CPMSM - Study Guide Material Exam With Complete
Solutions 100% Correct
What are four models of HMOs? - ANSWER Staff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types of committees? - ANSWER Standing
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - ANSWER 5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - ANSWER 5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? -
ANSWER 3
At least three active medical staff
,How many medical staff members must serve on a Medical Records Committee? -
ANSWER 1
At least one active medical staff
How often should the Medical Records committee meet? - ANSWER At least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics
Committee? - ANSWER 5
At least five active medical staff
How frequently does the Pharmacy & Therapeutics committee need to meet? - ANSWER
At least quarterly
How many members of the medical staff are required to serve on a Utilization Review
Committee? - ANSWER 1
At least one active medical staff
How often does a Utilization Review Committee need to meet? - ANSWER Every other
month
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? -
ANSWER Credentialing
What are the three reasons for credentialing? - ANSWER Patient Safety
Risk Management
Required by agencies
, Which three accreditors have been granted "deemed status"? - ANSWER TJC, HFAP,
DNV
Which two organizations offer accreditation for managed care organizations? -
ANSWER NCQA, URAC
What is the primary accreditor for ambulatory care facilities? ANSWER AAAHC
Which of the following accreditations specifically excludes physicians who are
employees of a facility as hospitalists and who are not listed in the provider directory
from the scope of the credentialing standards? ANSWER URAC
For which of the following accreditations need the following practitioners *not* 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 - ANSWER NCQA
What are Medicare CoP's minimum criteria for appointment to the medical staff/granting
of medical staff privileges? - ANSWER CCJET
character
competence
judgement
experience
training
Solutions 100% Correct
What are four models of HMOs? - ANSWER Staff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four types of committees? - ANSWER Standing
Ad hoc
Task force
Continuous quality improvement team
How many medical staff members comprise a Bylaws Committee? - ANSWER 5
At least five active medical staff
How many medical staff members comprise a Credentials Committee? - ANSWER 5
At least five active medical staff
How many medical staff members must serve on an Infection Control Committee? -
ANSWER 3
At least three active medical staff
,How many medical staff members must serve on a Medical Records Committee? -
ANSWER 1
At least one active medical staff
How often should the Medical Records committee meet? - ANSWER At least quarterly
How many medical staff members must serve on a Pharmacy & Therapeutics
Committee? - ANSWER 5
At least five active medical staff
How frequently does the Pharmacy & Therapeutics committee need to meet? - ANSWER
At least quarterly
How many members of the medical staff are required to serve on a Utilization Review
Committee? - ANSWER 1
At least one active medical staff
How often does a Utilization Review Committee need to meet? - ANSWER Every other
month
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? -
ANSWER Credentialing
What are the three reasons for credentialing? - ANSWER Patient Safety
Risk Management
Required by agencies
, Which three accreditors have been granted "deemed status"? - ANSWER TJC, HFAP,
DNV
Which two organizations offer accreditation for managed care organizations? -
ANSWER NCQA, URAC
What is the primary accreditor for ambulatory care facilities? ANSWER AAAHC
Which of the following accreditations specifically excludes physicians who are
employees of a facility as hospitalists and who are not listed in the provider directory
from the scope of the credentialing standards? ANSWER URAC
For which of the following accreditations need the following practitioners *not* 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 - ANSWER NCQA
What are Medicare CoP's minimum criteria for appointment to the medical staff/granting
of medical staff privileges? - ANSWER CCJET
character
competence
judgement
experience
training
