CPMSM TESTS COMPILATION BUNDLE

AHRQ - Agency for Healthcare Research and Qualtiy correct answer: An agency within DHHS established in 1989 to improve quality, appropriateness and effectiveness of US Healthcare AHRQ correct answer: Agency for Healthcare Research and Qualtiy 1989 Medicare Program correct answer: Establishe...

When developing clinical privileges the following are important to evaluate? correct answer: Established standards of practice such as, specialty board recommendations. What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty? correct answer: ...

Why is it important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs? correct answer: The facility will not get paid for treating patients unless service is provided by an authorized provider Which of the ...

Why it is important to check that the practitioner is not currently excluded suspended the board or in eligible to participate in federal healthcare programs correct answer: The facility won't get paid for treating patients unless service is provided by authorized provider Which of the followin...

Why is it important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs? correct answer: The facility won't get paid for treating patients unless service is provided by authorized provider Which credentials ...

HFAP correct answer: Refers to a CVO as a Professional Credentialing Organization (PCO) HFAP Appointment time frame correct answer: 2 years TJC Appointment time frame correct answer: No longer than every 2 years NCQA Appointment time frame correct answer: 3 years (to the month) URAC ...

Why get accredited? correct answer: 1. assists organizations in monitoring and improving quality of care 2. Deemed status 3. Marketing reasons - shows that expectations for providing safe, quality health care are met 4. may favorably influence liability insurance premiums 5. for a hospital, may...

What are four models of HMOs? correct answer: Staff Model Group Model Network Model Independent Practice Association (IPA) What are the four types of committees? correct answer: Standing Ad hoc Task force Continuous quality improvement team How many medical staff members comprise a Byl...

Where must accreditors submit their standards for approval? correct answer: CMS When is deemed status given? correct answer: After approval by CMS What are requirements set by forces outside the organization? correct answer: External criteria What factors are defined by the hospital's m...

Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? correct answer: Yes According to the Joint Commission, who may amend the medical staff bylaws? correct answer: Governing Body Failure to meet the established qualifications and criteria...

Applicant completes an application that includes, reasons for inability to perform, las of present illegal drug use, loss of license or felony convictions. Loss or limitation of privileges or disciplinary actions. Current malpractice insurance coverage, current signed attestation confirming the corr...

According to URAC who should oversee the clinical aspects of the credentialing program within the organization? correct answer: Senior Clinical Staff Person Name 3 sources of verification of education of a dentist according to NCQA correct answer: Dental school, specialty board, state licensing...

Medicare requires providers to perform what process every 3-5 years? correct answer: Revalidation According to DNV standards, initial appointments to the medical staff are not to exceed what time period? correct answer: 36 months / 3 years T/F: The Joint Commission standards require that the...

NPDB correct answer: National Practitioner Databank NPDB Contains: (what type of info) correct answer: - adverse licensure - clinical privilege actions - membership actions (professional/society) - paid malpractice judgements - exclusions from Medicare/Medicaid - actions by US DEA What ...