CPMSM - Study Guide Material
questions well answered
Staff Model
Group Model
Network Model
Independent Practice Association (IPA) - correct answer ✔✔What are four models of HMOs?
Standing
Ad hoc
Task force
Continuous quality improvement team - correct answer ✔✔What are the four types of
committees?
5
At least five active medical staff - correct answer ✔✔How many medical staff members
comprise a Bylaws Committee?
5
At least five active medical staff - correct answer ✔✔How many medical staff members
comprise a Credentials Committee?
3
,At least three active medical staff - correct answer ✔✔How many medical staff members must
serve on an Infection Control Committee?
1
At least one active medical staff - correct answer ✔✔How many medical staff members must
serve on a Medical Records Committee?
At least quarterly - correct answer ✔✔How often should the Medical Records committee meet?
5
At least five active medical staff - correct answer ✔✔How many medical staff members must
serve on a Pharmacy & Therapeutics Committee?
At least quarterly - correct answer ✔✔How often should the Pharmacy & Therapeutics
committee meet?
1
At least one active medical staff - correct answer ✔✔How many medical staff members must
serve on a Utilization Review Committee?
Every other month - correct answer ✔✔How often should the Utilization Review Committee
meet?
Credentialing - correct answer ✔✔What is the process of obtaining, verifying, and assessing the
qualifications of a health care practitioner who seeks to provide patient care services in or for a
hospital?
,Patient Safety
Risk Management
Required by agencies - correct answer ✔✔What are the three reasons for credentialing?
TJC, HFAP, DNV - correct answer ✔✔Which three accreditors have been granted "deemed
status"?
NCQA, URAC - correct answer ✔✔Which two organizations offer accreditation for managed care
organizations?
AAAHC - correct answer ✔✔Who is the main accreditor for ambulatory care facilities?
URAC - correct answer ✔✔Physicians who are employees of a facility as hospitalists and who
are not listed in the provider directory are not included in the scope of the credentialing
standards with this accreditation?
NCQA - correct answer ✔✔For which accreditation, do the following practitioners need *not*
to be credentialed including:
-exclusively in the inpatient setting caring for organization members only in the hospital setting
-practice exclusively in free-standing setting for members directed to facility
-pharmacists working for a PBM (pharmacy benefits management) organization for UM
functions
-locum tenens working less than 90 days
-rental network practitioners providing out of area care
CCJET
character
, competence
judgement
experience
training - correct answer ✔✔What are Medicare CoP's minimum criteria for appointment to the
medical staff/granting of medical staff privileges?
duties and privileges - correct answer ✔✔CMS regulations require that medical staff bylaws
include what information pertaining to each category of the medical staff?
No - correct answer ✔✔Do providers with refer and follow status have admitting
privileges/ordering privileges within the hospital?
Duties and prerogatives - correct answer ✔✔For TJC, does "privileges" refer to duties and
prerogatives of each category or the clinical privileges to provide care?
TJC - correct answer ✔✔Which accreditor requires an applicant to submit a statement that no
health problems exist which could affect his or her ability to provide care?
DNV - correct answer ✔✔Which accreditor has *no* specific requirements for professional
practice questions on the application or reapp?
Adhere to Medicare regulations - correct answer ✔✔For Medicare deemed facilities, the
delegation of credentialing agreement must include what clause?
Annually - correct answer ✔✔How often must the delegate organization provide a report to
Credentials for a URAC facility?
Continually monitoring member complaints for all practitioner sites
questions well answered
Staff Model
Group Model
Network Model
Independent Practice Association (IPA) - correct answer ✔✔What are four models of HMOs?
Standing
Ad hoc
Task force
Continuous quality improvement team - correct answer ✔✔What are the four types of
committees?
5
At least five active medical staff - correct answer ✔✔How many medical staff members
comprise a Bylaws Committee?
5
At least five active medical staff - correct answer ✔✔How many medical staff members
comprise a Credentials Committee?
3
,At least three active medical staff - correct answer ✔✔How many medical staff members must
serve on an Infection Control Committee?
1
At least one active medical staff - correct answer ✔✔How many medical staff members must
serve on a Medical Records Committee?
At least quarterly - correct answer ✔✔How often should the Medical Records committee meet?
5
At least five active medical staff - correct answer ✔✔How many medical staff members must
serve on a Pharmacy & Therapeutics Committee?
At least quarterly - correct answer ✔✔How often should the Pharmacy & Therapeutics
committee meet?
1
At least one active medical staff - correct answer ✔✔How many medical staff members must
serve on a Utilization Review Committee?
Every other month - correct answer ✔✔How often should the Utilization Review Committee
meet?
Credentialing - correct answer ✔✔What is the process of obtaining, verifying, and assessing the
qualifications of a health care practitioner who seeks to provide patient care services in or for a
hospital?
,Patient Safety
Risk Management
Required by agencies - correct answer ✔✔What are the three reasons for credentialing?
TJC, HFAP, DNV - correct answer ✔✔Which three accreditors have been granted "deemed
status"?
NCQA, URAC - correct answer ✔✔Which two organizations offer accreditation for managed care
organizations?
AAAHC - correct answer ✔✔Who is the main accreditor for ambulatory care facilities?
URAC - correct answer ✔✔Physicians who are employees of a facility as hospitalists and who
are not listed in the provider directory are not included in the scope of the credentialing
standards with this accreditation?
NCQA - correct answer ✔✔For which accreditation, do the following practitioners need *not*
to be credentialed including:
-exclusively in the inpatient setting caring for organization members only in the hospital setting
-practice exclusively in free-standing setting for members directed to facility
-pharmacists working for a PBM (pharmacy benefits management) organization for UM
functions
-locum tenens working less than 90 days
-rental network practitioners providing out of area care
CCJET
character
, competence
judgement
experience
training - correct answer ✔✔What are Medicare CoP's minimum criteria for appointment to the
medical staff/granting of medical staff privileges?
duties and privileges - correct answer ✔✔CMS regulations require that medical staff bylaws
include what information pertaining to each category of the medical staff?
No - correct answer ✔✔Do providers with refer and follow status have admitting
privileges/ordering privileges within the hospital?
Duties and prerogatives - correct answer ✔✔For TJC, does "privileges" refer to duties and
prerogatives of each category or the clinical privileges to provide care?
TJC - correct answer ✔✔Which accreditor requires an applicant to submit a statement that no
health problems exist which could affect his or her ability to provide care?
DNV - correct answer ✔✔Which accreditor has *no* specific requirements for professional
practice questions on the application or reapp?
Adhere to Medicare regulations - correct answer ✔✔For Medicare deemed facilities, the
delegation of credentialing agreement must include what clause?
Annually - correct answer ✔✔How often must the delegate organization provide a report to
Credentials for a URAC facility?
Continually monitoring member complaints for all practitioner sites
