CPCS Self-Test

Question 1

Why it is important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs?

a. A facility could lose its accreditation if it does not do so.
b. It is required by Medicare Conditions of Participation.
c. The facility won’t get paid for treating patients unless service is provided by authorized provider.

Answer 1

The facility won’t get paid for treating patients unless service is provided by authorized provider

Question 2

Which of the following credentials must be tracked on an ongoing basis?

a. Post graduate education completed
b. Closed medical malpractice claims
c. Licensure

Answer 2

Licensure

Question 3

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 practitioner that he/she is under investigation and initiate the hearing process.

Answer 3

Determine if there is evidence of poor quality that could affect the health and safety of its members

Question 4

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?

a. Emergency Medical Treatment and Active Labor Act
b. The National Practitioner Data Bank
c. The Patient Safety and Quality Improvement Act

Answer 4

The National Practitioner Data Bank

Question 5

When developing clinical privileging criteria, which of the following is important to evaluate?

a. How many providers are in that specialty.
b. Established standards of practice, such as specialty board recommendations.
c. Whether or not the quality department can support the FPPE process

Answer 5

Established standards of practice, such as specialty board recommendations

Question 6

What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty?

a. It’s required by accreditation standards.
b. It is required by the Medicare Conditions of Participation.
c. To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care

Answer 6

To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care

Question 7

Which of the following specialists is most likely to perform a PTCA?

a. OB/GYN
b. Urologist
c. Interventional Cardiologist

Answer 7

Interventional Cardiologist

Question 8

The Joint Commission hospital standards require that clinical privileges are hospital specific and

a. Based on the individual’s demonstrated current competence and the procedures the hospital can support.
b. Based on board certification.
c. Based on the privileges the individual is currently approved to perform at other hospitals.

Answer 8

Based on the individual’s demonstrated current competence and the procedures the hospital can support.

Question 9

Which of the following would be routinely performed by a cardiologist?

a. Hysterectomy
b. Transesophageal Echocardiography
c. Urethral dilation

Answer 9

Transesophageal Echocardiography

Question 10

Which NCQA-required committee makes recommendations regarding credentialing decisions?

a. Medical Executive Committee
b. Quality Care Committee
c. Credentialing Committee

Answer 10

Credentialing Committee

Question 11

ACHC standards require two medical staff committees to be delineated in the medical staff structure. One of them is the Medical Executive Committee . What is the other required medical staff committee?

a. Credentials Committee
b. Investigational Review Board
c. Utilization Review Committee

Answer 11

Utilization Review Committee

Question 12

How often does NCQA require that delegation reports be evaluated by the health plan?

a. Monthly
b. Quarterly
c. Semi-Annually

Answer 12

Semi-Annually

Question 13

Peer references should be obtained from:

a. Practitioners who have referred patients to the provider
b. Former hospital administrators
c. Practitioners in the same professional discipline as the applicant

Answer 13

Practitioners in the same professional discipline as the applicant

Question 14

NCQA recognizes which of the following as the final approval of an applicant who does not meet criteria for a clean file?

a. Medical Director
b. Credentialing Committee
c. Board of Directors

Answer 14

Medical Director

Question 15

If a medical staff member has privileges and/or medical staff appointment revoked, he/she must be:

a. Granted temporary privileges.
b. Provided due process.
c. Reported immediately to the national practitioner data bank

Answer 15

Provided due process

Question 16

Access to credentials files should be:

a. Described fully in an access policy.
b. Available to the organization’s patients and potential patients.
c. Available to any physician on the staff

Answer 16

Described fully in an access policy

Question 17

Which of the following bodies approves clinical privileges?

a. Credentials Committee
b. Medical Executive Committee
c. Governing Body or Board

Answer 17

Governing Body or Board

Question 18

What primary source verification is required by NCQA prior to provisional credentialing?

a. Licensure and 5-year malpractice history or NPDB
b. Education and Training
c. Ability to perform privileges requested

Answer 18

Licensure and 5-year malpractice history or NPDB

Question 19

According to The Joint Commission standards, initial appointments to the medical staff are made for a period of:

a. One year
b. Two years
c. Not to exceed three years

Answer 19

Not to exceed three years

Question 20

According to The Joint Commission standards, temporary privileges may be granted by:

a. The department chair
b. The CEO on the recommendation of the medical staff president or authorized designee
c. The department chair and the president of the medical staff

