CPMSM PREPARATION QUESTIONS & ANSWERS
Why is it important to check that the practitioner is not currently exclude, suspended,
debarred, or ineligible to participate in Federal health care programs? - Answers :The
facility will not get paid for treating patients unless the service is provided by an
authorized provider.
Which of the following specialists is most likely to perform a PTCA? - Answers
:Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital
specific and - Answers :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? - Answers
:Transesophageal Echocardiography
Which NCQA required committee makes recommendations regarding credentialing
decisions? - Answers :Credentialing Committee
HFAP standards require three medical staff committees to be delineated in the medical
staff structure; what are they? - Answers :Medical Executive Committee, the Utilization
Review Committee and the Utilization of Osteopathic Methods and Concepts
Committee
If you needed to find out about what the federal government requires in regards to anti-
trust issues, what law would you consult? - Answers :The Sherman Anti-trust Act
Peer references should be obtained from: - Answers :Practitioners in the same
professional discipline as the applicant.
Patrick v. Burgett is an important case because it: - Answers :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: - Answers :Provided due process
Access to credentials files should be: - Answers :Described fully in an access policy
Which of the following bodies approves clinical privileges? - Answers :The Governing
body / Board
Which primary source verification is required by NCQA prior to provisional
credentialing? - Answers :Licensure and 5 years of malpractice history or NPDB
, According to TJC standards, initial appointments to the medical staff are made for a
period of: - Answers :Not to exceed two years
According to TJC, temporary privileges may be granted by: - Answers :The CEO on the
recommendation of the medical staff president or authorized designee
According to TJC, which of the following items must be verified with a primary source? -
Answers :Licensure, training, experience and competence
According to NCQA standards, a copy of which is an acceptable verification of the
document? - Answers :DEA certificate
According to NCQA standards, which is an acceptable source for primary source
verification of Medicare and Medicaid sanction activity against physicians? - Answers
:Federation State Medical Boards
According to TJC standards, which of following is considered a designated equivalent
source for verification of board certification? - Answers :The American Board of Medical
Specialties
Which of the following organizations have been recognized by TJC and NCQA to
provide primary source verification of medical school graduation and residency training
for US graduates? - Answers :American Medical Association Master file
Which of the following credentials must be tracked on an ongoing basis? - Answers
:Licensure
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
Answers :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 thru 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? -
Answers :The Nation Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to
evaluate? - Answers :Established standards of practice such as specialty board
recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges
for each specialty? - Answers :To protect patient safety by ensuring current
competency, relevance to the facility, and accepted standards of care.
Why is it important to check that the practitioner is not currently exclude, suspended,
debarred, or ineligible to participate in Federal health care programs? - Answers :The
facility will not get paid for treating patients unless the service is provided by an
authorized provider.
Which of the following specialists is most likely to perform a PTCA? - Answers
:Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital
specific and - Answers :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? - Answers
:Transesophageal Echocardiography
Which NCQA required committee makes recommendations regarding credentialing
decisions? - Answers :Credentialing Committee
HFAP standards require three medical staff committees to be delineated in the medical
staff structure; what are they? - Answers :Medical Executive Committee, the Utilization
Review Committee and the Utilization of Osteopathic Methods and Concepts
Committee
If you needed to find out about what the federal government requires in regards to anti-
trust issues, what law would you consult? - Answers :The Sherman Anti-trust Act
Peer references should be obtained from: - Answers :Practitioners in the same
professional discipline as the applicant.
Patrick v. Burgett is an important case because it: - Answers :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: - Answers :Provided due process
Access to credentials files should be: - Answers :Described fully in an access policy
Which of the following bodies approves clinical privileges? - Answers :The Governing
body / Board
Which primary source verification is required by NCQA prior to provisional
credentialing? - Answers :Licensure and 5 years of malpractice history or NPDB
, According to TJC standards, initial appointments to the medical staff are made for a
period of: - Answers :Not to exceed two years
According to TJC, temporary privileges may be granted by: - Answers :The CEO on the
recommendation of the medical staff president or authorized designee
According to TJC, which of the following items must be verified with a primary source? -
Answers :Licensure, training, experience and competence
According to NCQA standards, a copy of which is an acceptable verification of the
document? - Answers :DEA certificate
According to NCQA standards, which is an acceptable source for primary source
verification of Medicare and Medicaid sanction activity against physicians? - Answers
:Federation State Medical Boards
According to TJC standards, which of following is considered a designated equivalent
source for verification of board certification? - Answers :The American Board of Medical
Specialties
Which of the following organizations have been recognized by TJC and NCQA to
provide primary source verification of medical school graduation and residency training
for US graduates? - Answers :American Medical Association Master file
Which of the following credentials must be tracked on an ongoing basis? - Answers
:Licensure
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
Answers :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 thru 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? -
Answers :The Nation Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to
evaluate? - Answers :Established standards of practice such as specialty board
recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges
for each specialty? - Answers :To protect patient safety by ensuring current
competency, relevance to the facility, and accepted standards of care.
