CPMSM EXAM STUDY GUIDE
Medical Education - TJC - Answers :Initials - PSV from Medical School (AMA/AOA,
ECFMG, AAPA)
Medical Education - TJC Accepted designated equivalent sources - Answers :AMA
Profile (as of 1996 - U.S. and Puerto Rico), AOA, Profile, ECFMG, AAPA
Medical Education - NCQA - Answers :Verify only the highest level of education/training
attained (PSV from MS not required if BC or Residency has been verified.
Medical Education NCQA Alternate Sources - Answers :Medical School, AMA/AOA,
ECFMG, State Licensing Agency
Medical Education - CMS - Answers :Medical Staff must have a mechanism to examine
evidence of professional education. Must be included in criteria for
membership/privileges. CMS does not specify acceptable sources for verification.
Medical Education - HFAP - Answers :PSV required. Additional sources: AMA profile,
AOA profile, ECFMG.
Medical Education - URAC - Answers :Credentialing application includes history of
education. PSV not required if board certified. May use state licensing board if the state
board verifies. Time limit - 6 months.
Medical Education - AAAHC - Answers :PSV required at initial appointment.
Medical Education - DNV - Answers :Bylaws define qualifications. Verify via AMA and
ECFMG.
ECMFG - Answers :Educational Commission for Foreign Medical Graduates
ECFMG Certification - Answers :Is required for foreign medical graduates for entry into
accredited GME programs in the U.S.
ECFMG Certificate - Answers :A standard ECFMG Certification, which can be used for
entry into accredited GME programs in the U.S. includes: Applicant name, Applicant
USMLE/ECFMG ID Number, Dates the exam requirements were taken, Date the
certificate was issued, Date(s) through which the passing performance on certain
exam(s) remain valid for the purpose of entry into GME.
Post-Graduate Training - TJC - Answers :Initial - PSV from training programs. Accepted
designated equivalent sources for U.S. and Puerto Rico: AMA and AOA profiles.
,Post-Graduate Training - NCQA - Answers :Verify only highest level of
education/training attained (Residency, not Fellowship). Verification of Fellowship does
NOT meet this standard. Initial - PSV from Residency program. Alternate sources:
AMA/AOA, state licensing agency. If state licensing agency is utilized, documentation
must be updated annually. **If the organization uses confirmation from a NCQA
approved source, the organization must verify that the source performs PSV, and, at
least annually, the organization must obtain written confirmation from the approved
source that it performs primary source verification.
Post-Graduate Training - CMS - Answers :Medical staff must have a mechanism to
verify training and experience. Governing Body ensures criteria for selection is based
on: Character, Competence, Training, Experience, Judgement.
Post-Graduate Training - HFAP - Answers :Training must be sufficient to support
requested privileges. PSV required through training program, AMA or AOA profile.
Post-Graduate Training - URAC - Answers :If not board certified, must verify highest
level of education. Must document history of education/training on application.
Post-Graduate Training - AAAHC - Answers :PSV required at initial appointment.
Post-Graduate Training - DNV - Answers :Bylaws define criteria for training. Verify
education - AMA profile.
Board Certification- TJC - Answers :Not required, unless bylaws/privileges require board
certification. (I&R) Verify through ABMS display agents - CertiFACTS, ABMS -
AMA/AOA or specialty board.
Board Certification- NCQA - Answers :Not Required. (I&R) Verify through ABMS display
agents, AMA/AOA profile, state licensing agency. May not use ABMS consumer
website. (I&R) Lifetime certification must be documented. day time limit.
Board Certification - CMS - Answers :No Requirements. Organizations may NOT make
decisions based solely on BC - must consider all elements (license, training,
experience, etc...).
Board Certification - HFAP - Answers :Not Required. Membership and Privileges cannot
be dependent solely upon certification, fellowship or membership in specialty body /
society. Must include other criteria, training, character, competence, judgement. Must
document certification status and verification must include sanction information. ABMS
display agents, AOA profile.
Board Certification - URAC - Answers :Not Required. Verify through ABMS display
agents, AMA/AOA profile, State licensing agency, if board certified. Verify at initial and
upon expiration. Six-month time limit.
