CPCS Flashcards
When preparing for a committee meeting, the medical services professional MOST likely would meet with whom to coordinate the agenda and meeting packet?
A) Medical Director
B) Vice President of Medical Affairs
C) Committee chairperson
C) Committee chairperson
According to The Joint Commission, which of the following dictates the qualifications and criteria for appointment to the medical staff?
A) Credentialing policies and procedures
B) Medical Executive Committee
C) Medical Staff Bylaws
C) Medical Staff Bylaws
According to URAC, within how many days must the practitioner be notified of credentialing decisions?
A) 10 days
B) 30 days
C) 60 days
A) 10 days
According to The Joint Commission, which of the following is an approved source for verification of a medical degree from a United States educational Institution?
A) AMA physician masterfile
B) ECFMG
C) ACGME
A) AMA physician masterfile
How many peer references does HFAP require at initial appointment?
A) One
B) Two
A) One
According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action?
A) Determine if there is evidence of poor quality that could affect the health and safety of its members
B) Immediately take action to remove the provider from its panel
C) Notify the practictioner that he or she is under investigation and initiate the hiring process
A) Determine if there is evidence of poor quality that could affect the health and safety of its members
According to The Joint Commission hospital standards, which of the following is an element of a self-governing medical staff?
A) The hospital’s board of directors determines the criteria for granting medical staff privileges
B) There can be any number of medical staffs as long as they are approved by the governing body
C) The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibility to practitioners with independent privileges.
C) The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibility to practitioners with independent privileges.
In order for a healthcare facility to participate in the Medicare and Medicaid programs it must comply with the:
A) Medicare Conditions of Participation
B) National Committee for Quality Assurance (NCQA) standards
C) The Joint Commission of Accreditation of Healthcare Organizations standards
A) Medicare Conditions of Participation
Robert’s Rules of order is an example of:
A) A code of conduct
B) Executive privilege
C) Parliamentary procedure
C) Parliamentary procedure
Which of the following providers is considered a primary care physician (PCP)?
A) Family medicine practitioner
B) General surgeon
C) Gastroenterologist
A) Family medicine practitioner
When credentialing and privileging practitioners, it is appropriate to?
A) Follow a routine process for each applicant
B) Handle each applicant on a case-by-case basis
C) Process all applications within one week of receipt
A) Follow a routine process for each applicant
Active, Associate, Courtesy, Honorary, and Consulting are examples of:
A) Privileges
B) Membership categories
C) Committees
B) Membership categories
What is the only hospital medical staff committee required by The Joint Commission hospital standards?
A) Utilization review committee
B) Credentials committee
C) Medical executive committee
C) Medical executive committee
You are working at an AAAHC accredited facility and you want to introduce the concept of utilizing a credentials verification organization. If the CVO is not accredited by a nationally recognized organization, you must:
A) Perform an assessment of the capability and quality of the CVO’s work
B) Perform an assessment of their turn-around times.
C) The organization must conduct an onsite survey every three years
A) Perform an assessment of the capability and quality of the CVO’s work
Can the hospital accept an NPDB self-query performed by the physician to satisfy The Joint Commission’s requirement for NPDB query?
A) Yes
B) No. The hospital or designated agent must perform the query.
B) No. The hospital or designated agent must perform the query.
Licensure Definition
A) License Independent Practitioner - Term used by TJC
B) A license is the authority a government agency grants an individual to practice
C) Process of obtaining, verifying, & assessing the qualifications of a healthcare practitioner who seeks to provide patient care services for a hospital
B) A license is the authority a government agency grants an individual to practice
According to TJC Standards temporary privileges may be granted to a Medical staff appointee if the recredentialing application is not submitted in a timely fashion to prevent any lapse.
A) True
B) False
B) False
HFAP requires a specific document to describe qualifications & criteria for candidates prior to MEC
A) Bylaws or Appended Credentialing Manual
B) Policies and Procedures
C) Rules and Regulations
A) Bylaws or Appended Credentialing Manual
What document allows a person to give directions about future medical care to designate another person if the individual loses decision making capacity?
A) Power of Attorney
B) Consent Release
C) Advanced Directive
C) Advanced Directive
NPDB operates by the following laws:
A) Title IV of the Health Care Quality Improvement Act of 1986 (HCQIA), Public Law 99-660 Section 1921 of the Social Security Act, Section 1128E of the Social Security Act
B) Title IV of the Health Care Quality Improvement Act of 1986 (HCQIA)
C) Federal & State Laws
A) Title IV of the Health Care Quality Improvement Act of 1986 (HCQIA), Public Law 99-660 Section 1921 of the Social Security Act, Section 1128E of the Social Security Act
What is an ex-officio member?