Answer 20

The CEO on the recommendation of the medical staff president or authorized designee

Question 21

According to The Joint Commission Standards, which of the following items must be verified with a primary source?

a. Medicare/Medicaid Sanctions
b. Licensure, training, experience, and competence
c. Date of last hepatitis test

Answer 21

Licensure, training, experience, and competence

Question 22

According to NCQA standards, a copy of which of the following is acceptable verification of the document?

a. DEA certificate
b. Licensure
c. Board certification

Answer 22

DEA certificate

Question 23

According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians?

a. Federation of State Medical Boards
b. American Board of Medical Specialties
c. Education Commission on Foreign Medical Graduates Profile

Answer 23

Federation of State Medical Boards

Question 24

According to The Joint Commission standards, which of following is considered a designated equivalent source for verification of board certification?

a. The American Board of Medical Specialties
b. Education Commission on Foreign Medical Graduates Profile
c. Federation of State Medical Boards

Answer 24

The American Board of Medical Specialties

Question 25

Which of the following organizations have been recognized by The Joint Commission and NCQA to provide primary source verification of medical school graduation and residency training for U.S. graduates? a. National Practitioner Data Bank b. American Medical Association Masterfile c. Federation of State Medical Boards

Answer 25

American Medical Association Masterfile

Question 26

According to NCQA standards, the application attestation statement must affirm that the application a. Was actually completed by the provider. b. Was signed in the presence of a notary public. c. Is correct and complete

Answer 26

Is correct and complete

Question 27

According to The Joint Commission standards, medical staff bylaws should define a. Mechanism for appointment/reappointment of physician employed non- independent practitioners. b. The structure of the medical staff. c. The mechanism for emergency department call schedule

Answer 27

The structure of the medical staff

Question 28

According to The Joint Commission hospital standards, professional criteria for the granting of clinical privileges must include at least a. Relevant training or experience, ability to perform privileges requested, current licensure, and competence. b. Verification of all current and prior malpractice suits filed and settlements made. c. Letters of reference from the Chief Executive Officer of all current and prior hospital affiliations

Answer 28

Relevant training or experience, ability to perform privileges requested, current licensure, and competence

Question 29

The Joint Commission hospital standards require medical staff bylaws to include a. A requirement that all quality of care information be reviewed by the medical staff president. b. A mechanism for removal of the hospital’s chief executive officer. c. A mechanism for selection and removal of officers.

Answer 29

A mechanism for selection and removal of officers.

Question 30

According to NCQA standards, which of the following is an approved source for verification of board certification? a. National Practitioner Data Bank b. State licensing agency if state agency conducts primary verification of board status c. Viewing of the original board certificate

Answer 30

State licensing agency if state agency conducts primary verification of board status

Question 31

According to The Joint Commission hospital standards, which of the following is a required component of the reappointment process? a. Documentation of the applicant’s health status b. Verification of residency training c. Medicare/Medicaid sanctions query

Answer 31

Documentation of the applicant’s health status

Question 32

According to URAC’s health network standards, each applicant within the scope of the credentialing program submits an application that includes at least which of the following: a. State licensure information, including current license(s) and history of licensure in all jurisdictions b. A listing of all current and past hospital affiliations c. A NPDB self-query

Answer 32

State licensure information, including current license(s) and history of licensure in all jurisdictions

Question 33

According to AAAHC, which must be monitored on an ongoing basis? a. Current licensure b. Medical malpractice liability coverage c. Health status

Answer 33

Current licensure

Question 34

According to The Joint Commission, a nurse practitioner functioning independently and providing a medical level of care must: a. Have a job description. b. Be granted delineated clinical privileges. c. Be directly supervised by an active physician staff member

Answer 34

Be granted delineated clinical privileges

Question 35

According to The Joint Commission, which of the following is an acceptable source for verification for medical education of an international graduate? a. Board certification b. Federation of State Medical Boards c. Education Commission for Foreign Medical Graduates

Answer 35

Education Commission for Foreign Medical Graduates

Question 36

When evaluating compliance with the required time-frame for recredentialing, NCQA counts the recredentialing period to the: a. Week b. Month c. Year

Answer 36

Month

Question 37

NCQA standards require the organization to verify board certification at recredentialing: a. If a practitioner has received Medicare/Medicaid sanctions. b. If a practitioner is requesting a change in status. c. In all cases.

