Cpmsm Practice Test Part I Of II

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Michelle

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1/50 Questions

Why it is important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs?
- A facility could lose its accreditation if it does not do so.
- It is required by Medicare Conditions of Participation.
- The facility won't get paid for treating patients unless service is provided by authorized provider.
- It would violate state licensure regulations.

About This Quiz

The CPMSM Practice Test Part I of II assesses knowledge on medical credentialing, including the importance of verifying practitioner eligibility for federal programs, ongoing licensure tracking, and criteria for clinical privileging. It ensures understanding of standards affecting patient safety and healthcare quality.

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2.

Which of the following credentials must be tracked on an ongoing basis?
- Medical school completion
- Post graduate education completed
- Closed medical malpractice claims
- Licensure
Correct Answer

A. Licensure

Explanation

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.

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2
3.

According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action?
- Determine it there is evidence of poor quality that could affect the health and safety of its members.
- Immediately take action to remove the provider from its panel
- Initiate Ongoing Professional Practice Evaluation.
- Notify the practitioner that he/she is under investigation and initiate the hearing process.
Correct Answer

A. Determine it there is evidence of poor quality that could affect the health and safety of its members.

Explanation

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.

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1
4.

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 and adverse action history?
- Emergency Medical Treatment and Active Labor Act
- The National Practitioner Data Bank
- The Patient Safety and Quality Improvement Act
- Sherman Anti-trust Act
Correct Answer

A. The National Practitioner Data Bank

Explanation

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.

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1
5.

When developing clinical privileging criteria, which of the following is important to evaluate?
- How many providers are in the specialty.
- Established standards of practice such as, specialty board recommendations.
- Whether or not the quality department can support the FPPE process.
- The average cost to the patient.
Correct Answer

A. Established standards of practice such as, specialty board recommendations.

Explanation

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.

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6.

What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty?
- It's required by accreditation standards.
- It is required by the Medicare Conditions of Participation
- To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care.
- It's required by bylaws.
Correct Answer

A. To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care.

Explanation

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.

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7.

Which of the following specialists is most likely to perform a PTCA?
- General Surgeon
- OB/GYN
- Urologist
- Interventional Cardiologist
Correct Answer

A. Interventional Cardiologist

Explanation

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.

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1
8.

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.
- Based on board certification
- Based on the privileges the individual is currently approved to perform at other hospitals
- Posted in a place that is accessible to all hospital employees
Correct Answer

A. Based on the individual's demonstrated current competence and the procedures the hospital can support.

Explanation

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.

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9.

Which of the following would be routinely performed by a cardiologist?
- Hysterectomy
- Transesophageal Echocardiography
- Urethral Dilation
- Renal dialysis
Correct Answer

A. Transesophageal Echocardiography

Explanation

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.

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2
10.

Which NCQA-required committee makes recommendations regarding credentialing decisions?
- Medical Executive Committee
- Quality Care Committee
- Credentialing Committee
- Patient Care Committee
Correct Answer

A. Credentialing Committee

Explanation

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.

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11.

HFAP standards require three medical staff committee to be delineated in the medical staff structure. Two of them are the Medical Executive Committee and the Utilization of Osteopathic Methods & Concepts Committee ( required for hospitals with ten or more DO's who admit patients and provide direct patient care). What is the other required medical staff committee?
- Credentials Committee
- Investigational Review Board
- Utilization Review Committee
- Medical Records Committee
Correct Answer

A. Utilization Review Committee

Explanation

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.

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12.

If you need to find out about what the Federal Government requires in regards to anti-trust issues, what law would you consult?
- Healthcare Quality Improvement Act
- Patient Safety and Quality Improvement Act
- Medicare Conditions of Participation
- Sherman Anti-trust Act
Correct Answer

A. Sherman Anti-trust Act

Explanation

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.

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2
13.

Peer references should be obtained from:
- Practitioners who have referred patients to the provider
- Family, friends and neighbors
- Former hospital administrators
- Practitioners in the same professional discipline as the applicant
Correct Answer

A. Practitioners in the same professional discipline as the applicant

Explanation

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.

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14.

Patrick v. Burgett is an important case because it:
- Showed that a hospital can assert that peer review is performed at the state's request
- Illustrates that the governing body is the ultimate authority
- Set aside the charitable immunity doctrine and held that the hospital was liable for negligent treatment of the patient
- Illustrates the potential for antitrust liability arising out of the peer review activities
Correct Answer

A. Illustrates the potential for antitrust liability arising out of the peer review activities

Explanation

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.

