Cpmsm Practice Test Part I Of II

A cardiologist is a medical professional specializing in the diagnosis and treatment of heart diseases. Transesophageal Echocardiography is a routine procedure performed by cardiologists to assess the structure and function of the heart using sound waves. This procedure involves inserting a probe into the esophagus to obtain detailed images of the heart. Hysterectomy is a surgical procedure performed by gynecologists to remove the uterus, while urethral dilation is typically performed by urologists to widen the urethra. Renal dialysis, on the other hand, is a procedure performed by nephrologists to filter waste and excess fluids from the blood in patients with kidney failure.

When documenting a telephone conversation regarding primary source verification, it is important to document the name of the person and organization contacted, the date of the call, what was discussed during the conversation, and who conducted the interview. This information is crucial for maintaining accurate records and ensuring that the verification process is properly documented. The date and time of the call alone may not provide sufficient information, and documenting who answered the call and the reason for the call may not be as relevant as the other details mentioned in the correct answer.

The correct answer is relevant training or experience, ability to perform privileges requested, current licensure, and competence. According to The Joint Commission hospital standards, these are the professional criteria that must be considered when granting clinical privileges. Verification of malpractice suits and settlements, letters of reference from the CEO, and participation in managed care plans are not mentioned as requirements for granting clinical privileges.

Licensure must be tracked on an ongoing basis because it is a formal permission or approval granted by a government authority that allows an individual to practice a certain profession, in this case, medicine. It ensures that the individual meets the necessary qualifications and standards to provide medical services. Tracking licensure is important to ensure that healthcare professionals are operating legally and maintaining their credentials. It also helps to monitor any changes or updates in licensure requirements or status, ensuring that healthcare providers are up to date and compliant with regulations.

The medical staff application should provide a chronological history of the applicant's education, training, and work history. This is important because it allows the medical institution to assess the applicant's qualifications, experience, and expertise in the field. By reviewing the applicant's education, training, and work history in a chronological order, the institution can evaluate the applicant's progression and development over time, as well as their relevant experiences and achievements. This information helps in determining the applicant's suitability for the position and their ability to contribute effectively to the medical staff.

Gender may not be used to evaluate credentials of applicants because it is a form of discrimination and goes against the principles of equal opportunity and fairness. Evaluating applicants based on their gender would be considered biased and unethical. Instead, credentials should be evaluated based on factors such as licensure, post-graduate training, and board certification, which are objective measures of an applicant's qualifications and expertise.

Peer references should be obtained from practitioners in the same professional discipline as the applicant because they can provide valuable insights into the applicant's skills, knowledge, and abilities in their specific field. These practitioners are likely to have a good understanding of the standards and expectations within the profession and can provide a credible assessment of the applicant's qualifications. Additionally, they may have worked closely with the applicant and can provide specific examples of their work ethic, professionalism, and interpersonal skills.

Primary source verification is the process of obtaining information directly from the issuing source, such as an educational institution or a licensing board. This ensures the accuracy and authenticity of the information provided. It is an important step in credentialing and verifying the qualifications and credentials of healthcare professionals. It is not related to the health care quality improvement act or economic credentialing. Delegated credentialing refers to the process of authorizing a third party to perform credentialing activities on behalf of a healthcare organization.

Red flags refer to warning signs or indicators of potential issues or problems. In the context of the given question, unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice can be considered red flags. These factors may raise concerns about the competence or credibility of a medical professional and warrant further investigation or scrutiny.

Periodically assessing appropriateness of clinical privileges for each specialty is important to protect patient safety. This ensures that healthcare professionals have the current competency, knowledge, and skills required to provide quality care. It also ensures that their practices are relevant to the facility and aligned with accepted standards of care. By regularly evaluating clinical privileges, healthcare organizations can identify any gaps or deficiencies in the healthcare professionals' abilities and take necessary actions to maintain patient safety. This practice is not only important for patient well-being but also aligns with the goal of providing high-quality healthcare services.

In order for a physician to practice medicine in any state in the United States, they must have a current state licensure. This means that they have met the requirements set by the state's medical board to legally practice medicine in that particular state. Having a state licensure ensures that the physician has completed the necessary education, training, and examinations required to provide medical care to patients within that state. It also serves as a way to regulate and monitor the quality of healthcare provided by physicians in that state.

The correct answer is "Described fully in an access policy." It is important to have a clear and comprehensive access policy that outlines who has access to the credentials files and under what circumstances. This ensures that access is granted only to authorized individuals and helps maintain the security and confidentiality of the organization's sensitive information.

