure
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
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 an adverse action history? -
ANSWER-National Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to
evaluate? - 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? - ANSWER-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? - ANSWER-
Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital
specific and: - ANSWER-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? - ANSWER-
Transesophageal Echocardiography
Which NCQA required committee makes recommendations regarding credentialing
decisions? - ANSWER-Credentials 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 and Concepts Committee (required for hospitals with 10 or more
DOs who admit patients and provide direct patient care). What is the other required
medical staff committee? - 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? - ANSWER-Sherman Anti-trust Act
Peer references should be obtained from: - ANSWER-Practitioners in the same
professional discipline as the applicant
Patrick v. Burgett is an important case because it: - 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: - ANSWER-Provided due process
Access to credentials files should be: - ANSWER-Described fully in an access policy
Which of the following bodies approves clinical privileges? - ANSWER-Governing body
of Board
What primary source verification is required by NCQA prior to provisional credentialing?
- ANSWER-Licensure and 5 year malpractice history or NPDB
According to The Joint Commission standards, initial appointments to the medical staff
are made for a period of: - ANSWER-Not to exceed two years
According to The Joint Commission standards, temporary privileges may be granted by:
- ANSWER-The CEO on recommendation of the medical staff president or authorized
designee
According to URAC's health network standards, each applicant within the scope of the
credentialing program submits an application that includes at least which of the
following: - ANSWER-State licensure information, including current license(s) and
history of licensure in all jurisdictions
According to AAAHC, which must be monitored on an ongoing basis? - ANSWER-
Current licensure
According to The Joint Commission, a nurse practitioner functioning independently and
providing a medical level of care must: - ANSWER-Be granted delineated clinical
privileges
