CPMSM - STUDY GUIDE MATERIAL
WITH COMPLETE SOLUTIONS
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 often should the Pharmacy & Therapeutics committee meet? - ANSWER-At least
quarterly
How many medical staff members must serve on a Utilization Review Committee? -
ANSWER-1
,At least one active medical staff
How often should the Utilization Review Committee 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
Who is the main accreditor for ambulatory care facilities? - ANSWER-AAAHC
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? - ANSWER-URAC
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 - 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
CMS regulations require that medical staff bylaws include what information pertaining to
each category of the medical staff? - ANSWER-duties and privileges
, What is CIN-BAD? - ANSWER-Chiropractic Information Network - Board Action
Databank
What year was CIN-BAD started? - ANSWER-1993
What is the CSA registration database? - ANSWER-Controlled Substances Act
DEA
Who maintains a database of individuals and entities excluded from federal programs
including Medicare and Medicaid? - ANSWER-OIG
Office of the Inspector General
Who maintains the list of people and organizations excluded from doing business with
the Federal Government? - ANSWER-SAM
System for Award Management
What is the former name of SAM? - ANSWER-EPLS
Excluded parties list system
What four systems are included in SAM? - ANSWER-CCR (Central Contractor Registry)
Fedreg (Federal Agency Registration)
ORCA - Online Representations and Certifications Applicaction
EPLS - Excluded Parties List System
In the managed care setting, how many levels of training must be verified? - ANSWER-
Only the highest level (residency) or board certification
Do providers with refer and follow status have admitting privileges/ordering privileges
within the hospital? - ANSWER-No
For TJC, does "privileges" refer to duties and prerogatives of each category or the
clinical privileges to provide care? - ANSWER-Duties and prerogatives
Which accreditor requires an applicant to submit a statement that no health problems
exist which could affect his or her ability to provide care? - ANSWER-TJC
Which accreditor has *no* specific requirements for professional practice questions on
the application or reapp? - ANSWER-DNV
For Medicare deemed facilities, the delegation of credentialing agreement must include
what clause? - ANSWER-Adhere to Medicare regulations
How often must the delegate organization provide a report to Credentials for a URAC
facility? - ANSWER-Annually
WITH COMPLETE SOLUTIONS
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 often should the Pharmacy & Therapeutics committee meet? - ANSWER-At least
quarterly
How many medical staff members must serve on a Utilization Review Committee? -
ANSWER-1
,At least one active medical staff
How often should the Utilization Review Committee 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
Who is the main accreditor for ambulatory care facilities? - ANSWER-AAAHC
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? - ANSWER-URAC
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 - 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
CMS regulations require that medical staff bylaws include what information pertaining to
each category of the medical staff? - ANSWER-duties and privileges
, What is CIN-BAD? - ANSWER-Chiropractic Information Network - Board Action
Databank
What year was CIN-BAD started? - ANSWER-1993
What is the CSA registration database? - ANSWER-Controlled Substances Act
DEA
Who maintains a database of individuals and entities excluded from federal programs
including Medicare and Medicaid? - ANSWER-OIG
Office of the Inspector General
Who maintains the list of people and organizations excluded from doing business with
the Federal Government? - ANSWER-SAM
System for Award Management
What is the former name of SAM? - ANSWER-EPLS
Excluded parties list system
What four systems are included in SAM? - ANSWER-CCR (Central Contractor Registry)
Fedreg (Federal Agency Registration)
ORCA - Online Representations and Certifications Applicaction
EPLS - Excluded Parties List System
In the managed care setting, how many levels of training must be verified? - ANSWER-
Only the highest level (residency) or board certification
Do providers with refer and follow status have admitting privileges/ordering privileges
within the hospital? - ANSWER-No
For TJC, does "privileges" refer to duties and prerogatives of each category or the
clinical privileges to provide care? - ANSWER-Duties and prerogatives
Which accreditor requires an applicant to submit a statement that no health problems
exist which could affect his or her ability to provide care? - ANSWER-TJC
Which accreditor has *no* specific requirements for professional practice questions on
the application or reapp? - ANSWER-DNV
For Medicare deemed facilities, the delegation of credentialing agreement must include
what clause? - ANSWER-Adhere to Medicare regulations
How often must the delegate organization provide a report to Credentials for a URAC
facility? - ANSWER-Annually
