CPMSM 2025 EXAM QUESTIONS WITH
CORRECT ANSWERS
What are the Medicare/Medicaid sanctions requirements for URAC? - Answer-Required
to be reported on application;
Verify through NPDB or issuing agency;
Verification time limit: 6 months
(Organizations required to monitor OIG reports)
What are the Medicare/Medicaid sanctions requirements for CMS Managed Care? -
Answer-Organization responsible for checking;
Prohibited from hiring, continuing to employ or contract with individuals on list;
Check OIG
What are the Medicare/Medicaid sanctions requirements for DNV? - Answer-Bylaws
address immediate and automatic suspension due to termination or revocation;
OIG exclusions verified at initial, reap, granting temp privileges
What are the Medicare/Medicaid sanctions requirements for HFAP? - Answer-Reviewed
at initial and reap;
Application requests information regarding disciplinary actions taken or pending
What are the board certification requirements for CMS Managed Care? - Answer-Must
be in specialty for which provider is being credentialed;
Accepts PSV board certification as education/training verification
What is the process for verifying education for AAAHC? - Answer-PSV upon initial
application
Per TJC, name the seven required verifications for temporary privileges. - Answer-
License;
Training;
Current competence;
Ability to perform privileges;
Complete application;
NPDB;
Additional criteria established in Bylaws
,Per NCQA, how often should organizations continue to monitor sanctions and license
limitations? - Answer-Within 30 days of reporting agency's release;
If no reporting schedule, every 6 months;
If no public record, every 12-18 months
What are the license requirements for CMS Managed Care? - Answer-Current, valid
license;
Verification within 6 months;
Organization required to monitor sanctions
Per Roberts Rules: A question regarding procedure is directed to the chair for
clarification. - Answer-Parliamentary inquiry
What is TJC guideline for malpractice history? - Answer-Evaluate unusual patterns or
excessive # of malpractice actions resulting in final judgements.
What are CMS & AAAHC standards for allied health practitioners? - Answer-Comply
with state law;
Board determines what categories are eligible.
What does AAAHC require for allied health practitioners? - Answer-Board approved
policies and procedures for oversight and evaluation.
What are AAAHC's guidelines for malpractice history? - Answer-Claims history provided
and evaluated at initial and reap.
Privileging guidelines per TJC. - Answer-The hospital must have a clearly documented
procedure for processing initial, renewal, and revision.
NPDB guidelines per CMS Managed Care. - Answer-NPDB is a source of verification
for history of malpractice claims.
Verification time limit: 6 months
How does AAAHC validate current competence? - Answer-Applicant must provide
documentation of current competence.
Per TJC, what three items must hospital bylaws include for adverse actions? - Answer-
Indications requiring actions;
Indications and process for recommending action;
Process for automatic and summary suspension
What does APIC stand for? - Answer-Association of Professionals in Infection Control
and Epidemiology
, What is a unique reason for adverse action on the managed care side? - Answer-Bad
advertising - Advertising for procedures not able to perform.
List 5 reasons for adverse action. - Answer-Denial of appointment; Reduction of
privileges; Suspension of privileges; Revocation; Change/reduction in category
What is the committee structure required by AAAHC? - Answer-Board of Directors
What committee structure does NCQA/URAC require? - Answer-Medical Director (clean
files may be approved by MD if policies outline what a clean file is & gives MD the ability
to approve)
Credentials Committee (no requirement for # on the committee)
What does ANCC stand for? - Answer-American Nurses Credentialing Center
Per URAC, what is the verification time limit for board certification? - Answer-6 months
prior to review
Per DNV & CMS, is there a requirement to assess a provider's ability to perform? -
Answer-Only for surgical privileges.
