CPCS Quiz III

40 Questions | Total Attempts: 970

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CPCS Quiz III

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Questions and Answers
  • 1. 
    According to NCQA, how often MUST an organization conduct an audit of the credentialing process delegated to another organization?
    • A. 

      Every six months

    • B. 

      Annually

    • C. 

      Every two years

    • D. 

      Every three years

  • 2. 
    According to URAC, which of the following credentials MUST be verified using primary sources?
    • A. 

      State licensure and DEA

    • B. 

      State licensure and highest level of education

    • C. 

      Malpractice claims history and highest level of education

    • D. 

      Board certification and DEA

  • 3. 
    A chiropractor has applied for membership in a PPO. He has a previous sanction against his license. What source would the credentialing professional query to obtain additional information regarding the sanction?
    • A. 

      Federation of Chiropractic Licensing Boards

    • B. 

      Federation of State Medical Boards

    • C. 

      AMA

    • D. 

      NPDB

  • 4. 
    Which of the following is an essential source when developing a policy regarding the functions of a peer review committee?
    • A. 

      OIG

    • B. 

      CMS

    • C. 

      HEDIS

    • D. 

      HCQIA

  • 5. 
    Which of the following is recognized by NCQA as an incomplete verification?
    • A. 

      Internet verification from a website not controlled by the primary source that attests to the accuracy and timeliness of the information

    • B. 

      Verbal verification documenting the date of verification, staff member’s signature/initials, and the credentials verified

    • C. 

      Latest cumulative reports released by the organization

    • D. 

      Dated and signed written verification from the primary source

  • 6. 
    Which of the following organizations could one query to obtain a current copy of a practitioner’s DEA?
    • A. 

      AMA

    • B. 

      NTIS

    • C. 

      NPDB

    • D. 

      FSMB

  • 7. 
    According to The Joint Commission, which of the following documents is required to be verified at the time of expiration?
    • A. 

      Board certification

    • B. 

      DEA

    • C. 

      License

    • D. 

      Professional liability insurance

  • 8. 
    Which of the following would be considered a standard of care violation?
    • A. 

      Antitrust

    • B. 

      Slander

    • C. 

      Negligence

    • D. 

      Defamation

  • 9. 
    Each hospital must request information from the NPDB when a physician applies for which of the following:
    • A. 

      Clinical privileges

    • B. 

      Status Change

    • C. 

      Residency

    • D. 

      Licensure

  • 10. 
    According to The Joint Commission, which of the following entities may amend the medical staff bylaws?
    • A. 

      Chief of Staff

    • B. 

      Governing Body

    • C. 

      Medical Staff

    • D. 

      Medical Executive Committee

  • 11. 
    According to the NCQA, which of the following sources can be used for verification of state licensure?
    • A. 

      FSMB

    • B. 

      AMA

    • C. 

      FCVS

    • D. 

      State Licensing Board

  • 12. 
    According to NCQA, which of the following verifications must be documented for credentialing?
    • A. 

      Board certification for all levels of training

    • B. 

      DEA license for all states where care is provided

    • C. 

      Hospital privileges with admitting status

    • D. 

      Malpractice insurance binder

  • 13. 
    According to The Joint Commission, which of the following resources can be used to verify board certification?
    • A. 

      ABMS

    • B. 

      AMA

    • C. 

      FCVS

    • D. 

      FSMB

  • 14. 
    According to URAC, the credentialing application MUST include which of the following? 
    • A. 

      Date of birth

    • B. 

      Current photo

    • C. 

      Social security number

    • D. 

      Release of information

  • 15. 
    How many peer references does HFAP require at initial appointment?
    • A. 

      One

    • B. 

      Two

    • C. 

      Three

    • D. 

      Four

  • 16. 
    According to NCQA, which of the following requires ongoing monitoring between credentialing cycles?
    • A. 

      Malpractice claims

    • B. 

      License sanctions

    • C. 

      DEA status

    • D. 

      Board certification

  • 17. 
    According to The Joint Commission, which of the following is an approved source for verification of a medical degree from a United States education institution?
    • A. 

      ACGME

    • B. 

      CAQH

    • C. 

      ECFMG

    • D. 

      AMA Physician Master file

  • 18. 
    According to NCQA, which of the following providers MUST be credentialed when working in an independent relationship within the inpatient setting? 
    • A. 

      Radiologists

    • B. 

      Pathologists

    • C. 

      Chiropractors

    • D. 

      Anesthesiologists

  • 19. 
    According to NCQA, which of the following sources may be used to verify ongoing monitoring of license sanctions?
    • A. 

      AMA

    • B. 

      EPLS

    • C. 

      NPDB

    • D. 

      OIG

  • 20. 
    What type of release should the medical services professional obtain for the release of negative information to another facility?
    • A. 

      Standard release for the organization

    • B. 

      Verbal release from the practitioner

    • C. 

      Special release developed by the legal department

    • D. 

      Special release developed by the medical executive committee

  • 21. 
    When preparing for a committee meeting, who would the medical services professional MOST likely meet with to coordinate the agenda and meeting packet? 
    • A. 