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2
15.

If a medical staff member has privileges and/or medical staff appointment revoked he/she must be:
- Granted temporary privileges
- Provided due process
- Reported immediately to the national practitioner data bank
- Offered a leave of absence from the medical staff
Correct Answer

A. Provided due process

Explanation

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.

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16.

Access to the credentials files should be:
- Available to all members of the organization's staff
- Described fully in an access policy
- Available to the organization's patients and potential patients
- Available to any physician on the staff
Correct Answer

A. Described fully in an access policy

Explanation

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.

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1
17.

Which of the following bodies approves clinical privileges?
- Credentials Committee
- Peer Review Committee
- Medical Executive Committee
- Governing Body or Board
Correct Answer

A. Governing Body or Board

Explanation

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.

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18.

What primary source verification is required by NCQA prior to provisional credentialing?
- Current competence
- Licensure and 5 year malpractice history of NPDB
- Education and Training
- Ability to perform privileges requested
Correct Answer

A. Licensure and 5 year malpractice history of NPDB

Explanation

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.

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1
19.

According to The Joint Commission standards, initial appointments to the medical staff are made for a period of:
- One year
- Two years
- Three years
- Not to exceed two years
Correct Answer

A. Three years

Explanation

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.

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0
20.

According to The Joint Commission standards, temporary privileges may be granted by:
- The department chair
- The CEO
- The CEO on the recommendation of the medical staff president or authorized designee
- The department chair and the president of the medical staff
Correct Answer

A. The CEO on the recommendation of the medical staff president or authorized designee

Explanation

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.

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21.

According to The Joint Commission standards, which of the following items must be verified with a primary source?
- Medicare/Medicaid Sanctions
- Proof of professional liability insurance
- Licensure, training, experience, and competence
- Date of the last hepatitis test
Correct Answer

A. Licensure, training, experience, and competence

Explanation

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.

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22.

According to NCQA standards, a copy of which of the following is acceptable verification of the document?
- DEA certificate
- Licensure
- Board certification
- Medical school diploma
Correct Answer

A. DEA certificate

Explanation

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.

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1
23.

According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians?
- Federation of State Medical Boards
- American Board of Medical Specialties
- Education Commission on Foreign Medical Graduates Profile
- Letter from the State licensing agency
Correct Answer

A. Federation of State Medical Boards

Explanation

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.

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1
24.

According to The Joint Commission standards, which of the following is considered a designated equivalent source for verification of board certification?
- The American Board of Medical Specialties
- Education Commission on Foreign Medical Graduates Profile
- Federation of State Medical Boards
- Viewing of the original certificate issued by the certifying board
Correct Answer

A. The American Board of Medical Specialties

Explanation

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

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25.

Which of the following organizations have been recognized by The Joint Commission and NCQA to provide primary source verification of medical school graduation and residency training for U.S. graduates?
- American Medical Association Masterfile
- National Practitioner Data Bank
- Federation of State Medical Boards
- Education Commission on Foreign Medical Graduates Profile
Correct Answer

A. American Medical Association Masterfile

Explanation

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.

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26.

According to NCQA standards, the application attestation statement must affirm that the application
- Is correct and complete
- Was actually completed by the provider
- Was signed in the presence of a notary public
- Releases all parties from liability provided truthful statements are made regarding the applicant
Correct Answer

A. Is correct and complete

Explanation

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.

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27.

According to The Joint Commission standards, medical staff bylaws should define
- The structure of the medical staff
- Mechanism for appointment/reappointment of physician employed non-independent practitioners
- A requirement that departments meet on at least a quarterly basis
- The mechanism for emergency department call schedule
Correct Answer

A. The structure of the medical staff

Explanation

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.

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28.

According to The Joint Commission hospital standards, professional criteria for the granting of clinical privileges must include at least
- Relevant training or experience, ability to perform privileges requested, current licensure, and competence
- Verification of all current and prior malpractice suite filed and settlements made
- Letters of reference from the Chief Executive Officer of all current and prior hospital affiliations
- Participation in all managed care plans for which the hospital holds contracts
Correct Answer

A. Relevant training or experience, ability to perform privileges requested, current licensure, and competence

Explanation

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.

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29.

