CPCS/CPMSM Real Exam Paper – A+ Graded Final
Submission
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 correctness and
completeness of the application. If an application from an external entity is used it must include the
questions and attestations as identified above. Signature stamps are not acceptable unless the
practitioner is physically impaired and the disability is documented in the practitioners file. - ✔✔NCQA
Health Plan/CVO
Which type of agenda is used on a meeting agenda to group together non-controversial business and
reports that can be approved under one motion instead of individually approving each item? -
✔✔Consent Agenda
According to NCQA under what circumstance would a Locum Tenens practitioner be exempt from
credentialing? - ✔✔Covering Practitioner
According to URAC, when developing a quality auditing process, prudent practice would be to audit
what percentage of completed credentialing files? - ✔✔
According to URAC, a complete credentials file should be reviewed by which professionals? - ✔✔
According to NCQA, what must be included in the organization's right to appeal policies? - ✔✔written
notification when a professional review action has been brought against a practitioner
reasons for the action
summary of the appeal rights and process
ability to request a hearing and the specific time period for submitting the request
allowing for at least 30 calendar days after the notification for practitioners to request a hearing
allowing representation by an attorney or another person
appointment of a hearing officer or a panel of individuals to review the appeal
and written notification of the appeal decision that contains specific reasons for the decision.
,Which Accrediting body requires an attestation to the practitioners identity? - ✔✔The Joint Commission
According to HFAP, how often must a reappraisal of membership and privileges occur? - ✔✔Every 24
months
Which Accrediting Agency requires all practitioners with clinical privileges to participate in continuing
education? - ✔✔DNV
According to CMS, what criteria are used by the governing board for the selection of medical staff
members? - ✔✔Character, competence, training, experience, and judgment
Which agency requires peer recommendations be obtained at initial credentialing and reappointment? -
✔✔AAAHC
Which regulatory agency standards must be followed for a hospital to bill for Medicare/Medicaid
services? - ✔✔CMS Conditions of Participation
Which Federal legislation created the National Practitioner Data Bank? - ✔✔HCQIA
According to TJC, what is required to make a recommendation to the Governing Board? - ✔✔Medical
Executive Committee
According to NCQA, the application process is located in what document? - ✔✔
Why it is important to check that the practitioner is not currently excluded, suspended, debarred, or
ineligible to
participate in Federal health care programs? - ✔✔The facility won't get paid for treating patients unless
service is provided by authorized provider.
Which credential must be tracked on an ongoing basis? - ✔✔Licensure
,According to NCQA standards, an organization that discovers sanction information, complaints, or
adverse
events regarding a practitioner must take what action? - ✔✔Determine if there is evidence of poor
quality that could affect the health and safety of its members.
What is the name of the entity that was established through the Health Care Quality Improvement Act
of 1986
to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move
from state
to state without disclosure or discovery of previous medical malpractice payment and adverse action
history? - ✔✔NPDB
When developing clinical privileging criteria, what is important to evaluate? - ✔✔Established standards
of practice such as, specialty board recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges for each
specialty? - ✔✔To protect patient safety by ensuring current competency, relevance to the facility, and
accepted standards
of care.
What type of specialists is most likely to perform a PTCA? - ✔✔Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital-specific and -
✔✔Based on the individual's demonstrated current competence and the procedures the hospital can
support.
What type of procedure would be routinely performed by a cardiologist? - ✔✔Transesophageal
Echocardiography
Which NCQA-required committee makes recommendations regarding credentialing decisions? -
✔✔Credentialing Committee
, HFAP standards require three medical staff committees to be delineated in the medical staff structure.
