Study Session 2/11/2025 Flashcards
1
Q
Established in 1956, an organization that assesses whether international medical graduates are ready to enter residency or fellowship programs in the United States.
A
ECFMG
2
Q
National non-profit organization that represents the 71-state medical and osteopathic boards of the U.S. and its territories and co-sponsors the USMLE.
A
FSMB
3
Q
Repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers and suppliers.
A
NPDB
4
Q
Database that contains information about people and entities in the healthcare field who have been involved in fraud, abuse or other wrongdoings.
A
FACIS
5
Q
Founded in 1847, is the largest and only national association that convenes 190+ state and specialty medical societies and other critical stakeholders to promote the art and science of medicine and the betterment of public health.
A
AMA
6
Q
This organization requires a process by which an organization reviews and evaluates qualifications of licensed practitioners to provide services to its members.
A
NCQA
7
Q
Not for Profit organization that sets and monitors voluntary professional education standards essential in preparing physicians to deliver safe, high-quality medical care.
A
ACGME
8
Q
Per ACHC, Which of the following is an approved source for verifying Education.
a. FSMB
b. ECFMG
c. NPDB
A
ECFMG
9
Q
At an ACHC accredited hospital which of the following source is recognized for verifying actions against a physician’s medical license.
a. ACGME
b. ECFMG
c. FACIS
A
FACIS
10
Q
NCQA only recognizes residency programs that have been accredited by which of the following?
a. NCQA
b. ACGME
c. AMA
A
ACGME
11
Q
FCVS
A
Federation Credentials Verification Service
12
Q
ABMS
A
American Board of Medical Specialties
13
Q
OIG
A
Office of Inspector General
14
Q
FEHB
A
Federal Employees Health Benefits Program
15
Q
USMLE
A
United States Medical Licensing Examination
16
Q
DNV
A
Det Norske Veritas
17
Q
CMS
A
Centers for Medicare & Medicaid Services
18
Q
____________ is defined as the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.
a. Electronic Communication
b. Telemedicine
c. Electronic Signature
A
Telemedicine
19
Q
According to The TJC the originating site can fully _______ and ________ the practitioner according to MS standards.
a. Audit and Delegate
b. Treatment and Services
c. Privilege and Credential
A
Privilege and Credential
20
Q
____________ requires that the medical staff review and analyze all relevant information regarding current licensure, training, experience, current competence, and ability to perform the privileges requested.
a. DNV
b. TJC
c. AAAHC
A
TJC
21
Q
According to ____________ the medical staff must examine each individual practitioner’s qualifications and demonstrated competencies to perform each task/activity/privilege listed for the applicable scope of privileges for that category of practitioner.
a. ACHC
b. TJC
c. NCQA
A
ACHC
22
Q
A ___________ _____________ can be utilized for items that are routine issues that do not require discussion. These items are voted on, without discussion, as a bundle.
a. Privileged Agenda
b. Consent Agenda
c. Memorandum of Actions
A
Consent Agenda
23
Q
Distributing __________ or _________ information is allowed prior to a meeting.
a. Confidential Documents or Peer Review
b. Meeting Notice or Statements
c. Agenda or attendance
A
Confidential Documents or Peer Review
24
Q
The DEA has a registration system in place which authorizes medical professionals, researchers, and manufacturers to access ___________?
a. The prescription drug monitoring program
b. Schedule I-V drugs
c. OTC medicines
A
Schedule I-V drugs
25
Authorized registrants received a __________, which is used for tracking controlled substances and as a unique identifier for anyone who can prescribe controlled substances.
a. PIN
b. Password
c. DEA number
DEA number
26
Which accrediting body requires statement / information regarding felony convictions?
a. NCQA, ACHC, AAAHC
b. TJC, DNV, URAC
c. DNV, URAC, Medicare
NCQA, ACHC, AAAHC
27
According to ___________ the applicant must provide information regarding criminal convictions other than a minor traffic violation.
a. URAC
b. AAAHC
c. TJC
AAAHC
28
Per _______ accreditation Education is verified by primary or secondary source on initial appointment.
a. AAAHC
b. Medicare
c. TJC
AAAHC
29
According to _____________, history of education and professional training must be included on the credentialing application.