The correct answer is based on the individual's demonstrated current competence and the procedures the hospital can support. The Joint Commission hospital standards require that clinical privileges are specific to the hospital and should be granted based on the individual's competency and the hospital's ability to support the procedures. This means that the hospital should assess the individual's skills and knowledge to ensure they are competent to perform the specific procedures, and also consider whether the hospital has the necessary resources and infrastructure to support those procedures.

The Education Commission of Foreign Medical Graduates is an acceptable source for verification of medical education for international graduates, according to The Joint Commission. This organization is responsible for evaluating the qualifications of international medical graduates and ensuring their readiness to enter U.S. graduate medical education programs. They assess the educational credentials of these graduates and provide certification, which is recognized by medical licensing authorities and healthcare organizations in the United States.

According to The Joint Commission standards, licensure, training, experience, and competence must be verified with a primary source. This means that the organization or individual must directly contact the relevant licensing board or organization to confirm the individual's qualifications and credentials. This is important to ensure that healthcare professionals have the necessary qualifications and skills to provide safe and effective care to patients. Verification of licensure, training, experience, and competence helps to maintain quality standards and ensure patient safety.

The correct answer is Medicare Conditions of Participation. In order for a healthcare facility to participate in the Medicare and Medicaid programs, it must comply with the Medicare Conditions of Participation. These conditions outline the requirements that healthcare providers must meet in order to receive reimbursement from Medicare and Medicaid. Compliance with these conditions ensures that the facility is providing safe and quality care to its patients. The other options listed, such as the standards set by The Joint Commission, NCQA, and AAHC/URAC, may also be important for accreditation and quality improvement, but they are not specific requirements for participation in Medicare and Medicaid.

When developing clinical privileging criteria, it is important to evaluate established standards of practice such as specialty board recommendations. These recommendations are based on the expertise and knowledge of professionals in the field and provide a benchmark for evaluating the competency and qualifications of healthcare providers. By considering these standards, healthcare organizations can ensure that their privileging criteria align with best practices and promote high-quality care. Evaluating the number of providers in the specialty, whether the quality department can support the FPPE process, and the average cost to the patient may be relevant factors to consider in other contexts, but they are not directly related to evaluating clinical privileging criteria.

An interventional cardiologist is most likely to perform a PTCA (percutaneous transluminal coronary angioplasty). This procedure is used to open blocked or narrowed coronary arteries, typically caused by coronary artery disease. As a specialist in cardiology, an interventional cardiologist has the expertise and training to perform PTCA, which involves inserting a balloon-tipped catheter into the blocked artery and inflating it to widen the artery and improve blood flow to the heart. General surgeons, OB/GYNs, and urologists are not typically trained in this specific procedure and would not be the most likely specialists to perform it.

Current licensure must be monitored on an ongoing basis according to AAAHC. This means that healthcare organizations need to regularly review and ensure that all their healthcare professionals have the necessary and up-to-date licenses to practice. This is important to maintain the quality and safety of patient care, as it ensures that healthcare providers are legally qualified and competent to perform their duties. Monitoring current licensure also helps organizations comply with regulatory requirements and mitigate any potential legal and liability issues.

The correct answer is A mechanism for selection and removal of officers. The Joint Commission hospital standards require medical staff bylaws to include a mechanism for selecting and removing officers. This ensures that there is a transparent and fair process in place for choosing individuals to hold leadership positions within the medical staff. It also allows for the removal of officers if they are not fulfilling their responsibilities or if there is a need for a change in leadership. Including this mechanism in the bylaws helps to maintain the integrity and effectiveness of the medical staff.

Residency training is considered post-graduate education because it is a specialized training program that medical school graduates undergo to become licensed physicians. It provides hands-on clinical experience in a specific medical specialty under the supervision of experienced doctors. Residency training occurs after completing medical school and is a crucial step towards becoming a fully qualified and independent physician.

The National Practitioner Data Bank 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 and adverse action history. It serves as a central repository of information regarding malpractice payments and adverse actions taken against healthcare practitioners, allowing hospitals and other healthcare organizations to access this information during the credentialing and privileging process. This helps ensure patient safety and quality of care by preventing practitioners with a history of malpractice or adverse actions from moving to new states without disclosure.

The correct answer is "Is correct and complete". According to NCQA standards, the application attestation statement must affirm that the application is both correct and complete. This means that the information provided in the application is accurate and all required fields have been filled out. It is important for the provider to ensure that the application is thoroughly reviewed and all necessary information is included before attesting to its accuracy and completeness.