      Medical director

    • B. 

      Committee chairperson

    • C. 

      Director of medical staff services

    • D. 

      Vice president of medical affairs

  • 22. 
    According to NCQA, which of the following MUST be verified in order to grant provisional credentialing? 
    • A. 

      DEA

    • B. 

      Board certification

    • C. 

      Professional liability insurance

    • D. 

      Five-year malpractice claims history

  • 23. 
    Which of the following are required to query the NPDB?
    • A. 

      Hospitals

    • B. 

      Medical malpractice payors

    • C. 

      Physicians

    • D. 

      State licensing boards

  • 24. 
    According to NCQA, which primary source must be utilized to verify licensure?
    • A. 

      State licensing agency

    • B. 

      AMA

    • C. 

      AOA

    • D. 

      FSMB

  • 25. 
    Which of the following BEST determines which procedures should be performed by which specialty? 
    • A. 

      ACGME

    • B. 

      White papers

    • C. 

      Medical school

    • D. 

      Specialty board

  • 26. 
    According to CMS guidelines, a roster listing each practitioner’s specific surgical privileges should be available in which locations?
    • A. 

      Surgical suite

    • B. 

      Surgical and medical floors

    • C. 

      Medical staff office and clinical nursing units

    • D. 

      Wherever surgical procedures are scheduled

  • 27. 
    According to NCQA, in which situation should a practitioner be notified about a discrepancy and be required to submit additional information?
    • A. 

      Actions on a license

    • B. 

      Incomplete verification from residency program director

    • C. 

      6-year-old malpractice claim

    • D. 

      Missing peer reference

  • 28. 
    According to The Joint Commission, Ongoing Professional Practice Evaluation (OPPE) should be conducted for which of the following individuals?
    • A. 

      Physicians only

    • B. 

      All privileged practitioners

    • C. 

      All allied health practitioners

    • D. 

      Independent allied health practitioners only

  • 29. 
    According to The Joint Commission, which of the following MUST be evaluated when determining a practitioner’s current competence. 
    • A. 

      Medicare/Medicaid sanctions

    • B. 

      Evidence of physical ability to perform the request privilege

    • C. 

      Evidence of compliance with the facility’s bylaws, rules, and regulations

    • D. 

      Criminal background check

  • 30. 
    According to The Joint Commission, which of the following dictates the qualifications and criteria for appointment to the medical staff?
    • A. 

      Credentials Committee

    • B. 

      Credentialing policies and procedures

    • C. 

      Medical Executive Committee

    • D. 

      Medical staff bylaws

  • 31. 
    According to CMS, members are appointed to the medical staff after receiving recommendation(s) from which of the following?
    • A. 

      Chief executive officer

    • B. 

      Chief medical officer

    • C. 

      Medical staff

    • D. 

      Existing members of medical staff

  • 32. 
    Within what time frame MUST practitioners in an AAAHC accredited organization be recredentialed? 
    • A. 

      Annually, unless state law provides otherwise

    • B. 

      At least every two years, unless state law provides otherwise

    • C. 

      At least every three years, unless state law provides otherwise

    • D. 

      AAAHC does not require recredentialing unless practitioner competence is in question

  • 33. 
    Which of the following practitioners would request privileges to perform an endoscopy?
    • A. 

      Pathologist

    • B. 

      Nephrologist

    • C. 

      Endocrinologist

    • D. 

      Gastroenterologist

  • 34. 
    According to The Joint Commission, a fair hearing and appeals process as described in the medical staff bylaws is available to which of the following?
    • A. 

      Active medical staff members

    • B. 

      All medical staff members

    • C. 

      Medical staff members with temporary privileges

    • D. 

      Medical staff members and non-members holding clinical privileges

  • 35. 
    According to NCQA, which of the following credentials MUST be verified at the time of recredentialing? 
    • A. 

      Lifetime board certification

    • B. 

      Current DEA

    • C. 

      Current malpractice insurance certificate

    • D. 

      Hospital privileges

  • 36. 
    According to URAC, within how many days MUST the practitioner be notified of credentialing? 
    • A. 

      10

    • B. 

      30

    • C. 

      60

    • D. 

      90

  • 37. 
    • A. 

      Medical staff bylaws

    • B. 

      Credentialing policies

    • C. 

      Rules and regulations

    • D. 

      Governing bylaws

  • 38. 
    According to URAC, who should oversee the clinical aspects of the credentialing program within the organization?
    • A. 

      Chief executive officer

    • B. 

      Chief operating officer

    • C. 

      Department chairperson

    • D. 

      Senior clinical staff person

  • 39. 
    According to The Joint Commission, which of the following committees is required to review and make recommendations regarding credentialing applications?
    • A. 

      Credentials

    • B. 

      Medical executive

    • C. 

      Peer review

    • D. 

      Quality improvement

  • 40. 
    According to AAAHC, primary or acceptable secondary source verification is required for which of the following?
    • A. 

      Board certification and licensure

    • B. 

      Education and training

    • C. 

      Hospital affiliations and work experience

    • D. 

      OIG sanctions and current liability insurance