CPMSM QUESTIONS & ANSWERS
Medicare requires providers to perform what process every 3-5 years? - Answers
:Revalidation
According to DNV standards, initial appointments to the medical staff are not to exceed
what time period? - Answers :36 months / 3 years
T/F: The Joint Commission standards require that the applicant's participation in
continuing education is evaluated and considered on initial appointment to the medical
staff. - Answers :False.
Participating in continuing education must be considered in decisions about
reappointment to membership on the medical staff or renewal or revision of individual
clinical privileges. The standards do not require this to be evaluated on initial
appointment.
According to NCQA standards, on initial application, review of information on sanctions,
restrictions on licensure and limitations on scope of practice must cover what period of
time? - Answers :The most recent five-year period
What are the two elements of Due Process? - Answers :Substantive and Procedural
According to the HCQIA, at what times must the hospital query the National Practitioner
Data Bank for a physician, dentist or other health care practitioner? - Answers :- Initial
appointment
- Reappointment (renewal)
- Request for new privileges
and every 2 years thereafter
What medical staff committee(s) is/are required by Joint Commission hospital standards
for the medical staff? - Answers :Medical Executive Committee
Under Robert's Rules of Order, when more than one motion is proposed, which motion
takes precedence? - Answers :the most recent motion takes precedence over the ones
T/F: Voluntary surrender or restriction of clinical privileges for 14 days is reportable to
the NPDB - Answers :False
Reportable on the 15th day
Which specialty is most likely to be granted privileges for surgical management of
congenital septal and valvular defects? - Answers :Cardiovascular or cardiothoracic
surgeon
,URAC standards require the organization to provide a written notification to providers
within how many days of the credentialing determination? - Answers :10 business days
(Note: NCQA requires within 60 calendar days)
NCQA standards require the organization to have written policies and procedures that
delineate certain practitioner rights and to communicate these rights to the practitioner.
Name the 3 rights that must be provided to applicants. - Answers :• Right to correct
erroneous information
• Right to receive the status of their credentialing or recredentialing application upon
request
• Right to review information submitted to support their application
What is the purpose of the MAC? - Answers :A MAC (or Medicare Administrative
Contractor) provides regional services on behalf of Medicare, including processing
claims, enrolling providers and other activities.
T/F: HFAP standards allow a hospital to accept the credentialing and privileging
decision of another organization (credentialing/privileging by proxy) for teleradiology
services - Answers :True
The case of Darling v. Charleston Memorial Community Hospital was significant in that
it set aside a long standing doctrine that was applied to hospitals. What is that doctrine?
- Answers :Charitable Immunity Doctrine
CMS Conditions of Participation for Hospitals require that criteria for selection to the
medical staff include evaluation of five areas. One of these is competence. Name the 4
remaining areas. - Answers :Character, judgment, experience and training
(Note: remember by using acronym CCJET)
NCQA requires which three factors prior to provisionally credentialing a provider? -
Answers :• PSV of a current, valid license to practice
• PSV of past 5 years of malpractice claims or settlements from the malpractice carrier,
or the results of the NPDB query
• A current and signed application with attestation
Cannot exceed 60 calendar days, at which time the full credentialing process must be
completed
AAAHC requires a provider to be recredentialed every three years except under what
circumstance? - Answers :- Every 3 years unless state law requires more frequently or
- if the organization cannot recredential a practitioner within the 36 month time frame
because the practitioner is on active military leave, maternity leave, or sabbatical.
According to HCQIA, a hospital that fails to report adverse actions may lose its immunity
up to what period of time? - Answers :3 years
,What is the federal law that was enacted for the purpose of encouraging good faith
professional review activities? - Answers :Healthcare Quality Improvement Act of 1986
Management - Answers :The process of accomplishing the goals of an organization
through the effective use of people and other resources.
Management: Planning - Answers :Determines in advance what should be done
- Determine department objectives
Set goals
- Formulate policies and procedures, programs, rules and regs
- Develop budgets and annual meeting calendars
- Schedule review and updates of governance documents
- Anticipating the future and determining the best course of action to achieve those
objectives.
