CPCS Quiz II

51 Questions | Total Attempts: 1297

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CPCS Quiz II

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Questions and Answers
  • 1. 
    According to TJC standards, temporary privileges may be granted by:
    • A. 

      The department chair

    • B. 

      The CEO

    • C. 

      The CEO or his/her designee on the recommendation of the medical staff president or department chair

    • D. 

      The department chair and the president of the medical staff.

  • 2. 
    According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians?
    • A. 

      The American Board of Medical Specialties

    • B. 

      Education Commission on Foreign Medical Graduates Profile

    • C. 

      Federation of State Medical Boards

    • D. 

      Letter from the State licensing Agency

  • 3. 
    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

    • D. 

      Surgical Suite and Wherever Surgical procedures are scheduled.

  • 4. 
    According to URAC, which of the following 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

  • 5. 
    Which specialty would be allowed to do Adrenal Surgery
    • A. 

      Gastroenterologist

    • B. 

      Otolaryngologist

    • C. 

      Oncologist

    • D. 

      General Surgeon

  • 6. 
    Within what time frame MUST practitioners in an AAAHC accredited organization  be re-credentialed? 
    • 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 re-credentialing unless practitioner competence is in question.

  • 7. 
    Which of the following is considered an internal source of credentialing criteria?
    • A. 

      Medicare Conditions of Participation

    • B. 

      Medical Staff Bylaws

    • C. 

      Joint Commission on Accreditation of Healthcare Organizations Standards

    • D. 

      National Committee for Quality Assurance Standards and Guidelines

  • 8. 
    • A. 

      Health Integrity Portability and Accountability Act

    • B. 

      Health Insurance Private and Accountability Act

    • C. 

      Health Insurance Portability and Accountability Act

    • D. 

      Health Insurance Portabili8ty and Accuracy Act

  • 9. 
    A database containing adverse actions against an individual and entities sanctioned in the healthcare field and includes disciplinary actions ranging from exclusions to letters of reprimand and probation.
    • A. 

      FACIS

    • B. 

      FVBS

    • C. 

      FSMB

    • D. 

      CDS

  • 10. 
    TJC hospital standards require the delineation of an individual’s clinical privileges include
    • A. 

      A generic statement of the scope of privileges

    • B. 

      A listing of each individual procedure the applicant is approved to perform

    • C. 

      Any limitations on an individual’s privileges to admit and treat patients or direct the course of treatment for the conditions for which the patients were admitted

    • D. 

      A generic statement of privileges combined with a listing of individual procedures the applicant is approved to perform.

  • 11. 
    Eligible entities that want the protection provided by the HCQIA are required:
    • A. 

      To query the NPDB at the time of initial credentialing and monthly

    • B. 

      To query the NPDB at the time of initial credentialing and once yearly

    • C. 

      To query the NPDB at the time of initial credentialing and at least every two years

    • D. 

      To query the NPDB at the time of initial credentialing, every two years, and whenever the physician changes staff categories.

  • 12. 
    Utilization Review is
    • A. 

      Chart review by an RN

    • B. 

      The process of evaluating the necessity, appropriateness and efficiency of healthcare services

    • C. 

      The process of evaluating the cost of healthcare delivery on a concurrent basis

    • D. 

      The review of discharge protocols

  • 13. 
    Define “Respondeat Superior”
    • A. 

      Agreement that identifies rights and obligations

    • B. 

      Amicus – brief filed by an interested party giving information or an opinion about a case

    • C. 

      Civil harm

    • D. 

      “Let the Master Answer/Speak”

  • 14. 
    In order for a hospital to participate in the Medicare program it must:
    • A. 

      Have an effective, hospital-wide QI program

    • B. 

      Provide a certain amount of charitable care

    • C. 

      Participate in managed care plans

    • D. 

      Have over 25 licensed beds

  • 15. 
    According to HIPAA, healthcare organizations are required to
    • A. 

      Have an Executive Committee of the Medical staff that can act for the Medical Staff

    • B. 

      Keep copies of credentials files for practitioners no longer on staff for a period of at least 5 years

    • C. 

      Inform patients/beneficiaries of their business practices concerning release of information

    • D. 

      Provide a repository of care information

  • 16. 
    The standards for good faith peer review are set out in the statute and include:
    • A. 

      The physician is afforded notice and fair hearing procedures

    • B. 

      The action is being taken with the belief that it will further quality health care

    • C. 

      Facts were obtained through investigation and review

    • D. 

      All of the above

  • 17. 
    If a practitioner is on a GSA or OIG exclusion list:
    • A. 

      The practitioner can’t bill federal healthcare programs for care rendered.

    • B. 

      Neither the practitioner nor facility providing services to patients at practitioner’s request can bill federal healthcare programs for care rendered.

    • C. 

      The facility providing services to patients at practitioners request can’t bill federal healthcare programs for care.

    • D. 

      None of the above, the exclusion is informational.

  • 18. 
    The sworn statement made by a witness that can be used as evidence in a court of law is:
    • A. 

      Affidavit

    • B. 

      Deposition

    • C. 

      Subpoena

    • D. 

      Witness transcript

  • 19. 
    Institutional Review Board (IRB) protocols conduct in hospital or clinic settings must comply with regulations set forth by the:
    • A. 

      CDC

    • B. 

      FDA

    • C. 

      OIG

    • D. 

      AMA

  • 20. 
    A CVO has how much time to complete verification for an MCO?
    • A. 

      60 days

    • B. 

      Six months

    • C. 

      90 days

    • D. 

      120 days

  • 21. 
    The first hospital surveys were carried out by the:
    • A. 

      American Medical Association

    • B. 

      American College of Surgeons

    • C. 

      Healthcare Financing Administration

    • D. 

      Joint Commission on Accreditation of Hospitals

  • 22. 
    A suicide of a patient in a setting where the patient receives around-the-clock care is called:
    • A. 

      Negligence

    • B. 

      Sentinel Event

    • C. 

      An Accident

    • D. 

      Risk Management

  • 23. 
    What is a quorum?
    • A. 

      2/3 of number of members must be present for business to be transacted

    • B. 

      51% of number of members must be present for business to be transacted

    • C. 

      Minimum number of members who must be present for business to be transacted

    • D. 

      None of the above

  • 24. 
    Organizations have the option of credentialing and reassessing dependent practitioners through:
    • A. 

      Human Resources Department

    • B. 

      Medical Staff credentialing/reappointment process

    • C. 

      Both a & b

    • D. 

      None of the above

  • 25. 
    What Committee is required by The Joint Commission:
    • A. 

      Credentials Committee

    • B. 

      Medical Executive Committee

    • C. 

      Physician Wellbeing Committee

    • D. 

      Both a & b