CPMSM Test Questions & Answers | 207 Questions with
100% Correct Answers | Verified 2023
HFAP - ✔️✔️Refers to a CVO as a Professional Credentialing Organization (PCO)
HFAP Appointment time frame - ✔️✔2
️ years
TJC Appointment time frame - ✔️✔N
️ o longer than every 2 years
NCQA Appointment time frame - ✔️✔️3 years (to the month)
URAC Appointment time frame - ✔️✔3
️ years
AAAHC Appointment time frame - ✔️✔️3 years
Attestation Statement - ✔️✔T ️ JC and Medicare do not specifically address, URAC allows
electronic signature, all others require.
Board Certification Verification - ✔️✔N
️ ot specifically required (only highest level of education)
has to be verified within 180 days per NCQA or 120 days if CVO is verifying.
CME - ✔️✔️HFAP may request every 2 years. TJC requires documentation. No others require.
TJC views of Competence - ✔️✔️Monitoring of provider competence must be ongoing.
URAC and NCQA views of Competence - ✔️✔️Monitoring of provider competence must be
ongoing and organization must have policies for monitoring in place.
HFAP view of Competence - ✔️✔️Competence can be monitored by proof of procedures
performed. This can be done by the provider providing their procedure logs.
AAAHC view of Competence - ✔️✔️Competence can be monitored by provided documentation
of competency.
Medicare view of Competence - ✔️✔G ️ overning body must verify character, competence,
judgement, education, and training.
Felony Conviction - ✔️✔️Only addressed by a question or statement of provider application by
NCAQ, HFAP, and AAAHC
NCQA and URAC on Education - ✔️✔️Only highest level of education verified.
TJC and Medicare - ✔️✔️Does no address Medicare and Medicaid sanctions.
NPDB - ✔️✔️NCQA and URAC do not require it but it is an acceptable verification of sanctions.
All other organizations require.
Site Visit - ✔️✔️NCQA is the only organization that requires a site visit under certain
circumstances.
, Temporary Privileges - ✔️✔️AAAHC and Medicare do not specifically address.
Temporary Privileges granting requirements - ✔️✔️This type of privilege can be granted by the
CEO upon recommendation from the Chief of Staff or authorized designee as long as license,
malpractice coverage, and NPDB have been verified.
NCQA specifically says Provisional (Temporary) Privileges - ✔️✔️Can be granted by Chief
Medical Official as long as their is a policy in place, the application is clean, and the privileges
can be granted for no more than 60 days.
Work History - ✔️✔U
️ RAC and Medicare do not address, NCAQ: History must be verified and
any gaps of 6 months or greater require explanation.
TJC & HFAP Work History - ✔️✔r️ equire the question to be asked: Has the provider ever been
terminated or suspended and NPDB must be compared to answer of the above question.
AAAHC Work History - ✔️✔️Any interruptions in employment must be accounted for.
Health Status Form - ✔️✔️All organizations require a current statement of ability to perform as a
provider. HFAP requires it to be documented from references.
Views on Allied Health Professionals - ✔️✔️NCQA: Credentials all providers the same
URAC: Adds that they must be listed in directory
TJC & AAAHC: Say that MCO must distinguish providers as those with and without the need for
supervision
Medicare: Can grant privileges with or without Medical Staff rights.
Disaster Plan - ✔️✔️TJC, HFAP, AAAHC require groups/organizations to have the plan
documented and in place.
DEA Verification - ✔️✔️Copies can be accepted, ensure there are no challenges to the
certificate.
Licensure - ✔️✔M ️ edicare: does not specifically address sanctions URAC: states that it has to
be verified in a 6 month time frame.
NCQA: Verified within 180 days (or 120 for CVO)
All organizations require that the monitoring of licensure be ongoing.
Malpractice - ✔️✔️AAAHC, TJC, Medicare: Not fully addressed but states if bylaws require
verification or proof of coverage, documentation must be obtained. All other organizations
require proof and verification.
Malpractice History - ✔️✔N️ CQA: Pulled and verified with in the correct time frames (180 days or
120 days if CVO)
URAC: 6 month time frame
All require at minimum to verify history for the last 5 years.