, Board Certification - AAAHC - Answers :Not Required. PSV if organization requires
board certification at application, reappointment, expiration. Continuous monitoring
required - verify upon expiration.
Board Certification - DNV - Answers :Not Required. Organizations may NOT make
decisions based solely on BC - must consider all elements (license, training,
experience, etc...).
NCQA Time Limits - Day Time Limit - Answers :When document is submitted
to CC, verification date may not be older than 180 days. When CVO submits verification
to Health Plan, verification may not be older than 120 days.
NCQA Time Limits - / 180 Medicare Advantage Time Limit - Answers :When
file is submitted to CC, attestation date may not be older than 365 days. When CVO
submits file to Health Plan, attestation date may not be older than 305 days. If physician
on Medicare Advantage plan, attestation may not be older than 180 days.
State License - TJC - Answers :(I&R) PSV required at initial appointment,
revision/additional of privileges, at expiration. Verify through state licensing board.
State License - NCQA - Answers :Statement on application regarding history of loss of
license. (I&R) PSV through state licensing board for ALL states where practitioner
provides care. License must be current when file presented to CC. NOTE: Utilize AIM
DocFinder only if directed to site by state board. time limit.
State License - CMS - Answers :Medical Staff must have mechanism to verify current
license. No defined acceptable sources - assumption would be licensing board. Silent
on verification at time at expiration.
State License - HFAP - Answers :PSV required for all states where practitioner
practices or intends to practice. Also - PSV all previous licenses held. Telemedicine -
must be licensed in state the practitioner and patient are located.
State License - URAC - Answers :PSV required. Verification must include date of
expiration, date verified, and sanction status. License must be current and valid when
presented to CC.
State License - AAAHC - Answers :PSV required. Ongoing monitoring required.
State License - DNV - Answers :PSV required at initial appointment and reappointment.
License Sanctions - TJC - Answers :(I&R) Doctor must provide information regarding
challenges to licensure or registration and voluntary / involuntary relinquishment of
license or registration. Info must be evaluated before recommending privileges. TJC
silent on verification. May be verified through licensing board or FSMB.
Medical Education - TJC - Answers :Initials - PSV from Medical School (AMA/AOA,
ECFMG, AAPA)
Medical Education - TJC Accepted designated equivalent sources - Answers :AMA
Profile (as of 1996 - U.S. and Puerto Rico), AOA, Profile, ECFMG, AAPA
Medical Education - NCQA - Answers :Verify only the highest level of education/training
attained (PSV from MS not required if BC or Residency has been verified.
Medical Education NCQA Alternate Sources - Answers :Medical School, AMA/AOA,
ECFMG, State Licensing Agency
Medical Education - CMS - Answers :Medical Staff must have a mechanism to examine
evidence of professional education. Must be included in criteria for
membership/privileges. CMS does not specify acceptable sources for verification.
Medical Education - HFAP - Answers :PSV required. Additional sources: AMA profile,
AOA profile, ECFMG.
Medical Education - URAC - Answers :Credentialing application includes history of
education. PSV not required if board certified. May use state licensing board if the state
board verifies. Time limit - 6 months.
Medical Education - AAAHC - Answers :PSV required at initial appointment.
Medical Education - DNV - Answers :Bylaws define qualifications. Verify via AMA and
ECFMG.
ECMFG - Answers :Educational Commission for Foreign Medical Graduates
ECFMG Certification - Answers :Is required for foreign medical graduates for entry into
accredited GME programs in the U.S.
ECFMG Certificate - Answers :A standard ECFMG Certification, which can be used for
entry into accredited GME programs in the U.S. includes: Applicant name, Applicant
USMLE/ECFMG ID Number, Dates the exam requirements were taken, Date the
certificate was issued, Date(s) through which the passing performance on certain
exam(s) remain valid for the purpose of entry into GME.
Post-Graduate Training - TJC - Answers :Initial - PSV from training programs. Accepted
designated equivalent sources for U.S. and Puerto Rico: AMA and AOA profiles.
