CPMSM PREPARATION QUESTIONS
WITH CORRECT SOLUTIONS
Why is it important to check that the practitioner is not currently exclude, suspended,
debarred, or ineligible to participate in Federal health care programs? - ANSWER-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? - ANSWER-
Licensure
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
ANSWER-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? -
ANSWER-The Nation Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to
evaluate? - ANSWER-Established standards of practice such as specialty board
recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges
for each specialty? - ANSWER-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? - ANSWER-
Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital
specific and - ANSWER-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? - ANSWER-
Transesophageal Echocardiography
Which NCQA required committee makes recommendations regarding credentialing
decisions? - ANSWER-Credentialing Committee
, HFAP standards require three medical staff committees to be delineated in the medical
staff structure; what are they? - ANSWER-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? - ANSWER-The Sherman Anti-trust Act
Peer references should be obtained from: - ANSWER-Practitioners in the same
professional discipline as the applicant.
Patrick v. Burgett is an important case because it: - ANSWER-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: - ANSWER-Provided due process
Access to credentials files should be: - ANSWER-Described fully in an access policy
Which of the following bodies approves clinical privileges? - ANSWER-The Governing
body / Board
Which primary source verification is required by NCQA prior to provisional
credentialing? - ANSWER-Licensure and 5 years of malpractice history or NPDB
According to TJC standards, medical staff bylaws are required to include - ANSWER-a
mechanism for selection and removal of officers
According to NCQA standards, which of the following is an approved source for
verification of board certification? - ANSWER-State licensing agency if the state
licensing agency conducts primary source verification of board status
According to TJC standards, which of the following is a required component of the
reappointment process? - ANSWER-Documentation of the applicant's health status
According to URAC's health network standards, each applicant within the scope of the
credentialing program submits an application that includes at least which of the
following: - ANSWER-State licensure information, including current licensure and history
of licensure in all jurisdictions.
According to AAAHC, which must be monitored on an on-going basis? - ANSWER-
Current licensure
According to TJC standards, a nurse practitioner functioning independently and
providing a medical level of care must: - ANSWER-be granted delineated clinical
privileges
WITH CORRECT SOLUTIONS
Why is it important to check that the practitioner is not currently exclude, suspended,
debarred, or ineligible to participate in Federal health care programs? - ANSWER-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? - ANSWER-
Licensure
According to NCQA standards, an organization that discovers sanction information,
complaints, or adverse events regarding a practitioner must take what action? -
ANSWER-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? -
ANSWER-The Nation Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to
evaluate? - ANSWER-Established standards of practice such as specialty board
recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges
for each specialty? - ANSWER-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? - ANSWER-
Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital
specific and - ANSWER-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? - ANSWER-
Transesophageal Echocardiography
Which NCQA required committee makes recommendations regarding credentialing
decisions? - ANSWER-Credentialing Committee
, HFAP standards require three medical staff committees to be delineated in the medical
staff structure; what are they? - ANSWER-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? - ANSWER-The Sherman Anti-trust Act
Peer references should be obtained from: - ANSWER-Practitioners in the same
professional discipline as the applicant.
Patrick v. Burgett is an important case because it: - ANSWER-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: - ANSWER-Provided due process
Access to credentials files should be: - ANSWER-Described fully in an access policy
Which of the following bodies approves clinical privileges? - ANSWER-The Governing
body / Board
Which primary source verification is required by NCQA prior to provisional
credentialing? - ANSWER-Licensure and 5 years of malpractice history or NPDB
According to TJC standards, medical staff bylaws are required to include - ANSWER-a
mechanism for selection and removal of officers
According to NCQA standards, which of the following is an approved source for
verification of board certification? - ANSWER-State licensing agency if the state
licensing agency conducts primary source verification of board status
According to TJC standards, which of the following is a required component of the
reappointment process? - ANSWER-Documentation of the applicant's health status
According to URAC's health network standards, each applicant within the scope of the
credentialing program submits an application that includes at least which of the
following: - ANSWER-State licensure information, including current licensure and history
of licensure in all jurisdictions.
According to AAAHC, which must be monitored on an on-going basis? - ANSWER-
Current licensure
According to TJC standards, a nurse practitioner functioning independently and
providing a medical level of care must: - ANSWER-be granted delineated clinical
privileges