A) service as a member of a body by virtue of an office or position held and, can have voting rights based on hospital bylaws
B) tends to be an established, experienced, and respected, member of the medical staff.
C) A member who recommends approval or disapproval to the board.
A) service as a member of a body by virtue of an office or position held and, can have voting rights based on hospital bylaws
Office of the Inspector General is the list of individuals organizations that have been excluded from participation in Medicare, Medicaid, and Federal health care programs.
A) True
B) False
A) True
There may be licensed independent practitioners such as physician assistants or nurse practitioners who are: Allowed by state laws and licensing regulations to practice w/out direction of a physician and may also be granted medical staff membership
A) True
B) False
A) True
The six areas of “general competencies”: Patient care, medical/clinical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice were developed by?
A) TJC
B) ACGME and ABMS
C) AMA
B) ACGME and ABMS
Locum Tenens Definition
A) A healthcare practitioner that acts like a proctor
B) A healthcare practitioner or individual that fills in for another for a given length of time
C) A group of healthcare practitioners
B) A healthcare practitioner or individual that fills in for another for a given length of time
According to JC & HFAP name four approved sources PSV for Medical Education:
A) Medical School, AMA, ECFMG, AOA
B) Medical School, ECFMG, Sealed Transcript, AMA, AOA
C) Medical School, State Agency (if the state agency performs primary source), FCVS, AMA, AOA
A) Medical School, AMA, ECFMG, AOA
T/F Only the highest of training must be verified according to NCQA
A) True
B) False
A) True
True or false, Can the originating site use the credentialing and privileging decision of the distant-site telemedicine providers?
A) True
B) False
A) True
Who requires peer references on initial appointment?
A) TJC, HFAP, AAAHC, DNV
B) HFAP, TJC, NCQA
C) URAC, TJC, HFAP
A) TJC, HFAP, AAAHC, DNV
Who reappoints?
A) TJC, HFAP, NCQA
B) TJC, HFAP, DNV, NCQA, URAC, AAAHC
C) TJC, NCQA, URAC, HFAP
B) TJC, HFAP, DNV, NCQA, URAC, AAAHC
Who requires an attestation?
A) NCQA, URAC, AAAHC
B) TJC, DNV, NCQA
C) URAC, DNV, NQCA
A) NCQA, URAC, AAAHC
URAC education verification time limit
A) 180 days
B) 120 days
C) 365 days
A) 180 days
Is a payment made by an insurance company reportable to the NPDB?
A) Yes
B) No
A) Yes
Who requires that all licensed independent practitoners must be credentialed and privileged through the organized Medical Staff structure?
A) TJC
B) NCQA
C) URAC
A) TJC
Telemedicine originating site is?
A) Site where the patient is receiving care is located
B) Site where the physician is located
A) Site where the patient is receiving care is located
Which accreditation standards define that the governing body has the ultimate authority and responsibility for oversight and delivery of care rendered by LIPs and other practitioners credentialed and privileged through the medical staff process?
A) TJC, HFAP, DNV, AAAHC
B) TJC
C) TJC, HFAP and AAAHC
A) TJC, HFAP, DNV, AAAHC
CMS recommends that an appraisal be conducted at least every
A) 6 months
B) 12 months
C) 24 months
C) 24 months
Entities must report clinical privileges actions to the NPDB if they result from a professional review action and last longer than
A) 15 days
B) 30 days
C) 60 days
B) 30 days
According to HFAP standards temporary privileges may be granted
A) For time of emergency or disaster, Locum tenens, During review and consideration of application,For care of specific patients
B) Not specifically addressed
C) When is a clean file, and all relevant training or experience have been verified.
A) For time of emergency or disaster, Locum tenens, During review and consideration of application, For care of specific patients
Education verification not required if the practitioner is board certified
A) AAAHC
B) TJC
C) URAC
C) URAC
Which of the following require verification of employment and work history?
A) TJC
B) HFAP
C) DNV-GL
D) URAC
B) HFAP
Which of the following require peer recommendations for initial and reappointment?
A) AAAHC
B) TJC
C) NCQA & URAC
D) HFAP & DNV-GL
A) AAAHC
Which of the following must verify OIG Medicare/Medicaid exclusions at initial, reappointment and when granting temporary privileges?
A) DNV GL
B) HFAP
C) URAC
A) DNV GL
TJC recommends, but does not require that hospitals based evaluation of experience, ability and current competence on the six areas of General Competencies.