Accountable Care Organization - ✔️✔️Pt Centered and includes offices, hospitals, nursing
homes. The healthcare organization is characterized by a payment and care delivery model that
100% Correct Answers | Verified 2023
HFAP - ✔️✔️Refers to a CVO as a Professional Credentialing Organization (PCO)
HFAP Appointment time frame - ✔️✔2
️ years
TJC Appointment time frame - ✔️✔N
️ o longer than every 2 years
NCQA Appointment time frame - ✔️✔️3 years (to the month)
URAC Appointment time frame - ✔️✔3
️ years
AAAHC Appointment time frame - ✔️✔️3 years
Attestation Statement - ✔️✔T ️ JC and Medicare do not specifically address, URAC allows
electronic signature, all others require.
Board Certification Verification - ✔️✔N
️ ot specifically required (only highest level of education)
has to be verified within 180 days per NCQA or 120 days if CVO is verifying.
CME - ✔️✔️HFAP may request every 2 years. TJC requires documentation. No others require.
TJC views of Competence - ✔️✔️Monitoring of provider competence must be ongoing.
URAC and NCQA views of Competence - ✔️✔️Monitoring of provider competence must be
ongoing and organization must have policies for monitoring in place.
HFAP view of Competence - ✔️✔️Competence can be monitored by proof of procedures
performed. This can be done by the provider providing their procedure logs.
AAAHC view of Competence - ✔️✔️Competence can be monitored by provided documentation
of competency.
Medicare view of Competence - ✔️✔G ️ overning body must verify character, competence,
judgement, education, and training.
Felony Conviction - ✔️✔️Only addressed by a question or statement of provider application by
NCAQ, HFAP, and AAAHC
NCQA and URAC on Education - ✔️✔️Only highest level of education verified.
TJC and Medicare - ✔️✔️Does no address Medicare and Medicaid sanctions.
NPDB - ✔️✔️NCQA and URAC do not require it but it is an acceptable verification of sanctions.
All other organizations require.
Site Visit - ✔️✔️NCQA is the only organization that requires a site visit under certain
circumstances.
, Temporary Privileges - ✔️✔️AAAHC and Medicare do not specifically address.
Temporary Privileges granting requirements - ✔️✔️This type of privilege can be granted by the
CEO upon recommendation from the Chief of Staff or authorized designee as long as license,
malpractice coverage, and NPDB have been verified.
NCQA specifically says Provisional (Temporary) Privileges - ✔️✔️Can be granted by Chief
Medical Official as long as their is a policy in place, the application is clean, and the privileges
can be granted for no more than 60 days.
Work History - ✔️✔U
️ RAC and Medicare do not address, NCAQ: History must be verified and
any gaps of 6 months or greater require explanation.
TJC & HFAP Work History - ✔️✔r️ equire the question to be asked: Has the provider ever been
terminated or suspended and NPDB must be compared to answer of the above question.
AAAHC Work History - ✔️✔️Any interruptions in employment must be accounted for.
Health Status Form - ✔️✔️All organizations require a current statement of ability to perform as a
provider. HFAP requires it to be documented from references.
Views on Allied Health Professionals - ✔️✔️NCQA: Credentials all providers the same
URAC: Adds that they must be listed in directory
TJC & AAAHC: Say that MCO must distinguish providers as those with and without the need for
supervision
Medicare: Can grant privileges with or without Medical Staff rights.
Disaster Plan - ✔️✔️TJC, HFAP, AAAHC require groups/organizations to have the plan
documented and in place.
DEA Verification - ✔️✔️Copies can be accepted, ensure there are no challenges to the
certificate.
Licensure - ✔️✔M ️ edicare: does not specifically address sanctions URAC: states that it has to
be verified in a 6 month time frame.
NCQA: Verified within 180 days (or 120 for CVO)
All organizations require that the monitoring of licensure be ongoing.
Malpractice - ✔️✔️AAAHC, TJC, Medicare: Not fully addressed but states if bylaws require
verification or proof of coverage, documentation must be obtained. All other organizations
require proof and verification.
Malpractice History - ✔️✔N️ CQA: Pulled and verified with in the correct time frames (180 days or
120 days if CVO)
URAC: 6 month time frame
All require at minimum to verify history for the last 5 years.
Accountable Care Organization - ✔️✔️Pt Centered and includes offices, hospitals, nursing
homes. The healthcare organization is characterized by a payment and care delivery model that