Answer 37

In all cases

Question 38

To whom does the AAAHC give the responsibility for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management? a. Credentials committee b. Governing body c. Medical director

Answer 38

Governing body

Question 39

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. The Joint Commission standards c. National Committee for Quality Assurance (NCQA) standards

Answer 39

Medicare Conditions of Participation

Question 40

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. The medical staff is self-governing, and as such, its organization does not have to be approved by the governing body. c. The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges.

Answer 40

The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges

Question 41

Robert’s Rules of order is an example of a. executive privilege. b. parliamentary procedure. c. a code of conduct

Answer 41

parliamentary procedure

Question 42

The medical staff application should provide a chronological history of a. The applicant’s education, training, and work history. b. CME activities and completion of residency. c. Marriages since medical school

Answer 42

The applicant’s education, training, and work history

Question 43

In order to participate in a health plan, a provider must be accepted to the plan’s a. Medical team b. Provider panel c. Point of service plan

Answer 43

Provider panel

Question 44

In order for a physician to practice medicine in any state in the United States, he/she must possess a. Appropriate board certification. b. Membership on the provider panel of the majority of the state’s major health plans. c. Current state licensure

Answer 44

Current state licensure

Question 45

Which of the following is considered post-graduate education? a. College b. Board Certification c. Residency training

Answer 45

Residency training

Question 46

Which of the following elements may not be used to evaluate credentials of applicants? a. Gender b. Licensure c. Post-graduate training

Answer 46

Gender

Question 47

The release of liability statement signed by the applicant for medical staff appointment should include: a. The name of the department chairman for all past hospital appointments. b. A statement providing immunity to those who respond in good faith to requests for information. c. Primary source verification

Answer 47

A statement providing immunity to those who respond in good faith to requests for information

Question 48

Primary source verification is: a. Considered economic credentialing. b. Receiving information directly from the issuing source. c. Delegated credentialing

Answer 48

Receiving information directly from the issuing source

Question 49

Unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice are examples of: a. Red flags. b. Medicare sanctions. c. Events reportable to the National Practitioner Data Bank

Answer 49

Red flags

Question 50

When documenting a telephone conversation regarding primary source verification what should be documented? a. The date and time of the call only. b. Who answered the call. c. Name of person and organization contacted, date of call, what was discussed and who conducted the interview

Answer 50

Name of person and organization contacted, date of call, what was discussed and who conducted the interview

Question 51

According to ACHC standards, when confirming malpractice coverage the organization must: a. Query the NPDB b. Obtain the claim history with each carrier over the last five years c. Have evidence of professional liability insurance, which includes certificate showing amounts of coverage

Answer 51

Have evidence of professional liability insurance, which includes certificate showing amounts of coverage

Question 52

Which of the following providers is considered a primary care physician (PCP)? a. General surgeon b. Family medicine practitioner c. Gastroenterologist

Answer 52

Family medicine practitioner

Question 53

Which body has the obligation to the community to assure that only appropriately educated, trained and currently competent practitioners are granted medical staff membership and clinical privileges? a. Medical Staff b. Governing Body c. The Joint Commission

Answer 53

Governing Body

Question 54

When credentialing and privileging practitioners it is appropriate to: a. Handle each applicant on a case-by-case basis. b. Follow a routine process for each applicant. c. Process all applications within one week of receipt

Answer 54

Follow a routine process for each applicant

Question 55

Medical liability insurance should be held in what limits? a. $500,000 per occurrence and $1,000,000 annual aggregate b. $1,000,000 per occurrence and $3,000,000 annual aggregate c. As specified by the medical staff and board of directors