Management: Determine department objectives - Answers :Planning
Management: Develop budgets and annual meeting calendars - Answers :Planning
Management: Anticipating the future and determining the best course of action to
achieve those objectives. - Answers :Planning
Management: Determines how work in the department would be accomplished,
preparing - Answers :Organizing
Management: Organizing - Answers :Determines How work in the department would be
accomplished, preparing
- Identify roles and responsibilities for the staff
- Assign duties to staff
- Assign levels of supervision
- Coordinate activities and teams to achieve departmental goals
- Organize the people and material resources to design a formal structure of activities
and authority
Management: Coordinate activities and teams to achieve departmental goals - Answers
:Organizing
Management: Identify roles and responsibilities for the staff - Answers :Organizing
Management: Assign levels of supervision - Answers :Organizing
Management: Staffing - Answers :Determines numbers, training and experience levels
of employees
, - Assess, appoint, evaluate and develop employees
- Work with HR for hiring of staff and performance appraisals
- Process of acquiring, training, motivating, developing and apprising employees
Management: Determines numbers, training and experience levels of employees -
Answers :Staffing
Management: Assess, appoint, evaluate and develop employees - Answers :Staffing
Management: Process of acquiring, training, motivating, developing and apprising
employees - Answers :Staffing
Management: Influencing - Answers :Including motivation, coaching and problem
solving
- Knows and understand their staff
- Influence through supervision, guidance and motivation
- Find out what they want and give it to them
- Influence by supervising, guiding and motivating employees
Management: Knows and understand their staff - Answers :Influencing
Management: Influence through supervision, guidance and motivation - Answers
:Influencing
Management: Find out what your employees want and give it to them - Answers
:Influencing
Management: Controlling - Answers :Ensures that events proceed as planned and
objectives are achieved
- Monitor goals and take action to ensure goals and objectives are met
- Control budgets and inventory
- Perform file audits
- Ensure compliance with accreditation standards and regulatory requirements
- Budgets, cost controls, business plans and resource management are included in this
function.
Management: Monitor goals and take action to ensure goals and objectives are met -
Answers :Controlling
Management: Control budgets and inventory - Answers :Controlling
Management: Perform file audits - Answers :Controlling
Medicare requires providers to perform what process every 3-5 years? - Answers
:Revalidation
According to DNV standards, initial appointments to the medical staff are not to exceed
what time period? - Answers :36 months / 3 years
T/F: The Joint Commission standards require that the applicant's participation in
continuing education is evaluated and considered on initial appointment to the medical
staff. - Answers :False.
Participating in continuing education must be considered in decisions about
reappointment to membership on the medical staff or renewal or revision of individual
clinical privileges. The standards do not require this to be evaluated on initial
appointment.
According to NCQA standards, on initial application, review of information on sanctions,
restrictions on licensure and limitations on scope of practice must cover what period of
time? - Answers :The most recent five-year period
What are the two elements of Due Process? - Answers :Substantive and Procedural
According to the HCQIA, at what times must the hospital query the National Practitioner
Data Bank for a physician, dentist or other health care practitioner? - Answers :- Initial
appointment
- Reappointment (renewal)
- Request for new privileges
and every 2 years thereafter
What medical staff committee(s) is/are required by Joint Commission hospital standards
for the medical staff? - Answers :Medical Executive Committee
Under Robert's Rules of Order, when more than one motion is proposed, which motion
takes precedence? - Answers :the most recent motion takes precedence over the ones
T/F: Voluntary surrender or restriction of clinical privileges for 14 days is reportable to
the NPDB - Answers :False
Reportable on the 15th day
Which specialty is most likely to be granted privileges for surgical management of
congenital septal and valvular defects? - Answers :Cardiovascular or cardiothoracic
surgeon
,URAC standards require the organization to provide a written notification to providers
within how many days of the credentialing determination? - Answers :10 business days
(Note: NCQA requires within 60 calendar days)
NCQA standards require the organization to have written policies and procedures that
delineate certain practitioner rights and to communicate these rights to the practitioner.
Name the 3 rights that must be provided to applicants. - Answers :• Right to correct
erroneous information
• Right to receive the status of their credentialing or recredentialing application upon
request
• Right to review information submitted to support their application
What is the purpose of the MAC? - Answers :A MAC (or Medicare Administrative
Contractor) provides regional services on behalf of Medicare, including processing
claims, enrolling providers and other activities.
