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CPMSM EXAM QUESTIONS AND ANSWERS LATEST UPDATED
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CPMSM EXAM QUESTIONS AND ANSWERS LATESTUPDATED 2024-2025
HFAP - ANSWER identifies a CVO as a Professional Credentialing Organisation
(PCO).
HFAP appointment time frame - ANSWER: Two years.
TJC appointment time frame - ANSWER: No more than every two years.
NCQA appointment time frame - ANSWER: Three years (to the month).
URAC appointment time frame - ANSWER: Three years
AAAHC Appointment Time Frame: 3 Years
Attestation Statement - ANSWER TJC and Medicare do not address it expressly;
URAC enables electronic signature; all others do.
Board Certification Verification - ANSWER Not officially needed (just the highest
level of education), but must be confirmed within 180 days per NCQA or 120 days
if a CVO is verifying.
CME - ANSWER HFAP may request every two years. TJC demands paperwork.
There are no other requirements.
TJC's Views on Competence - ANSWER Monitoring of provider competence must
be continual.
,URAC and NCQA Views on Competence - ANSWER Monitoring of provider
competence must be ongoing, and organisations must have monitoring mechanisms
in place.
HFAP's View of Competence - ANSWER Proof of procedures performed can be
used to monitor competence. This can be accomplished by the provider submitting
their procedure logs.
AAAHC's View of Competence - ANSWER Competence can be monitored using
the documentation given.
ANSWER: The governing body must verify character, competence, judgement,
education, and training.
Felony Conviction - ANSWER Only addressed by a question or statement of
provider application by NCAQ, HFAP, or AAAHC.
NCQA and URAC on Education - ANSWER: Only the highest level of education
is confirmed.
TJC and Medicare - ANSWER Does not address Medicare or Medicaid sanctions.
NPDB - ANSWER NCQA and URAC do not mandate it, however, it is an
appropriate way to verify sanctions. Every other organisation need it.
Site Visit - ANSWER NCQA is the only organisation that needs a site visit in
certain situations.
Temporary Privileges - The AAAHC and Medicare do not address this precisely.
,Temporary Privileges Granting Requirements - ANSWER The CEO may issue this
sort of privilege upon suggestion from the Chief of Staff or an authorised designee,
provided that the license, malpractice coverage, and NPDB have been validated.
NCQA clearly states that Provisional (Temporary) powers - ANSWER can be
provided by the Chief Medical Official as long as there is a policy in place, the
application is clean, and the powers are granted for a maximum of 60 days.
Work History - ANSWER URAC and Medicare do not address this; NCAQ:
History must be confirmed, and any gaps of 6 months or more demand explanation.
TJC and HFAP Work History - ANSWER require the following question to be
asked: Has the provider ever been dismissed or suspended? The NPDB must be
compared to the answer to the above question.
AAAHC Work History - ANSWER: Any breaks in employment must be
documented.
Health Status Form - ANSWER: All organisations require a current statement of
provider ability. HFAP demands that it be substantiated with references.
Views on Allied Health Professionals - ANSWER NCQA: All providers have the
same credentials.
URAC: specifies that they must be listed in the directory.
According to TJC and AAAHC, MCOs must distinguish between providers who
require supervision and those who do not.
Medicare may give privileges with or without Medical Staff rights.
Disaster Plan - TJC, HFAP, and AAAHC all require groups/organizations to have a
documented and implemented plan.
, DEA Verification - ANSWER Copies can be accepted; nevertheless, there should
be no challenges to the certificate.
Licensure - ANSWER Medicare: does not directly discuss sanctions, but URAC
stipulates that it must be confirmed within six months.
NCQA: Verified within 180 days (120 for CVO).
All organisations require ongoing licensure monitoring.
Malpractice - ANSWER AAAHC, TJC, Medicare: Not fully addressed, but
specifies that if bylaws require verification or evidence of coverage, documentation
must be provided. Every other organisation requires proof and verification.
Malpractice History - ANSWER NCQA: Pulled and validated within the
appropriate time dates (180 days or 120 days if CVO).
URAC: 6-month timeframe
All require at least a five-year verification history.
Accountable Care Organisation - ANSWER Pt Centred, with offices, hospitals,
and nursing homes. The healthcare organisation is distinguished by a payment and
care delivery model that tries to link provider compensation to quality measures
and lower total cost of care for patients. Patients are assigned to certain doctors.
EMTALA - ANSWER Emergency Medical Treatment and Active Labour Act - It
must be an emergency.
-Must screen to see if it is a true emergency.
-Stabilise the patient before to transfer.
-Must have a "on call" list. (Medicare doesn't specify how many days must be
covered.)
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