CPMSM Preparation EXAM 2025
QUESTIONS AND 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? - ANS The facility will
not get paid for treating patients unless the service is provided by an authorized provider.
Which of the following credentials must be tracked on an ongoing basis? - ANS Licensure
According to NCQA standards, an organization that discovers sanction information, complaints,
or adverse events regarding a practitioner must take what action? - ANS 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? - ANS The Nation Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to evaluate? -
ANS Established standards of practice such as specialty board recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges for each
specialty? - ANS To protect patient safety by ensuring current competency, relevance to the
facility, and accepted standards of care.
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, Which of the following specialists is most likely to perform a PTCA? - ANS Interventional
Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital specific and
- ANS 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? -
ANS Transesophageal Echocardiography
Which NCQA required committee makes recommendations regarding credentialing decisions? -
ANS Credentialing Committee
HFAP standards require three medical staff committees to be delineated in the medical staff
structure; what are they? - ANS 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? - ANS The Sherman Anti-trust Act
Peer references should be obtained from: - ANS Practitioners in the same professional
discipline as the applicant.
Patrick v. Burgett is an important case because it: - ANS 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: - ANS Provided due process
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Access to credentials files should be: - ANS Described fully in an access policy
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, Which of the following bodies approves clinical privileges? - ANS The Governing body / Board
Which primary source verification is required by NCQA prior to provisional credentialing? -
ANS 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: -
ANS Not to exceed two years
According to TJC, temporary privileges may be granted by: - ANS 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? -
ANS Licensure, training, experience and competence
According to NCQA standards, a copy of which is an acceptable verification of the document? -
ANS DEA certificate
According to NCQA standards, which is an acceptable source for primary source verification of
Medicare and Medicaid sanction activity against physicians? - ANS Federation State Medical
Boards
According to TJC standards, which of following is considered a designated equivalent source for
verification of board certification? - ANS 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? - ANS American Medical Association Master file
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QUESTIONS AND 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? - ANS The facility will
not get paid for treating patients unless the service is provided by an authorized provider.
Which of the following credentials must be tracked on an ongoing basis? - ANS Licensure
According to NCQA standards, an organization that discovers sanction information, complaints,
or adverse events regarding a practitioner must take what action? - ANS 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? - ANS The Nation Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to evaluate? -
ANS Established standards of practice such as specialty board recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges for each
specialty? - ANS To protect patient safety by ensuring current competency, relevance to the
facility, and accepted standards of care.
1
Page
@COPYRIGHT BRAINBARTER 2025/2026
, Which of the following specialists is most likely to perform a PTCA? - ANS Interventional
Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital specific and
- ANS 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? -
ANS Transesophageal Echocardiography
Which NCQA required committee makes recommendations regarding credentialing decisions? -
ANS Credentialing Committee
HFAP standards require three medical staff committees to be delineated in the medical staff
structure; what are they? - ANS 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? - ANS The Sherman Anti-trust Act
Peer references should be obtained from: - ANS Practitioners in the same professional
discipline as the applicant.
Patrick v. Burgett is an important case because it: - ANS 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: - ANS Provided due process
2
Access to credentials files should be: - ANS Described fully in an access policy
Page
@COPYRIGHT BRAINBARTER 2025/2026
, Which of the following bodies approves clinical privileges? - ANS The Governing body / Board
Which primary source verification is required by NCQA prior to provisional credentialing? -
ANS 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: -
ANS Not to exceed two years
According to TJC, temporary privileges may be granted by: - ANS 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? -
ANS Licensure, training, experience and competence
According to NCQA standards, a copy of which is an acceptable verification of the document? -
ANS DEA certificate
According to NCQA standards, which is an acceptable source for primary source verification of
Medicare and Medicaid sanction activity against physicians? - ANS Federation State Medical
Boards
According to TJC standards, which of following is considered a designated equivalent source for
verification of board certification? - ANS 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? - ANS American Medical Association Master file
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Page
@COPYRIGHT BRAINBARTER 2025/2026