T/F: HFAP standards allow a hospital to accept the credentialing and privileging
decision of another organization (credentialing/privileging by proxy) for teleradiology
services - Answers :True
The case of Darling v. Charleston Memorial Community Hospital was significant in that
it set aside a long standing doctrine that was applied to hospitals. What is that doctrine?
- Answers :Charitable Immunity Doctrine
CMS Conditions of Participation for Hospitals require that criteria for selection to the
medical staff include evaluation of five areas. One of these is competence. Name the 4
remaining areas. - Answers :Character, judgment, experience and training
(Note: remember by using acronym CCJET)
NCQA requires which three factors prior to provisionally credentialing a provider? -
Answers :• PSV of a current, valid license to practice
• PSV of past 5 years of malpractice claims or settlements from the malpractice carrier,
or the results of the NPDB query
• A current and signed application with attestation
Cannot exceed 60 calendar days, at which time the full credentialing process must be
completed
AAAHC requires a provider to be recredentialed every three years except under what
circumstance? - Answers :- Every 3 years unless state law requires more frequently or
- if the organization cannot recredential a practitioner within the 36 month time frame
because the practitioner is on active military leave, maternity leave, or sabbatical.
According to HCQIA, a hospital that fails to report adverse actions may lose its immunity
up to what period of time? - Answers :3 years
,What is the federal law that was enacted for the purpose of encouraging good faith
professional review activities? - Answers :Healthcare Quality Improvement Act of 1986
Management - Answers :The process of accomplishing the goals of an organization
through the effective use of people and other resources.
Management: Planning - Answers :Determines in advance what should be done
- Determine department objectives
Set goals
- Formulate policies and procedures, programs, rules and regs
- Develop budgets and annual meeting calendars
- Schedule review and updates of governance documents
- Anticipating the future and determining the best course of action to achieve those
objectives.
Management: Determine department objectives - Answers :Planning
Management: Develop budgets and annual meeting calendars - Answers :Planning
Management: Anticipating the future and determining the best course of action to
achieve those objectives. - Answers :Planning
Management: Determines how work in the department would be accomplished,
preparing - Answers :Organizing
Management: Organizing - Answers :Determines How work in the department would be
accomplished, preparing
- Identify roles and responsibilities for the staff
- Assign duties to staff
- Assign levels of supervision
- Coordinate activities and teams to achieve departmental goals
- Organize the people and material resources to design a formal structure of activities
and authority
Management: Coordinate activities and teams to achieve departmental goals - Answers
:Organizing
Management: Identify roles and responsibilities for the staff - Answers :Organizing
Management: Assign levels of supervision - Answers :Organizing
Management: Staffing - Answers :Determines numbers, training and experience levels
of employees
, - Assess, appoint, evaluate and develop employees
- Work with HR for hiring of staff and performance appraisals
- Process of acquiring, training, motivating, developing and apprising employees
Management: Determines numbers, training and experience levels of employees -
Answers :Staffing
Management: Assess, appoint, evaluate and develop employees - Answers :Staffing
Management: Process of acquiring, training, motivating, developing and apprising
employees - Answers :Staffing
Management: Influencing - Answers :Including motivation, coaching and problem
solving
- Knows and understand their staff
- Influence through supervision, guidance and motivation
- Find out what they want and give it to them
- Influence by supervising, guiding and motivating employees
Management: Knows and understand their staff - Answers :Influencing
Management: Influence through supervision, guidance and motivation - Answers
:Influencing
Management: Find out what your employees want and give it to them - Answers
:Influencing
Management: Controlling - Answers :Ensures that events proceed as planned and
objectives are achieved
- Monitor goals and take action to ensure goals and objectives are met
- Control budgets and inventory
- Perform file audits
- Ensure compliance with accreditation standards and regulatory requirements
- Budgets, cost controls, business plans and resource management are included in this
function.
Management: Monitor goals and take action to ensure goals and objectives are met -
Answers :Controlling
Management: Control budgets and inventory - Answers :Controlling
Management: Perform file audits - Answers :Controlling