a. AAAHC
b. URAC
c. TJC
URAC
30
All physicians or licensed practitioners providing patient care services via telemedicine are subject to the credentialing and privileging process of the ______ ____________.
a. Distant Site
b. Originating Site
c. Both a & b
Originating Site
31
What organization states it must implement mechanisms for reviewing credentialing information for completeness, accuracy, and conflicting information?
a. DNV
b. NCQA
c. URAC
URAC
32
Which of the following is NOT part of what should be included in a record retention policy for storing credential files?
a. Who has access to credential files and under what circumstances
b. Where the keys to locked storage are kept
c. The preferred filing method for organizing documents
The preferred filing method for organizing documents
33
What kind of motion has no order of precedence and arises incidentally and decided immediately?
a. Main motion
b. Incidental motion
c. Privileged motion
Incidental motion
34
What organization states education must be verified within 180 days of credentialing decision?
a. TJC
b. URAC
c. NCQA
URAC
35
Which choice below shows all organizations that address what information is needed regarding felony convictions?
a. TJC, DNV, URAC
b. NCQA, ACHC, AAAHC
c. DNV, Medicare, NCQA
NCQA, ACHC, AAAHC
36
When a practitioner and a patient are located in different states, the practitioner providing the patient care services must be?
a. Must have license in the distant site and meet standards with state or local laws
b. Must be licensed and/or meet the other applicable standards that are required by state or local laws in both states
c. Must meet state or local laws with the originating site
Must be licensed and/or meet the other applicable standards that are required by state or local laws in both states
37
Some accreditors have standards specific to the review of information received in the credentialing and privileging process. Who does not?
a. Medicare, AAAHC, DNV
b. All have standards or requirements for review of information
c. AAAHC, ACHC, TJC, DNV
Medicare, AAAHC, DNV
38
Which organization references CR 3 Element A Fact 2: DEA or CDS certificates must be verified in each state where the practitioner provides care to its members?
a. TJC
b. URAC
c. NCQA
NCQA
39
What is one disadvantage of a healthcare organization using a centralized database for physician credentialing
a. To many people accessing files and files can get misplaced
b. To many audits to make sure data integrity is not jeopardized
c. Increased risk of inappropriate dissemination of information
Increased risk of inappropriate dissemination of information
40
What is a Quorum?
a. The number of people that must be present to transact business
b. Establishing a meeting
c. Taking good minutes in a meeting
The number of people that must be present to transact business
41
What does NCQA state if a provider does not prescribe medications that require a DEA or CDS?
a. Provider should always have a DEA or CDS in he/she wants to be considered for credentialing
b. There must be a document in place to explain why the practitioner does not prescribe medications
c. Peer or covering colleague must prescribe on behalf of the practitioner without the certification
There must be a document in place to explain why the practitioner does not prescribe medications
42
Which accreditor verifies education with primary or secondary source on initial appointment?
a. DNV
b. TJC
c. AAAHC
AAAHC
43
What standard states a provider must provide information regarding criminal convictions other than minor traffic violations.
a. AAAHC
b. URAC
c. TJC
AAAHC
44
Which accreditation does not specifically address telemedicine, but states if provided by contract, the governing body maintains responsibility?
a. URAC
b. AAAHC
c. DNV
AAAHC
45
URAC requires the organization to implement mechanisms for reviewing credentialing information for these 3 things?
a. continuing education, adherence to medical staff rules, compliance with licensure requirements
b. training, experience, ability to perform privilege
c. completeness, accuracy, conflicting information
completeness, accuracy, conflicting information
46
A _______ ______ may be maintained showing who accessed the files, on what date, and for what reason?
a. control log
b. record retention policy
c. sign-in sheet
control log
47
Which is not a Subsidiary Motion?
a. Adjourn
b. Postpone indefinitely
c. Amend
Adjourn
48
If a practitioner does not prescribe medications requiring a DEA or CDS certificate, _______ requires a documented process to require an explanation as to why the practitioner does not prescribe medications?
a. DNV
b. AAAHC
c. NCQA
NCQA
49
Sealed transcripts may be accepted if the organization shows evidence that it inspected the contents of the envelope and confirmed that practitioner completed the appropriate training program with what accreditation?
a. TJC
b. URAC
c. NCQA
NCQA
50
______ states that the applicant must provide information regarding criminal convictions other than minor traffic violations?