Answer 55

As specified by the medical staff and board of directors

Question 56

Which of the following would be an appropriate question to ask an applicant for medical staff? a. How many children to you have? b. Are you married? c. Do you have any medical conditions, treated or untreated, that would negatively affect your ability to provide the services or perform the privileges you are requesting

Answer 56

Do you have any medical conditions, treated or untreated, that would negatively affect your ability to provide the services or perform the privileges you are requesting

Question 57

The governing body delegates the responsibility of credentialing, recredentialing, and privileging to: a. The hospital administrator b. The medical staff office c. The medical staff

Answer 57

The medical staff

Question 58

Who should have access to medical staff meeting minutes? a. Personnel as documented in a records access policy and procedure b. Medical Staff President c. Governing Body members

Answer 58

Personnel as documented in a records access policy and procedure

Question 59

In addition to conclusions, recommendations made, and actions taken, which of the following should always be documented in meeting minutes: a. Names and professional titles of all in attendance b. Date and location of next scheduled meeting c. Any required follow-up to occur.

Answer 59

Any required follow-up to occur

Question 60

Active, Associate, Courtesy, Honorary, Consulting are all examples of: a. Committees b. Membership categories c. Privileges

Answer 60

Membership categories

Question 61

Changes in medical staff bylaws are not final until formally approved by the: a. Medical staff b. Medical staff president c. Governing body

Answer 61

Governing body

Question 62

What is the only hospital medical staff committee required by The Joint Commission hospital standards? a. Credentials committee b. Medical executive committee c. Utilization review committee

Answer 62

Medical executive committee

Question 63

The Health Care Quality Improvement Act: a. Provides immunity for health care entities that do not report information to the National Practitioner Data Bank. b. Keeps hospitals and physicians who perform peer review from being sued. c. Provides qualified immunity from antitrust liability arising out of peer review activities that are conducted in good faith

Answer 63

Provides qualified immunity from antitrust liability arising out of peer review activities that are conducted in good faith

Question 64

If you have a question regarding whether or not information regarding a practitioner should be released to a third party, which of the following would be the best person to ask? a. Director of Medical Records b. Chief of Staff c. Organization’s attorney

Answer 64

Organization’s attorney

Question 65

Prior to releasing information to a third party regarding a practitioner, the organization should acquire a. A picture ID of the provider b. A signed consent and release form c. Approval from the organization’s attorney

Answer 65

A signed consent and release form

Question 66

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 initial on-site visit of the CVO to assess their capabilities and quality of work b. Perform an assessment of the capability and quality of the CVO’s work c. Perform an assessment of their turn-around times

Answer 66

Perform an assessment of the capability and quality of the CVO’s work

Question 67

Under DNV, what medical staff authority, in addition to the Chief Executive Officer, is required for granting temporary privileges? a. Medical Executive Committee b. Member of the Executive Committee, President of the Medical Staff, or Medical Director c. President of the Medical Staff

Answer 67

Member of the Executive Committee, President of the Medical Staff, or Medical Director

Question 68

According to the DNV, if the medical staff has an executive committee, who must attend the meetings? a. Medical Staff Members and CEO b. Medical Staff Members only c. Medical Staff Members, CEO and CNO (or designee) on an ex-officio basis

Answer 68

Medical Staff Members, CEO and CNO (or designee) on an ex-officio basis

Question 69

Automatic Suspension of clinical privileges may be considered at a DNV accredited hospital for which of the following instances? a. Providing an incomplete application; not disclosing three professional references b. Revocation/restriction of professional license; non-compliance with completing medical records c. Revocation/restriction of professional license; non-compliance in attending all medical staff meetings; and not utilizing all clinical privileges granted

Answer 69

Revocation/restriction of professional license; non-compliance with completing medical records

Question 70

According to the DNV, a History and Physical completed within 30 days prior to admission or registration shall include an entry in the medical record which documents an examination for any change in the patient’s current medical condition. Within what time frame must this be placed in the patient’s medical record? a. Within 48 hours prior to the admission or registration b. Immediately upon admission or registration, but prior to surgery or high-risk procedures c. Within 24 hours after admission or registration, and prior to surgery requiring anesthesia services or high-risk procedure

Answer 70

Within 24 hours after admission or registration, and prior to surgery requiring anesthesia services or high-risk procedure