Two of
them are the Medical Executive Committee and the Utilization of Osteopathic Methods & Concepts
Committee
(required for hospitals with ten or more DOs who admit patients and provide direct patient care). What
is the
other required medical staff committee? - ✔✔Utilization Review Committee
If you needed to find out about what the Federal Government requires in regards to anti-trust issues,
what law
would you consult? - ✔✔Sherman Anti-trust Act
Peer references should be obtained from - ✔✔Practitioners in the same professional discipline as the
applicant
Patrick v. Burgett is an important case because it: - ✔✔Illustrates the potential for antitrust liability
arising out of peer review activities
If a medical staff member has privileges and/or medical staff appointment revoked, he/she must be: -
✔✔Provided due process
Access to credentials files should be: - ✔✔Described fully in an access policy
What body approves clinical privileges? - ✔✔Governing Body or Board
What primary source verification is required by NCQA prior to provisional credentialing? - ✔✔Licensure
and 5 year malpractice history or NPDB
According to The Joint Commission standards, initial appointments to the medical staff are made for a
period of: - ✔✔Not to exceed two years
Submission
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 correctness and
completeness of the application. If an application from an external entity is used it must include the
questions and attestations as identified above. Signature stamps are not acceptable unless the
practitioner is physically impaired and the disability is documented in the practitioners file. - ✔✔NCQA
Health Plan/CVO
Which type of agenda is used on a meeting agenda to group together non-controversial business and
reports that can be approved under one motion instead of individually approving each item? -
✔✔Consent Agenda
According to NCQA under what circumstance would a Locum Tenens practitioner be exempt from
credentialing? - ✔✔Covering Practitioner
According to URAC, when developing a quality auditing process, prudent practice would be to audit
what percentage of completed credentialing files? - ✔✔
According to URAC, a complete credentials file should be reviewed by which professionals? - ✔✔
According to NCQA, what must be included in the organization's right to appeal policies? - ✔✔written
notification when a professional review action has been brought against a practitioner
reasons for the action
summary of the appeal rights and process
ability to request a hearing and the specific time period for submitting the request
allowing for at least 30 calendar days after the notification for practitioners to request a hearing
allowing representation by an attorney or another person
appointment of a hearing officer or a panel of individuals to review the appeal
and written notification of the appeal decision that contains specific reasons for the decision.
,Which Accrediting body requires an attestation to the practitioners identity? - ✔✔The Joint Commission
According to HFAP, how often must a reappraisal of membership and privileges occur? - ✔✔Every 24
months
Which Accrediting Agency requires all practitioners with clinical privileges to participate in continuing
education? - ✔✔DNV
According to CMS, what criteria are used by the governing board for the selection of medical staff
members? - ✔✔Character, competence, training, experience, and judgment
Which agency requires peer recommendations be obtained at initial credentialing and reappointment? -
✔✔AAAHC
Which regulatory agency standards must be followed for a hospital to bill for Medicare/Medicaid
services? - ✔✔CMS Conditions of Participation
Which Federal legislation created the National Practitioner Data Bank? - ✔✔HCQIA
According to TJC, what is required to make a recommendation to the Governing Board? - ✔✔Medical
Executive Committee
According to NCQA, the application process is located in what document? - ✔✔
Why it is important to check that the practitioner is not currently excluded, suspended, debarred, or
ineligible to
participate in Federal health care programs? - ✔✔The facility won't get paid for treating patients unless
service is provided by authorized provider.
Which credential must be tracked on an ongoing basis? - ✔✔Licensure
,According to NCQA standards, an organization that discovers sanction information, complaints, or
adverse
events regarding a practitioner must take what action? - ✔✔Determine if there is evidence of poor
quality that could affect the health and safety of its members.
What is the name of the entity that was established through the Health Care Quality Improvement Act
of 1986
to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move
from state
to state without disclosure or discovery of previous medical malpractice payment and adverse action
history? - ✔✔NPDB
When developing clinical privileging criteria, what is important to evaluate? - ✔✔Established standards
of practice such as, specialty board recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges for each
specialty? - ✔✔To protect patient safety by ensuring current competency, relevance to the facility, and
accepted standards
of care.
What type of specialists is most likely to perform a PTCA? - ✔✔Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are hospital-specific and -
✔✔Based on the individual's demonstrated current competence and the procedures the hospital can
support.
What type of procedure would be routinely performed by a cardiologist? - ✔✔Transesophageal
Echocardiography
Which NCQA-required committee makes recommendations regarding credentialing decisions? -
✔✔Credentialing Committee
, HFAP standards require three medical staff committees to be delineated in the medical staff structure.
Two of
them are the Medical Executive Committee and the Utilization of Osteopathic Methods & Concepts
Committee
(required for hospitals with ten or more DOs who admit patients and provide direct patient care). What
is the
other required medical staff committee? - ✔✔Utilization Review Committee
If you needed to find out about what the Federal Government requires in regards to anti-trust issues,
what law
would you consult? - ✔✔Sherman Anti-trust Act
Peer references should be obtained from - ✔✔Practitioners in the same professional discipline as the
applicant
Patrick v. Burgett is an important case because it: - ✔✔Illustrates the potential for antitrust liability
arising out of peer review activities
If a medical staff member has privileges and/or medical staff appointment revoked, he/she must be: -
✔✔Provided due process
Access to credentials files should be: - ✔✔Described fully in an access policy
What body approves clinical privileges? - ✔✔Governing Body or Board
What primary source verification is required by NCQA prior to provisional credentialing? - ✔✔Licensure
and 5 year malpractice history or NPDB
According to The Joint Commission standards, initial appointments to the medical staff are made for a
period of: - ✔✔Not to exceed two years