a. ACHC
b. NCQA
c. AAAHC
AAAHC
51
What accreditation standards are a direct quote of the CMS regulations regarding telemedicine?
a. ACHC and DNV
b. NCQA and URAC
c. ACHC and AAAHC
ACHC and DNV
52
Under NCQA, the ___________ must, at a minimum, review the credentials for practitioners who do not meet established thresholds, give thoughtful consideration to the credentialing, information and document its credentialing, discussions in the meeting minutes.
a. Medical Director
b. Board of Delegated Board Committee
c. Credentials Committee
Credentials Committee
53
Generating a report from a credentialing database containing information; comparing data from credentialing database and/or provider / contracting data elements; identifying outliers and correct discrepancies; generating a report to verify accuracy are steps that can be done on a periodic basis to ensure data ________________.
a. Security
b. Accuracy
c. Retention
Accuracy
54
Motions that bring about a question do not quite fit under the categories of the Parliamentary Motions Guide and can only be made ___________.
a. while no business is pending
b. to assist the body in disposing of a main motion
c. when the motion last proposed is considered and disposed of first
while no business is pending
55
TJC states "all physicians or licensed practitioners providing patient care services via telemedicine are subject to _______________.
a. The credentialing and privileging processes of the originating site
b. The credentialing and privileging processes of the distant site
c. The credentialing and privileging processes of the billing site
The credentialing and privileging processes of the originating site
56
The Credentialing Committee must, at a minimum, review the credentials for practitioners who do not meet established thresholds, consider the credentialing information and document its credentialing discussions in the meeting minutes. Files meeting established criteria may be reviewed and approved by the Credentialing Committee or by a medical director or designated physician.
a. URAC
b. ACHC
c. NCQA
NCQA
57
It is essential that _________________ be evaluated on a periodic basis.
a. HIPAA Policies
b. Data Accuracy
c. Access Permissions
Data Accuracy
58
Robert’s Rules of Order — 11th Edition (RONR) is the most widely used parliamentary manual in the United States, with various versions used by approximately 80% of organizations. The second most commonly used parliamentary authority is:
a. The New Standard Code of Parliamentary Procedure, which is used by approximately 15%
b. Demeter’s Manual of Parliamentary Law and Procedure, used by about 5% of groups
c. Sturgis’s Standard Code of Parliamentary Procedure, percentage if use not stated
The New Standard Code of Parliamentary Procedure, which is used by approximately 15%
59
Initial appointment to the medical staff and granting of initial clinical privileges shall include primary source verification of current DEA number (if required).
a. AAAHC
b. ACHC
c. DNV
DNV
60
History of education and professional training must be included on the credentialing application.
a. URAC
b. NCQA
c. TJC
URAC
61
The application requests information regarding any criminal history and a criminal background investigation is conducted based on information provided in the application or as required by Federal and State regulations.
a. NCQA
b. ACHC
c. AAAHC
ACHC
62
Many healthcare facilities utilize telemedicine providers to provide __________________ that are not readily available to the facility or to provide specialty care consultations for isolated specialties or practitioners.
a. services
b. admissions
c. consults
services
63
Regarding the analysis and use of information received, some ______________ have standards specific to the review of the information received in the credentialing and recredentialing processes.
a. regulations
b. MS bylaws
c. Accreditors
Accreditors
64
It is a good idea to perform periodic ____________ to credentials files to verify compliance with the requirement of bylaws, accrediting agencies, and state and federal regulations.
a. checklists
b. audits
c. surveys
audits
65
Parliamentary law protects the rights of the _________, while assuring the will of the ____________.
a. majority minority
b. minority, majority
c. patients, doctors
minority, majority
66
What accrediting organization requires a DEA to be verified on an ongoing basis (if applicable), at a minimum at expiration, appointment and reappointment?
a. NCQA
b. DNV
c. AAAHC
AAAHC
67
What accrediting body required the highest level of education or training to be verified?
a. URAC
b. DNV
c. NCQA
URAC
68
What accrediting body states that the applicant must provide information regarding criminal convictions other than minor traffic violations?
a. AAAHC
b. TJC
c. NCQA
AAAHC
69
What is telemedicine?