,Post-Graduate Training - NCQA - Answers :Verify only highest level of
education/training attained (Residency, not Fellowship). Verification of Fellowship does
NOT meet this standard. Initial - PSV from Residency program. Alternate sources:
AMA/AOA, state licensing agency. If state licensing agency is utilized, documentation
must be updated annually. **If the organization uses confirmation from a NCQA
approved source, the organization must verify that the source performs PSV, and, at
least annually, the organization must obtain written confirmation from the approved
source that it performs primary source verification.
Post-Graduate Training - CMS - Answers :Medical staff must have a mechanism to
verify training and experience. Governing Body ensures criteria for selection is based
on: Character, Competence, Training, Experience, Judgement.
Post-Graduate Training - HFAP - Answers :Training must be sufficient to support
requested privileges. PSV required through training program, AMA or AOA profile.
Post-Graduate Training - URAC - Answers :If not board certified, must verify highest
level of education. Must document history of education/training on application.
Post-Graduate Training - AAAHC - Answers :PSV required at initial appointment.
Post-Graduate Training - DNV - Answers :Bylaws define criteria for training. Verify
education - AMA profile.
Board Certification- TJC - Answers :Not required, unless bylaws/privileges require board
certification. (I&R) Verify through ABMS display agents - CertiFACTS, ABMS -
AMA/AOA or specialty board.
Board Certification- NCQA - Answers :Not Required. (I&R) Verify through ABMS display
agents, AMA/AOA profile, state licensing agency. May not use ABMS consumer
website. (I&R) Lifetime certification must be documented. day time limit.
Board Certification - CMS - Answers :No Requirements. Organizations may NOT make
decisions based solely on BC - must consider all elements (license, training,
experience, etc...).
Board Certification - HFAP - Answers :Not Required. Membership and Privileges cannot
be dependent solely upon certification, fellowship or membership in specialty body /
society. Must include other criteria, training, character, competence, judgement. Must
document certification status and verification must include sanction information. ABMS
display agents, AOA profile.
Board Certification - URAC - Answers :Not Required. Verify through ABMS display
agents, AMA/AOA profile, State licensing agency, if board certified. Verify at initial and
upon expiration. Six-month time limit.
, Board Certification - AAAHC - Answers :Not Required. PSV if organization requires
board certification at application, reappointment, expiration. Continuous monitoring
required - verify upon expiration.
Board Certification - DNV - Answers :Not Required. Organizations may NOT make
decisions based solely on BC - must consider all elements (license, training,
experience, etc...).
NCQA Time Limits - Day Time Limit - Answers :When document is submitted
to CC, verification date may not be older than 180 days. When CVO submits verification
to Health Plan, verification may not be older than 120 days.
NCQA Time Limits - / 180 Medicare Advantage Time Limit - Answers :When
file is submitted to CC, attestation date may not be older than 365 days. When CVO
submits file to Health Plan, attestation date may not be older than 305 days. If physician
on Medicare Advantage plan, attestation may not be older than 180 days.
State License - TJC - Answers :(I&R) PSV required at initial appointment,
revision/additional of privileges, at expiration. Verify through state licensing board.
State License - NCQA - Answers :Statement on application regarding history of loss of
license. (I&R) PSV through state licensing board for ALL states where practitioner
provides care. License must be current when file presented to CC. NOTE: Utilize AIM
DocFinder only if directed to site by state board. time limit.
State License - CMS - Answers :Medical Staff must have mechanism to verify current
license. No defined acceptable sources - assumption would be licensing board. Silent
on verification at time at expiration.
State License - HFAP - Answers :PSV required for all states where practitioner
practices or intends to practice. Also - PSV all previous licenses held. Telemedicine -
must be licensed in state the practitioner and patient are located.
State License - URAC - Answers :PSV required. Verification must include date of
expiration, date verified, and sanction status. License must be current and valid when
presented to CC.
State License - AAAHC - Answers :PSV required. Ongoing monitoring required.
State License - DNV - Answers :PSV required at initial appointment and reappointment.
License Sanctions - TJC - Answers :(I&R) Doctor must provide information regarding
challenges to licensure or registration and voluntary / involuntary relinquishment of
license or registration. Info must be evaluated before recommending privileges. TJC
silent on verification. May be verified through licensing board or FSMB.