A) True
B) False
A) True
Per NCQA which of the following is not an acceptable attestation signature?
A) The attestation signature may be faxed or scanned
B) The attestation signature may be a stamp signature
C) The attestation signature may be electronic or digital
B) The attestation signature may be a stamp signature
Which of the following is not a parliamentary procedure?
A) Adjourn
B) Call Question
C) Divide the Table
C) Divide the Table
Per NCQA which of the following is the highest level of training?
A) Medical School
B) Internship
C) Residency
D) Fellowship
C) Residency
True or False. URAC verification of education is not required if the practitioner is board certified.
A) True
B) False
A) True
Per URAC which of the following are not included within the scope of the credentialing standards?
A) Non-physicians
B) Physicians who are employees of a facility as hospitalists and who are not listed in the provided directory
C) Facilities that provide covered health care services to consumers
B) Physicians who are employees of a facility as hospitalists and who are not listed in the provided directory
Which of the following is not included in the AOA Osteopathic Physician Profile Report?
A) DEA status
B) Osteopathic Specialty Board Certification
C) Former name(s) and former addresses (city/state)
D) ECFMG status
D) ECFMG status
Which of the following confers deemed status?
A) AOA
B) TJC
C) CMS
D) HCQIA
C) CMS
According to NCQA what is the verification time limit for the attestation?
A) 365 days
B) 120 days
C) 180 days
A) 365 days
According to NCQA which of the following documents must be verified through the direct source?
A) Professional Liability Insurance
B) License
C) DEA
B) License
According to NCQA a practitioner must provide documentation of work history for a minimum of how many years?
A) 3
B) 5
C) 7
B) 5
NIAHO Standards are a direct quotation of the?
A) CMS regulations
B) Medical Staff Rules & Regulations
C) Medical Staff Bylaws
D) HFAP Standards
A) CMS regulations
True or False. According to TJC new requests for privileges (those not occurring together with appointment) are typically processed in the same manner as the initial grant of privileges.
A) True
B) False
A) True
According to TJC, the organization may delegate appointment decisions to which of the following?
A) A committee of two members of the Governing Body
B) Medical Executive Committee
C) Credentials Committee of the medical staff
A) A committee of two members of the Governing Body
TJC requires the medical staff to review which information prior to recommending privileges?
A) Board certification status
B) Relevant practitioner specific data
C) Open malpractice claims
B) Relevant practitioner specific data
According to the Joint Commission, who is responsible for developing criteria for FPPE when issues affecting the provision of safe patient care are identified?
A) Medical Staff
B) Governing Body
C) Department Chair
A) Medical Staff
Peritoneal dialysis is treatment ordered by which of the following practitioners?
A) Nephrologist
B) Oncologist
C) Hematologist
A) Nephrologist
How frequently does CMS recommend that an appraisal of each member of the medical staff be conducted?
A) At least every 24 months following initial appointment
B) At least every 6 months following initial appointment
C) Annually following initial appointment and every two years thereafter
A) At least every 24 months following initial appointment
According to NCQA, at recredentialing, which of the following must be verified within 180 days prior to the credentialing decision?
A) Lifetime board certification
B) Hospital Affiliation
C) Privileges
A) Lifetime board certification
According to URAC, how often must a periodic review of delegated functions occur?
A) No less than every two years
B) No less than every three years
C) No less than annually
B) No less than every three years
In what document does CMS require a description of privileging criteria and the procedures for applying the criteria?
A) Rules and Regulations
B) Credentialing Policies
C) Medical Staff Bylaws
C) Medical Staff Bylaws
Which legislation prohibits a physician with a financial arrangement with an entity from referring Medicare / Medicaid patients to that entity?
A) Stark Law
B) HCQIA
C) EMTALA
A) Stark Law
NCQA requires an organization to have which of the following?
A) Department-specific procedures
B) Credentialing Policies and Procedures
C) Governing Board Bylaws
B) Credentialing Policies and Procedures
According to TJC, the credentialing decision is communicated to the practitioner within what timeframe?
A) 15 days
B) 30 days
C) As specified in the medical staff bylaws
C) As specified in the medical staff bylaws
According to NCQA, an initial application must include which of the following verifications?
A) All active licenses
B) Hospital Affiliations
C) Five years of pending malpractice claims history
C) Five years of pending malpractice claims history
According to TJC, the AMA is considered an equivalent primary source for which of the following?
A) Licensure actions
B) Medical school graduation
C) Medicare/Medicaid sanctions
B) Medical school graduation