a. The use of medical information exchanged form one site to another via electronic communications
b. The use of electronic means for providers to provide consults to other facilities or providers
c, When medical information is reviewed by the patient via a patient portal
The use of medical information exchanged form one site to another via electronic communications
70
These accrediting bodies telemedicine standards are a direct quotation of the CMS regulations.
a. ACHC, NCQA
b. NCQA, URAC
c. ACHC, DNV
ACHC, DNV
71
These organizations do address analysis and use of information received in the credentialing & privileging process.
a. Medicare, DNV, URAC, AAAHC
b. TJC, ACHC, NCQA, URAC
c. ACHC, AAAHC, URAC TJC
TJC, ACHC, NCQA, URAC
72
The following are the typical elements included in credentialing and privileging databases:
a. Demographic, Addresses, Appointment, License, Certification, Medical Education/Training, CME, and Committees
b. Staff Membership, Malpractice Insurance, Appointment, Licenses, Peer Reviews, & Certifications
c. Demographic, Addresses, Committees, Malpractice Insurance, Privileges, FPPE & OPPE
Demographic, Addresses, Appointment, License, Certification, Medical Education/Training, CME, and Committees
73
Which of the below is the most widely used parliamentary manual in the United States?
a. Robert’s Rules of Order
b. Demeter’s Manual of Parliamentary Law and Procedure
c. The New Standard Code of Parliamentary Procedure
Robert’s Rules of Order
74
This organization states that the practitioner application requests information regarding actions against DEA certificate or state CDS certificate.
a. DNV
b. ACHC
c. TJC
ACHC
75
The NCQA states that any of the following can be used to verify education and training.
a. The school, AMA Physician Masterfile, ECFMG, AOA, physician Masterfile, and the AAPA profile for verification of PA education and NCCPA certification
b. The primary source; the state licensing agency or specialty board, or registry; sealed transcripts may be accepted if the organization shows evidence that it inspected the contents of the envelope and confirmed that practitioner completed (graduated from) the appropriate training program; AMA Physician Masterfile
c. Education is verified with primary or secondary source on initial appointment
The primary source; the state licensing agency or specialty board, or registry; sealed transcripts may be accepted if the organization shows evidence that it inspected the contents of the envelope and confirmed that practitioner completed (graduated from) the appropriate training program; AMA Physician Masterfile
76
This organization requires that the applicant must provide information regarding criminal convictions other than minor traffic violations.
a. DNV
b. ACHC
c. AAAHC
AAAHC
77
When referencing telemedicine, who retains the responsibility for overseeing the safety and quality of services offered to its patients?
a. Distant site
b. Originating site
c. Healthcare facility
Originating site
78
When referencing analysis and use of information received, which standard states “files meeting established criteria may be reviewed and approved by the Credentialing Committee or by a medical director or designated physician?”
a. ACHC
b. NCQA
c. URAC
NCQA
79
In supporting departmental operations, how often should data be evaluated for accuracy?
a. on a monthly basis
b. on an annual basis
c. on a periodic basis
on a periodic basis
80
A motion to “Amend” falls under what type of motion?
a. Main
b. Privileged
c. Subsidiary
Subsidiary
81
Which standard does not require verification of DEA certificate or state controlled dangerous substance certificate?
a. NCQA
b. DNV
c. URAC
URAC
82
Education verification not required if the practitioner is board certified, under what standard?
a. ACHC
b. DNV
c. URAC
URAC
83
Which accreditations do not address felony convictions?
a. TJC, DNV, URAC
b. TJC, DNV, URAC, CMS
c. NCQA, ACHC, AAAHC
TJC, DNV, URAC
84
Who always retains the responsibility for overseeing the safety and quality of services offered to its patients?
a. The governing board
b. The originating site
c. Medical Staff Committee
The originating site
85
Which two standards are a direct quote of CMS Regulations regarding telemedicine?
a. TJC and AAAHC
b. NCQA and URAC
c. ACHC and DNV
ACHC and DNV
86
Which entity states that information received must be consistently applied for each requesting practitioner?
a. NCQA
b. TJC
c. AAAHC
TJC
87
When using an electronic filing system, what allows for ease of sorting files at a later date?
a. a control log
b. centralized database
c. consistent naming logic
consistent naming logic
88
Most groups formally adopt written rules of parliamentary procedure. How is this accomplished for the medical staff?
