CPCS Quiz I
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- 1.How many peer references does HFAP require at initial appointmen?
- A.
One
- B.
Two
- 2.According to URAC, who should oversee the clinical aspects of the credentialing program within the organization?
- A.
Department chair
- B.
Chief executive officer
- C.
Senior clinical staff person
- 3.Which of the following best determines which procedures should be performed by which specialty?
- A.
ACGME
- B.
Medical school
- C.
Specialty board
- 4.According to NCQA, which of the following credentials must be verified at the time of recredentialing?
- A.
Lifetime board certification
- B.
Hospital privileges
- C.
Current DEA
- 5.Each hospital must request information from the NPDB when a physician applies for which of the following?
- A.
Residency
- B.
Status change
- C.
Clinical privileges
- 6.According to The Joint Commission, ongoing professional practice evaluation (OPPE) should be conducted for which of the following individuals?
- A.
Physician only
- B.
All privileges practitioners
- C.
All allied health practitioners
- 7.According to NCQA, which of the following sources may be used to verify ongoing monitoring of licenses sanctions?
- A.
AMA
- B.
EPLS
- C.
NPDB
- 8.According to NCQA, how often must an organization conduct an audit of the credentialing process delegated to another organization?
- A.
Annually
- B.
Every 2 years
- C.
Every 3 years
- 9.According to AAAHC primary or acceptable secondary source verification is required for which of the following?
- A.
Education and training
- B.
Board certification and license
- C.
Hospital affiliations and work experience
- 10.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.
Special release developed by the legal department
- C.
Special release developed by the medical executive committee
- 11.According to NCQA, which of the following sources can be used for verification of state licensure?
- A.
AMA
- B.
FSMB
- C.
State licensing board
- 12.According to URAC, the credentialing application must include which of the following?
- A.
Date of birth
- B.
Social Security number
- C.
Release of information
- 13.According to The Joint Commission, which of the following documents is required to be verified at the time of expiration?
- A.
DEA
- B.
License
- C.
Professional liability insurance
- 14.Which of the following is an essential source when developing a policy regarding the functions of a peer review committee?
- A.
CMS
- B.
HCQIA
- C.
HEDIS
- 15.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 requested privilege
- C.
Evidence of compliance with the facility's bylaws, rules, and regulations
- 16.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
- 17.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.
Missing peer reference
- C.
Six-year-old malpractice claim
- 18.According to The Joint Commission, which of the following entities may amend the medical staff bylaws?
- A.
Governing body
- B.
Medical Staff
- C.
Medical executive committee
- 19.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 and non-members holding clinical privileges
- 20.According to NCQA, which of the following providers must be credentialed when working in an independent relationship setting?
- A.
Radiologists
- B.
Chiropractors
- C.
Anesthesiologist
- 21.According to NCQA, which primary source must be utilized to verify licensure?
- A.
State licensing agency
- B.
AMA
- C.
FSMB
- 22.When preparing for a committee meeting, the medical services professional MOST likely would meet with whom to coordinate the agenda and meeting packet?
- A.
Medical director
- B.
Committee chairperson
- C.
Vice president of medical affairs
- 23.Which of the following organizations could a credentialing professional query to obtain a current copy of a practitioner's DEA?
- A.
NTIS
- B.
NPDB
- C.
FSMB
- 24.According to The Joint Commission, which of the following dictates the qualifications and criteria for appointment to the medical staff?
- A.
Credentialing policies and procedures
- B.
Medical executive committee
- C.
Medical staff bylaws
- 25.According to The Joint Commission, which of the following is an approved source for verification of a medical degree from a United States educational Institution?
- A.
ACGME
- B.
ECFMG
- C.
AMA Physician Masterfile
- 26.Which of the following are required to query the NPDB?
- A.
Hospitals
- B.
Physicians
- C.
Medical malpractice payors
- 27.Which of the following practitioners would request privileges to perform an endoscopy?
- A.
Nephrologist
- B.
Endocrinologist
- C.
Gastroenterologist
- 28.According to CMS, members are appointed to the medical staff after receiving recommendation(s) from which of the following?
- A.
Medical Staff
- B.
Chief medical officer
- C.
Chief executive officer
- 29.According to The Joint Commission, which of the following is required to review and make recommendations regarding credentialing applications?
- A.
Credentials
- B.
Medical executive
- C.
Peer review
- 30.According to NCQA, which of the following must an organization have in place in order to enter a delegated credentialing agreement?
- A.
Medical staff bylaws
- B.
Credentialing policies
- C.
Rules and regulations
- 31.A chiropractor has applied for membership in a preferred provider organization. The chiropractor has a previous sanction against his license. Which source should the credentialing professional query to obtain additional information regarding the sanction?
- A.
Federation of Chiropractic Licensing Boards
- B.
FSMB
- C.
NPDB
- 32.According to URAC, within how many days must the practitioner be notified of credentialing decisions?
- A.
10
- B.
30
- C.
60
- 33.According to NCQA, which of the following requires ongoing monitoring between credentialing cycles?
- A.
Malpractice claims
- B.
License sanctions
- C.
DEA status
- 34.Which of the following would be considered a standard of care violation?
- A.
Slander
- B.
Negligence
- C.
Defamation
- 35.According to The Joint Commission, which of the following resources can be used to verify certification?
- A.
ABMS
- B.
AMA
- C.
FSMB
- 36.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.
Dated and signed written verification from the primary source
- 37.According to NCQA, which of the following must be verified in order to grant provisional credentialing?
- A.
Board certification
- B.
Professional liability insurance
- C.
Five-year malpractice claims history
- 38.According to CMS guidelines a roster listing each practitioner's specific surgical privileges should be available in which locations?
- A.
Surgical and medical floors
- B.
Medical Staff office and clinical nursing units
- C.
Wherever surgical procedures are scheduled
- 39.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
- 40.According to URAC, which of the following credentials must be verified using primary sources?
- A.
Board certification and DEA
- B.
State licensure and DEA
- C.
State licensure and highest level of education
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