The Sherman Anti-trust Act is the correct answer because it is a federal law that addresses anti-trust issues. It was enacted in 1890 and is designed to prevent businesses from engaging in anti-competitive practices, such as monopolies or price-fixing. It gives the federal government the authority to investigate and take action against companies that violate the law. Therefore, if you need to find out about what the Federal Government requires in regards to anti-trust issues, consulting the Sherman Anti-trust Act would be the appropriate course of action.

Robert's Rules of Order is a well-known guidebook for conducting meetings and making decisions in a fair and orderly manner. It provides a set of rules and procedures that are commonly used in parliamentary settings, such as legislative bodies or organizations with governing boards. Therefore, the correct answer is "Parliamentary procedure."

To participate in a managed care plan, a provider must be accepted to the plan's provider panel. This means that the provider has been approved and included in the network of healthcare professionals who are contracted with the managed care plan to provide services to its members. Being accepted to the provider panel allows the provider to receive reimbursement for services rendered to patients enrolled in the managed care plan.

According to URAC's health network standards, each applicant within the scope of the credentialing program is required to submit an application that includes state licensure information, including current license(s) and history of licensure in all jurisdictions. This ensures that the applicant is licensed to practice in the relevant jurisdictions and provides a comprehensive overview of their licensure history. The other options listed, such as a listing of hospital affiliations, NPDB self-query, and copies of current licensure, may also be required, but they are not explicitly mentioned as a minimum requirement in the given information.

Temporary privileges can be granted by the CEO on the recommendation of the medical staff president or authorized designee according to The Joint Commission standards. This means that the CEO has the authority to grant temporary privileges, but only after receiving a recommendation from the medical staff president or someone authorized by them. This ensures that there is a proper process in place and that decisions regarding temporary privileges are made in consultation with the medical staff leadership.

According to The Joint Commission standards, medical staff bylaws should define the structure of the medical staff. This means that the bylaws should outline the organization and hierarchy of the medical staff, including the roles and responsibilities of different members. This helps to ensure clear lines of authority and accountability within the medical staff, promoting effective and efficient functioning of the healthcare organization.

The correct answer is "In all cases." According to NCQA standards, the organization is required to verify board certification at recredentialing regardless of the practitioner's situation. This means that whether the practitioner has received Medicare/Medicaid sanctions, is requesting a change in status, or has acquired additional board certification since last credentialed, the organization must verify their board certification.

The approved source for verification of board certification according to NCQA standards is the state licensing agency, but only if the state agency conducts primary verification of board status. This means that the state licensing agency must independently verify the board certification rather than relying solely on information provided by the practitioner. The other options, such as the National Practitioner Data Bank, viewing the original board certificate, and the Health Care Integrity Protection Data Bank, are not specified as approved sources for verification of board certification according to NCQA standards.

If a medical staff member has their privileges and/or medical staff appointment revoked, they must be provided with due process. Due process ensures that the individual is given a fair and impartial hearing before any actions are taken against them. It allows the staff member to present their case, provide evidence, and defend themselves against any allegations. This ensures that the decision to revoke privileges is based on a fair evaluation of the facts and protects the rights of the staff member.

The American Board of Medical Specialties is considered a designated equivalent source for verification of board certification according to The Joint Commission standards.

The governing body or board is responsible for approving clinical privileges. This body has the authority to make decisions regarding the granting of privileges to healthcare providers. They review the credentials and qualifications of the healthcare professionals and determine whether they meet the necessary requirements to provide specific clinical services. The governing body or board ensures that only competent and qualified individuals are granted clinical privileges, thus ensuring the safety and quality of patient care.

The correct answer is that the medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges. This means that the medical staff has the authority to create guidelines and standards for monitoring and supervising practitioners who have independent privileges. This ensures that there is a system in place to ensure the quality and safety of patient care provided by these practitioners.

The American Medical Association Masterfile has been recognized by The Joint Commission and NCQA to provide primary source verification of medical school graduation and residency training for U.S. graduates.

The NCQA requires primary source verification of licensure and a 5-year malpractice history from the NPDB (National Practitioner Data Bank) prior to provisional credentialing. This means that the NCQA checks directly with the licensing board and NPDB to confirm that the healthcare provider has a valid license and to review any malpractice history over the past 5 years. This verification process ensures that the healthcare provider meets the necessary requirements and has a clean record before being granted provisional credentialing.

