CPCS Quiz II

51 Questions | Total Attempts: 1175

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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

  • 26. 
    Which of the following would be an example of internal criteria?
    • A. 

      Verification of current licensure

    • B. 

      Verification of residency program completion

    • C. 

      Verification of current malpractice

    • D. 

      Demonstration of current competency

  • 27. 
    According to NCQA standards, a copy of which of the following is acceptable verification of the item?
    • A. 

      DEA Certificate

    • B. 

      Licensure

    • C. 

      Board Certification

    • D. 

      Medical School Diploma

  • 28. 
    Robert’s Rules of Order is an example of
    • A. 

      Executive Privilege

    • B. 

      Parliamentary procedure

    • C. 

      Code of Conduct

    • D. 

      Bylaws

  • 29. 
    In order for healthcare facilities to participate in the Medicare and Medicaid programs it must comply with:
    • A. 

      The Joint Commission standards

    • B. 

      Medicare Conditions of Participation

    • C. 

      National Committee on Quality Assurance standards

    • D. 

      American Accreditation Healthcare Commission standards

  • 30. 
    Substantive and procedural are two distinct elements of
    • A. 

      Medical Staff membership

    • B. 

      Due process

    • C. 

      Privileging criteria

    • D. 

      Credentialing qualifications

  • 31. 
    What case involved a podiatrist who performed surgery and left the patient in pain unable to walk normally.  The key issues were negligent credentialing, failure to have proper supervision and liable under corporate negligence doctrine? 
    • A. 

      Gonzalez v. Nork & Mercy Hospital

    • B. 

      Darling v. Charleston Memorial Community Hospital

    • C. 

      Elam v. College Park Hospital

    • D. 

      Abrams v. St. John’s Hospital

  • 32. 
    What is Cholecystitis?
    • A. 

      Inflammation of the gallbladder

    • B. 

      Inflammation of the bladder with bladder stones

    • C. 

      Inflammation of the bile duct

    • D. 

      Inflammation of the stomach

  • 33. 
    What organization has led the national effort for improving the quality of healthcare provided by practitioners in managed care plans?
    • A. 

      TJC

    • B. 

      URAC

    • C. 

      CMS

    • D. 

      NCQA

  • 34. 
    A hospital that is held liable for damages incurred by a patient as a result of substandard care provided by a member of its medical staff is said to be guilty of?
    • A. 

      Gross negligence

    • B. 

      Failure to supervise

    • C. 

      Corporate negligence

    • D. 

      Malpractice

  • 35. 
    You may not request an expedited appointment if:
    • A. 

      You have a malpractice claim in excessive of $25,000

    • B. 

      You have multiple malpractice claims, no matter the resolution of the case

    • C. 

      There is a current challenge or a previously successful challenge to licensure or registration

    • D. 

      All of the above

  • 36. 
    The first step in planning a successful meeting is:
    • A. 

      Calling the chairman to review the agenda

    • B. 

      Preparing a well-planned agenda

    • C. 

      Making sure that a meal will be provided

    • D. 

      Preparing meeting minutes from the previous meeting

  • 37. 
    TJC criteria for clinical privileges pertain to evidence of
    • A. 

      Current licensure in any state

    • B. 

      Graduation from an accredited U.S. university

    • C. 

      Adequate professional liability insurance

    • D. 

      Ability to perform the privileges requested

  • 38. 
    This term describes the industry measure of best performance for a particular indicator or performance goal:
    • A. 

      Break-even point

    • B. 

      Capitation

    • C. 

      Benchmark

    • D. 

      Incremental cost

  • 39. 
    The purpose of a point-of-service plan is to:
    • A. 

      Reduce referral demands for the PCP

    • B. 

      Allow the member choices of access and associated costs of services

    • C. 

      Access to providers while traveling out of service area

    • D. 

      Outline clinical care strategic plan within a vertically integrated system

  • 40. 
    The use of a planned and coordinated approach to providing healthcare with the goal of quality care at a lower cost is known as:
    • A. 

      Managed care

    • B. 

      Primary care

    • C. 

      An integrated delivery system

    • D. 

      Open access

  • 41. 
    Which accrediting body requires primary source verification of medical education?
    • A. 

      AAAHC, URAC, CMS, HFAP

    • B. 

      AAAHC, HFAP, TJC

    • C. 

      TJC, URAC, CMS

    • D. 

      TJC & CMS

  • 42. 
    Which accrediting body requires state licensure to be verified when privileges are revised or added?
    • A. 

      HFAP & CMS

    • B. 

      TJC

    • C. 

      HFAP

    • D. 

      TJC, AAAHC & NCQA

  • 43. 
    Which accrediting body requires verification of identify?
    • A. 

      CMS

    • B. 

      NCQA

    • C. 

      TJC

    • D. 

      None of the above

  • 44. 
    NCQA attestation includes which of the following:
    • A. 

      Completeness and correctness of the application

    • B. 

      Health status

    • C. 

      History or loss or limitation of licensure or privileges

    • D. 

      All of the above

  • 45. 
    What type of practitioner may have clinical privileges without membership?
    • A. 

      One granted temporary privileges

    • B. 

      One granted Honorary Staff

    • C. 

      One granted to the Academic Staff

    • D. 

      All of the above

  • 46. 
    When can Disaster Privileges be granted?
    • A. 

      To fulfill an important patient care need

    • B. 

      When an emergency has been declared (Activation of Emergency Management Plan

    • C. 

      When all orthopedic surgeons on staff have gone to the annual conference

    • D. 

      When an application is complete and clean and the next Credentials Committee is 25 days away

  • 47. 
    Who can sign off/approve a “clean” application under NCQA standards?
    • A. 

      Medical Director

    • B. 

      Board of Directors

    • C. 

      Department Chair

    • D. 

      Chief of Staff

  • 48. 
    Which accrediting body requires primary source verification (PSV) of post graduate education?
    • A. 

      NCQA

    • B. 

      TJC

    • C. 

      NCQA & TJC

    • D. 

      None of the above

  • 49. 
    Which accrediting body requires verification of the highest of 3 levels of education?
    • A. 

      NCQA

    • B. 

      TJC & NCQA

    • C. 

      CMS

    • D. 

      CMS & TJC

  • 50. 
    What is the highest level of education to be verified for a board certified practitioner as considered by your response to question #9?
    • A. 

      Fellowship

    • B. 

      Board Certification

    • C. 

      Residency

    • D. 

      Medical Education

  • 51. 
    What does HIPPA stand for?
    • 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