The Joint Commission hospital standards require medical staff bylaws to include
- A mechanism for selection and removal of officers
- A requirement that all quality of care information be reviewed by the medical staff president
- A mechanism for removal of the hospital's chief executive officer
- A statement that the medical staff members must attend at least 25% of medical staff meetings held
Correct Answer

A. A mechanism for selection and removal of officers

Explanation

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.

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3
30.

According to NCQA standards, which of the following is an approved source for verification of board certification?
- National Practitioner Data Bank
- State licensing agency if state agency conducts primary verification of board status
- Viewing of the original board certificate
- Health Care Integrity Protection Data Bank
Correct Answer

A. State licensing agency if state agency conducts primary verification of board status

Explanation

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.

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31.

According to The Joint Commission hospital standards, which of the following is a required component of the reappointment process?
- Documentation of the applicant's health status
- Verification of residency training
- Medicare/Medicaid sanctions query
- Primary source verification of malpractice suits
Correct Answer

A. Documentation of the applicant's health status

Explanation

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.

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32.

According to URAC's health network standards, each applicant within the scope or the credentialing program submits an application that includes at least which of the following:
- State licensure information, including current license(s) and history of licensure in all jurisdictions
- A listing of all current and past hospital affiliations
- A NPDB self-query
- Copies of all current licensure
Correct Answer

A. State licensure information, including current license(s) and history of licensure in all jurisdictions

Explanation

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.

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33.

According to AAAHC, which must be monitored on an ongoing basis?
- Current licensure
- Medical malpractice liability coverage
- Health status
- Hospital and other healthcare facility affiliation
Correct Answer

A. Current licensure

Explanation

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.

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34.

According to the Joint Commission, a nurse practitioner functioning independently and providing a medical level of care must:
- Have a job description
- Be granted delineated clinical privileges
- Be directly supervised by an active physician staff member
- Participate in medical staff quality assessment activities
Correct Answer

A. Be granted delineated clinical privileges

Explanation

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.

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35.

According to The Joint Commission, which of the following is an acceptable source for verification for medical education of an international graduate?
- Board certification
- Federation of State Medical Boards
- Education Commission of Foreign Medical Graduates
- National Practitioner Data Bank
Correct Answer

A. Education Commission of Foreign Medical Graduates

Explanation

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.

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36.

When evaluating compliance with the required time-frame for recredentialing, NCQA counts the recredentialing period to the:
- Day
- Week
- Month
- Year
Correct Answer

A. Month

Explanation

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.

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37.

NCQA standards require the organization to verify board certification at recredentialing:
- If a practitioner has received Medicare/Medicaid sanctions
- If a practitioner is requesting a change in status
- In all cases
- If a practitioner has acquired additional board certification since last credentialed
Correct Answer

A. In all cases

Explanation

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.

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38.

To whom does AAAHC give the responsibility for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management?
- Medical Staff
- Credentials committee
- Governing body
- Medical director
Correct Answer

A. Governing body

Explanation

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.

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39.

In order for a healthcare facility to participate in the Medicare and Medicaid programs it must comply with the
- Medicare Conditions of Participation
- The Joint Commission of Accreditation of Healthcare Organizations standards
- National Committee for Quality Assurance (NCQA) standards
- American Accreditation HealthCare Commission/Utilization Review Accreditation Commission (AAHC/URAC) standards
Correct Answer

A. Medicare Conditions of Participation

Explanation

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.

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40.

According to The Joint Commssion hospital standards,which of the following is an element of a self-governing medical staff?
- The medical staff determines the mechanim for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges.
- There can be any number of organized medical staffs as long as they are approved by the governing body.
- The hospital's board of directors determines the criteria for granting medical staff privilelges.
- The medical staff is self-governing, and as such, its organization does not have to be approved by the governing body.
Correct Answer

A. The medical staff determines the mechanim for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges.

Explanation

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.

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41.

Robert's Rule of order is an example of
- Executive privilege
- Parliamentary procedure
- A code of conduct
- Bylaws
Correct Answer

A. Parliamentary procedure

Explanation

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."

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42.

The medical staff application should provide a chronological history of
- The applicant's education, training, and work history
- CME acivities and completion of residency
- Marriages since medical school
- Leadership positions held
Correct Answer

A. The applicant's education, training, and work history

Explanation

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.

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43.

In order to participate in a managed care plan, a provider must be accepted to the plan's
- Provider panel
- Medical staff
- Medical team
- Point of service plan
Correct Answer

A. Provider panel

Explanation

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.

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44.