The Federation of State Medical Boards is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians because they maintain a comprehensive database that includes information on disciplinary actions taken against physicians by state medical boards. This database provides reliable and up-to-date information on any sanctions or restrictions placed on a physician's license, making it a trustworthy source for verifying their eligibility to participate in Medicare and Medicaid programs.

The Credentialing Committee is the NCQA-required committee that makes recommendations regarding credentialing decisions. This committee is responsible for reviewing and evaluating the qualifications and credentials of healthcare professionals to ensure they meet the necessary standards for providing quality care. They assess factors such as education, training, licensure, and experience to determine if a healthcare professional should be credentialed and granted privileges within a healthcare organization. The committee plays a crucial role in maintaining the integrity and quality of the healthcare workforce.

A DEA certificate is an acceptable verification of the document according to NCQA standards. This certificate is issued by the Drug Enforcement Administration and is required for healthcare providers to prescribe controlled substances. It serves as evidence that the provider is authorized to handle and prescribe these medications. Therefore, a copy of the DEA certificate can be considered a valid form of verification for the document in question.

According to NCQA standards, when an organization discovers sanction information, complaints, or adverse events regarding a practitioner, they must determine if there is evidence of poor quality that could affect the health and safety of its members. This means that the organization must assess the situation and evaluate whether the practitioner's actions or performance pose a risk to the well-being of the organization's members. Based on this assessment, appropriate actions can be taken to address any potential risks or concerns.

When evaluating compliance with the required time-frame for recredentialing, NCQA counts the recredentialing period in months. This means that the time-frame for recredentialing is measured and assessed on a monthly basis.

The release of liability statement signed by the applicant for medical staff appointment should include a statement providing immunity to those who respond in good faith to request for information. This is important because it protects the individuals who provide information from any legal repercussions if they provide accurate information in good faith. This encourages transparency and ensures that the information provided is truthful and reliable.

The correct answer is that the facility won't get paid for treating patients unless service is provided by an authorized provider. This is because Federal health care programs, such as Medicare, require that services be provided by practitioners who are not currently excluded, suspended, debarred, or ineligible to participate in these programs. If the facility fails to check the practitioner's status and provides services by an unauthorized provider, they will not receive payment for those services.

A nurse practitioner functioning independently and providing a medical level of care must be granted delineated clinical privileges. This means that they have been authorized by the hospital or healthcare organization to perform specific medical procedures or provide specific treatments without direct supervision. This is important to ensure that the nurse practitioner is qualified and competent to provide the level of care required. It also allows the nurse practitioner to have autonomy in their practice and provide timely and efficient care to patients.

The Joint Commission (TJC) has updated its standards regarding the initial appointment period for medical staff. Previously, initial appointments were typically made for a period of two years. However, with recent revisions, TJC has extended this initial appointment period to three years. This change reflects a recognition of the need for a more extended timeframe to evaluate medical staff members thoroughly and aligns with evolving practices and standards within the healthcare industry.

The AAAHC gives the responsibility for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management to the governing body. The governing body is typically responsible for overseeing the overall operations and decision-making of an organization or institution, including the implementation and enforcement of policies and procedures. Therefore, it is logical that they would be given the authority to approve and ensure compliance with these specific areas.

According to The Joint Commission hospital standards, the reappointment process requires the documentation of the applicant's health status. This means that when a healthcare professional is being considered for reappointment, their health status must be assessed and documented to ensure that they are physically and mentally capable of carrying out their duties effectively and safely. This is an important component of the reappointment process as it helps to safeguard patient safety and quality of care.

The correct answer is Utilization Review Committee. HFAP standards require three medical staff committees to be delineated in the medical staff structure, including the Medical Executive Committee, the Utilization of Osteopathic Methods & Concepts Committee (required for hospitals with ten or more DO's who admit patients and provide direct patient care), and the Utilization Review Committee. The Utilization Review Committee is responsible for reviewing and evaluating the utilization of medical services and resources within the hospital to ensure appropriate and efficient care is provided to patients.

The case of Patrick v. Burgett is important because it demonstrates the potential for antitrust liability that can arise from peer review activities. This means that the case highlights the possibility of legal action being taken against a hospital or medical organization if their peer review process is found to be in violation of antitrust laws. The case does not specifically show that a hospital can assert that peer review is performed at the state's request, illustrate that the governing body is the ultimate authority, or set aside the charitable immunity doctrine.