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CPMSM PREPARATION EXAM WITH ALL QUESTIONS AND ANSWERS
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CPMSM PREPARATION EXAM WITH ALL QUESTIONSAND ANSWERS
Why is it necessary to ensure that the practitioner is not now excluded, suspended,
debarred, or ineligible to participate in Federal health care programs? - ANSWER
The facility will not be compensated for treating patients unless the service is
performed by an authorized provider.
Which of the following credentials must be monitored continuously? - Answer
Licensure
According to NCQA requirements, what action should an organization take if it
learns sanction information, complaints, or adverse events involving a practitioner?
- ANSWER Determine whether there is evidence of low quality that may
jeopardize the health and safety of its members.
What is the name of the entity created by the Health Care Quality Improvement Act
of 1986 to limit the ability of incompetent physicians, dentists, and other health
care practitioners to move from state to state without disclosing or discovering their
prior medical malpractice payment and adverse action history? - ANSWER The
National Practitioner Data Bank
When designing clinical privileging criteria, which of the following should be
evaluated? - ANSWER Established norms of practice, such as recommendations
from specialty boards.
What is the primary rationale for periodically reviewing the appropriateness of
clinical privileges for each specialty? - ANSWER To preserve patient safety,
ensure current expertise, relevance to the facility, and adherence to acknowledged
standards of care.
Which of the following specialists is most likely to carry out a PTCA? - Answer:
Interventional Cardiologist.
,The Joint Commission hospital standards require clinical privileges to be
hospital-specific and based on the individual's demonstrated current competence
and the operations that the hospital can support.
Which of the following would a cardiologist routinely perform? - ANSWER
Transesophageal echocardiography
Which NCQA-mandated committee offers recommendations on credentialing
decisions? ANSWER Credentialing Committee
HFAP standards mandate that three medical staff committees be defined in the
medical staff organization; what are these? - ANSWER Medical Executive
Committee, Utilization Review Committee, and the Utilization of Osteopathic
Methods and Concepts Committee.
Which law would you consult if you needed to know what the federal government
requires in terms of antitrust issues? - ANSWER The Sherman Anti-Trust Act
Peer references should be collected from practitioners in the applicant's
professional discipline.
Patrick v. Burgett is a significant case because it demonstrates the potential for
antitrust liability stemming from peer review operations.
If a medical staff member's credentials and/or medical staff appointment are
revoked, he/she must be: - Provided with due process.
Access to credentials files should be: ANSWER. Described completely in an access
policy
, Which of the following bodies grants clinical privileges? - ANSWER The
governing body/board
Which primary source verification is required by NCQA before temporary
credentialing? - ANSWER Licensure with 5 years of malpractice history or NPDB.
According to TJC norms, initial appointments with medical staff are made for a
period of: Not to exceed two years.
According to TJC, temporary rights may be given by the CEO on the
recommendation of the medical staff president or authorized designee.
TJC requires that which of the following items be confirmed with a primary source.
- ANSWER Licensure, training, experience, and competencies
According to NCQA guidelines, which is an acceptable form of document
verification? - ANSWER DEA Certificate
According to NCQA criteria, what is an appropriate primary source for verifying
Medicare and Medicaid sanction activity against physicians? - ANSWER
Federation State Medical Boards.
According to TJC guidelines, which of the following is an authorized equivalent
source for verifying board certification? - ANSWER American Board of Medical
Specialties
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