Written assessment of training, experience, health status, & performance
What should minutes include? List 3. - Answer-Topic, discussion,
conclusion/recommendation
List five essentials included in minutes. - Answer-Name of committee;
Location/date/time; Name of chair; Attendees; Report of quorum
What does A, AN mean? - Answer-Lack of, without
What does FCVS stand for? - Answer-Federal Credentials Verification Service
Per NCQA, what requirement must be met for felony convictions? - Answer-Application
must include statement regarding felony convictions
What does the prefix endo mean? - Answer-Inside
What does USMLE stand for? - Answer-United States Medical Licensing Exam
Per TJC, how long should temporary privileges last? - Answer-120 days
Which agencies appointment timeframe is not to exceed 3 years? - Answer-DNV,
NCQA, URAC, AAAHC, CMS Managed Care
CORRECT ANSWERS
What are the Medicare/Medicaid sanctions requirements for URAC? - Answer-Required
to be reported on application;
Verify through NPDB or issuing agency;
Verification time limit: 6 months
(Organizations required to monitor OIG reports)
What are the Medicare/Medicaid sanctions requirements for CMS Managed Care? -
Answer-Organization responsible for checking;
Prohibited from hiring, continuing to employ or contract with individuals on list;
Check OIG
What are the Medicare/Medicaid sanctions requirements for DNV? - Answer-Bylaws
address immediate and automatic suspension due to termination or revocation;
OIG exclusions verified at initial, reap, granting temp privileges
What are the Medicare/Medicaid sanctions requirements for HFAP? - Answer-Reviewed
at initial and reap;
Application requests information regarding disciplinary actions taken or pending
What are the board certification requirements for CMS Managed Care? - Answer-Must
be in specialty for which provider is being credentialed;
Accepts PSV board certification as education/training verification
What is the process for verifying education for AAAHC? - Answer-PSV upon initial
application
Per TJC, name the seven required verifications for temporary privileges. - Answer-
License;
Training;
Current competence;
Ability to perform privileges;
Complete application;
NPDB;
Additional criteria established in Bylaws
,Per NCQA, how often should organizations continue to monitor sanctions and license
limitations? - Answer-Within 30 days of reporting agency's release;
If no reporting schedule, every 6 months;
If no public record, every 12-18 months
What are the license requirements for CMS Managed Care? - Answer-Current, valid
license;
Verification within 6 months;
Organization required to monitor sanctions
Per Roberts Rules: A question regarding procedure is directed to the chair for
clarification. - Answer-Parliamentary inquiry
What is TJC guideline for malpractice history? - Answer-Evaluate unusual patterns or
excessive # of malpractice actions resulting in final judgements.
What are CMS & AAAHC standards for allied health practitioners? - Answer-Comply
with state law;
Board determines what categories are eligible.
What does AAAHC require for allied health practitioners? - Answer-Board approved
policies and procedures for oversight and evaluation.
What are AAAHC's guidelines for malpractice history? - Answer-Claims history provided
and evaluated at initial and reap.
Privileging guidelines per TJC. - Answer-The hospital must have a clearly documented
procedure for processing initial, renewal, and revision.
NPDB guidelines per CMS Managed Care. - Answer-NPDB is a source of verification
for history of malpractice claims.
Verification time limit: 6 months
How does AAAHC validate current competence? - Answer-Applicant must provide
documentation of current competence.
Per TJC, what three items must hospital bylaws include for adverse actions? - Answer-
Indications requiring actions;
Indications and process for recommending action;
Process for automatic and summary suspension
What does APIC stand for? - Answer-Association of Professionals in Infection Control
and Epidemiology
, What is a unique reason for adverse action on the managed care side? - Answer-Bad
advertising - Advertising for procedures not able to perform.
List 5 reasons for adverse action. - Answer-Denial of appointment; Reduction of
privileges; Suspension of privileges; Revocation; Change/reduction in category
What is the committee structure required by AAAHC? - Answer-Board of Directors
What committee structure does NCQA/URAC require? - Answer-Medical Director (clean
files may be approved by MD if policies outline what a clean file is & gives MD the ability
to approve)
Credentials Committee (no requirement for # on the committee)
What does ANCC stand for? - Answer-American Nurses Credentialing Center
Per URAC, what is the verification time limit for board certification? - Answer-6 months
prior to review
Per DNV & CMS, is there a requirement to assess a provider's ability to perform? -
Answer-Only for surgical privileges.
Written assessment of training, experience, health status, & performance
What should minutes include? List 3. - Answer-Topic, discussion,
conclusion/recommendation
List five essentials included in minutes. - Answer-Name of committee;
Location/date/time; Name of chair; Attendees; Report of quorum
What does A, AN mean? - Answer-Lack of, without
What does FCVS stand for? - Answer-Federal Credentials Verification Service
Per NCQA, what requirement must be met for felony convictions? - Answer-Application
must include statement regarding felony convictions
What does the prefix endo mean? - Answer-Inside
What does USMLE stand for? - Answer-United States Medical Licensing Exam
Per TJC, how long should temporary privileges last? - Answer-120 days
Which agencies appointment timeframe is not to exceed 3 years? - Answer-DNV,
NCQA, URAC, AAAHC, CMS Managed Care