a. Adopting a bylaws provision specified manual of parliamentary law and edition be the authority
b. Once quorum is established, take a majority vote
c. Medical Executive Committee in conjunction with Medical Director decides
Adopting a bylaws provision specified manual of parliamentary law and edition be the authority
89
Which entity’s standard does not specifically address DEA?
a. NCQA
b. Medicare
c. ACHC
Medicare
90
Which standard requires PSV of education including AOA, AMA, and ECFMG, with documentation sufficient to support the requested privileges?
a. ACHC
b. Medicare
c. NCQA
ACHC
91
Which standard states the applicant must provide information regarding criminal convictions other than minor traffic violations?
a. NCQA
b. ACHC
c. AAAHC
AAAHC
92
How is telemedicine defined?
a. Only for use where providers can't reach patients at a clinic
b. A separate medical specialty
c. The use of medical information exchanged from one site to another via electronic communications to improve patient's health status
The use of medical information exchanged from one site to another via electronic communications to improve patient's health status
93
What accreditation states, "the Credentialing Committee must, at a minimum, review the credentials for practitioners who do not meet established thresholds, give thoughtful consideration to the credentialing information and document its credentialing discussions in the meeting minutes."
a. TJC
b. NCQA
c. URAC
NCQA
94
It is a good idea to perform periodic audits for credentials files to verify compliance with the requirements of bylaws, accrediting agencies and?
a. Medical Staff Services
b. Medicare CoP's
c. State and Federal Regulations
State and Federal Regulations
95
For which accreditation does medical staff criteria for consideration of automatic suspension include when the practitioner's DEA certificate has been revoked, suspended or on probation for any reason?
a. TJC
b. DNV
c. AAAHC
DNV
96
Which accrediting body states "the organization need only verify the highest level of credentials attained."
a. NCQA
b. ACHC
c. URAC
NCQA
97
Which accreditation states the application must include a statement regarding felony convictions.
a. TJC
b. NCQA
c. ACHC
NCQA
98
Which accreditation states "the medical staff must actually examine each individual practitioner's qualifications and demonstrated competencies to perform each task/activity/privilege listed for the applicable scope of privileges for that category of practitioner."
a. TJC
b. ACHC
c. NCQA
ACHC
99
If paper credentialing files are used, current files may be stored on-site, while historical files may be _____.
a. shredded
b. stored in boxes in a storage room
c. stored offsite
stored offsite
100
_____ do not relate to the pending business but have to do with special matters of immediate importance that should be allowed to interrupt the consideration of anything else.
a. Main motion
b. Subsidiary motion
c. Privileged motion
Privileged motion
101
Primary source verification is required and includes AMA, AOA, and ECFMG. Documentation regarding training and education must be sufficient to support requested privileges.
a. TJC
b. ACHC
c. NCQA
ACHC
102
If applicable, verify DEA/CDS on an ongoing basis; at a minimum, at expiration, appointment, and reappointment. Verify from primary or secondary source.
a. AAAHC
b. ACHC
c. NCQA
AAAHC
103
The application requests information regarding any criminal history and a criminal background investigation is conducted based on information provided in the application or as required by Federal and State regulations.
a. DNV
b. ACHC
c. AAAHC
ACHC
104
Which site always retains the responsibility for overseeing the safety and quality of services offered to its patients?
a. Originating site
b. Distant site
c. both a & b
Originating site
105
Name the 3 accrediting bodies that do not specifically address analysis and use of information received.
a. Medicare, DNV, AAAHC
b. URAC, NCQA, Medicare
c. TJC, Medicare, DNV
Medicare, DNV, AAAHC
106
When should essential data accuracy be evaluated?
a. Annually
b. Periodically
c. According to medical staff bylaws
Periodically
107
What is the precedence of motions?
a. Main, Secondary, Privileged
b. Privileged, Incidental, Main
c. Privileged, Subsidiary, Main
Privileged, Subsidiary, Main
108
Hysterectomy: a surgery to remove the uterus.
Gynecology
109
Electromyogram (EMG): a diagnostic test that measures the electrical activity of muscles
Neurologist
Physiatrist
Physician Medicine & Rehabilitation
Physical Therapist