In order for a physician to practice medicine in any state in the United States, he/she must posess
- Malpractice insurance with limits of $1 million per occurrence and $3 million annual aggregate
- Appropriate board certification
- Membership on the provier panel of the majority of the state's major managed care plans
- Current state licensure
Correct Answer

A. Current state licensure

Explanation

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.

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45.

Which of the following is considered post-graduate education?
- Medical School
- College
- Board Cerification
- Residency training
Correct Answer

A. Residency training

Explanation

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.

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2
46.

Which of the following elements may not be used to evaluate credentials of applicants
- Gender
- Licensure
- Post-graduate training
- Board certifiation
Correct Answer

A. Gender

Explanation

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.

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47.

The release of liability statement signed by the applicant for medical staff appointment should include:
- The name of te department chairman for all past hospital appointments
- A statement providing immunity to those who respond in good faith to request for information
- A statement of the correctness of the information provided
- Primary source verification
Correct Answer

A. A statement providing immunity to those who respond in good faith to request for information

Explanation

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.

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1
48.

Primary source verification is:
- Receiving information directly from the issuing source
- Required by the health care quality improvement act
- Considered economic credentialing
- Delegated crdentialiing
Correct Answer

A. Receiving information directly from the issuing source

Explanation

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.

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49.

Unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice are example of:
- Red flags
- Medicare sanctions
- Events reportable to the National Practitioner Data Bank
- Professional liability actions
Correct Answer

A. Red flags

Explanation

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.

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Quiz Edited by
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Mar 04, 2015

Quiz Created by
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Cpmsm Practice Test Part I Of II

Why it is important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs?

Quiz Preview

Which of the following credentials must be tracked on an ongoing basis?

According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action?

When developing clinical privileging criteria, which of the following is important to evaluate?

What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty?

Which of the following specialists is most likely to perform a PTCA?

The Joint Commission hospital standards require that clinical privileges are hospital-specific and

Which of the following would be routinely performed by a cardiologist?

Which NCQA-required committee makes recommendations regarding credentialing decisions?

If you need to find out about what the Federal Government requires in regards to anti-trust issues, what law would you consult?

Peer references should be obtained from:

Patrick v. Burgett is an important case because it:

If a medical staff member has privileges and/or medical staff appointment revoked he/she must be:

Access to the credentials files should be:

Which of the following bodies approves clinical privileges?

What primary source verification is required by NCQA prior to provisional credentialing?

According to The Joint Commission standards, initial appointments to the medical staff are made for a period of:

According to The Joint Commission standards, temporary privileges may be granted by:

According to The Joint Commission standards, which of the following items must be verified with a primary source?

According to NCQA standards, a copy of which of the following is acceptable verification of the document?

According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians?

According to The Joint Commission standards, which of the following is considered a designated equivalent source for verification of board certification?

Which of the following organizations have been recognized by The Joint Commission and NCQA to provide primary source verification of medical school graduation and residency training for U.S. graduates?

According to NCQA standards, the application attestation statement must affirm that the application

According to The Joint Commission standards, medical staff bylaws should define

According to The Joint Commission hospital standards, professional criteria for the granting of clinical privileges must include at least

The Joint Commission hospital standards require medical staff bylaws to include

According to NCQA standards, which of the following is an approved source for verification of board certification?

According to The Joint Commission hospital standards, which of the following is a required component of the reappointment process?

According to URAC's health network standards, each applicant within the scope or the credentialing program submits an application that includes at least which of the following:

According to AAAHC, which must be monitored on an ongoing basis?

According to the Joint Commission, a nurse practitioner functioning independently and providing a medical level of care must:

According to The Joint Commission, which of the following is an acceptable source for verification for medical education of an international graduate?

When evaluating compliance with the required time-frame for recredentialing, NCQA counts the recredentialing period to the:

NCQA standards require the organization to verify board certification at recredentialing:

To whom does AAAHC give the responsibility for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management?

In order for a healthcare facility to participate in the Medicare and Medicaid programs it must comply with the

According to The Joint Commssion hospital standards,which of the following is an element of a self-governing medical staff?

Robert's Rule of order is an example of

The medical staff application should provide a chronological history of

In order to participate in a managed care plan, a provider must be accepted to the plan's

In order for a physician to practice medicine in any state in the United States, he/she must posess

Which of the following is considered post-graduate education?

Which of the following elements may not be used to evaluate credentials of applicants

The release of liability statement signed by the applicant for medical staff appointment should include:

Primary source verification is:

Unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice are example of: