CPMSM Study Questions

CPMSM Study Questions Why is it important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs? - The facility will not get paid for treating patients unless service is provided by an authorized provider Which of the following credentials must be tracked on an ongoing basis? - Licensure According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action? - 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 through 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 an adverse action history? - National Practitioner Data Bank When developing clinical privileging criteria, which of the following is important to evaluate? - Established standards of practice such as, specialty board recommendations What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty? - To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care Which of the following specialists is most likely to perform a PTCA? - Interventional Cardiologist The Joint Commission hospital standards require that clinical privileges are hospital specific and: - 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? - Transesophageal Echocardiography Which NCQA required committee makes recommendations regarding credentialing decisions? - Credentials Committee HFAP standards require three medical staff committees to be delineated in the medical staff structure. Two of them are the Medical Executive Committee and the Utilization of Osteopathic Methods and Concepts Committee (required for hospitals with 10 or more DOs who admit patients and provide direct patient care). What is the other required medical staff committee? - Utilization Review Committee If you needed to find out about what the Federal Government requires in regards to anti-trust issues, what law would you consult? - Sherman Anti-trust Act Peer references should be obtained from: - Practitioners in the same professional discipline as the applicant Patrick v. Burgett is an important case because it: - 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: - Provided due process Access to credentials files should be: - Described fully in an access policy Which of the following bodies approves clinical privileges? - Governing body of Board What primary source verification is required by NCQA prior to provisional credentialing? - Licensure and 5 year malpractice history or NPDB According to The Joint Commission standards, initial appointments to the medical staff are made for a period of: - Not to exceed two years According to The Joint Commission standards, temporary privileges may be granted by: - The CEO on recommendation of the medical staff president or authorized designee According to The Joint Commission standards, which of the following items must be verified with a primary source? - Licensure, training, experience, and competence According to NCQA standards, a copy of which of the following is acceptable verification of the document? - DEA certificate According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against