Study Session 2/25/2025

Question 1

Which data bank is the official government-wide system of records of debarments, suspension and other exclusionary actions?

a. OIG
b. NPDB
c. SAM

Answer 1

SAM

Question 2

In the managed care setting, the MCO may verify only what education?

a. Medical/professional school
b. the highest level of education and training, or board certification, if applicable.
c. Fellowship training

Answer 2

the highest level of education and training, or board certification, if applicable.

Question 3

If you want to modify wording of a motion, what would you say?

a. I move to change the motion
b. I move to debate the motion
c. I move to amend the motion

Answer 3

I move to amend the motion

Question 4

Which accreditation states that OIG Medicare/Medicaid Exclusions must be primary source verified when granting temporary privileges?

a. ACHC
b. NCQA
c. DNV

Answer 4

DNV

Question 5

ACHC requires the NPDB be queried when?

a. on initial and reappointment
b. on initial only
c. yearly

Answer 5

on initial and reappointment

Question 6

The ______ & ______ are recognized as ABMS display agents?

a. AOA & CIN-BAD
b. FSMB (PDC) & AMA
c. OIG & ECFMG

Answer 6

FSMB (PDC) & AMA

Question 7

______ allows education verification to be from a sealed transcript. The organization must provide evidence of inspecting the contents of the envelope and confirming education completion / graduation.

a. NCQA
b. URAC
c. DNV

Answer 7

NCQA

Question 8

Which motion does not require a seconding motion?

a. Register a complaint
b. Kill main motion
c. Close meeting

Answer 8

Register a complaint

Question 9

________ states that the organization can verify Medicare / Medicaid sanctions with the issuing organization or the NPDB?

a. URAC
b. NCQA
c. DNV

Answer 9

URAC

Question 10

________ states that organizations are responsible for the ongoing monitoring of Medicare/Medicaid sanctions between recredentialing cycles and that information must be reviewed within 30 days of release by the reporting entity?

a. URAC
b. NCQA
c. DNV

Answer 10

NCQA

Question 11

In certain cases, _________ allows the use of other reliable secondary sources, such as another hospital that has documented PSV of the applicant’s credentials. Prior to using such sources, an attempt must be made to contact the primary source. This attempt should be documented by keeping the returned letters or by documenting the letters that were sent with no response.

a. AAAHC
b. NCQA
c. TJC

Answer 11

TJC

Question 12

Which Regulatory agency restricts the ability of incompetent physicians, dentists, and other health care practitioners who move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history.

a. FSMB
b. NPDB
c. Medicare

Answer 12

NPDB

Question 13

Organizations must have processes in place to ensure that credentials file are accessed only by authorized staff. Requirements for storage, maintenance and disposal of credentialing documents must also be defined.

a. NCQA
b. Medicare
c. URAC

Answer 13

URAC

Question 14

“I move to postpone the motion to..” is what type of motion.

a. Privileged
b. Subsidiary
c. Incidental

Answer 14

Subsidiary

Question 15

The organization must verify the most recent 5 year period available for sanctions or limitations on any state licensure held (past and present).

a. NCQA
b. URAC
c. ACHC

Answer 15

NCQA

Question 16

Must have evidence of professional liability insurance including current certificates showing amount insurance, malpractice litigation history from insurance carrier.

a. TJC
b. DNV
c. ACHC

Answer 16

ACHC

Question 17

Which accreditor says MS 6 SR 5(c) Review of involvement in any professional liability action is required at initial and reappointment.

a. Medicare
b. TJC
c. DNV

Answer 17

DNV

Question 18

The AMA Masterfile data meets the credentialing requirements for what 6 standards?

a. URAC, Medicare, NCQA, AAAHC, ACHC, DNV
b. NCQA, Medicare, NCQA, DNV, TJC, AAAHC
c. Medicare, DNV, TJC, ACHC, NCQA, AAAHC

Answer 18

Medicare, DNV, TJC, ACHC, NCQA, AAAHC

Question 19

For this accreditation PSV of education is required. Documentation regarding training and education must be sufficient to support requested privileges.

a. URAC
b. ACHC
c. NCQA

Answer 19

ACHC

Question 20

All of the following are important when you are recording meeting minutes except for _________.

a. Name of committee and type of meeting
b. Name of chair or person calling the meeting
c. Opinion of the GB about credentialing decision

Answer 20

Opinion of the GB about credentialing decision

Question 21

What is the time limit for verification of Medicare/ Medicaid sanctions for URAC?

a. 72 hours
b. 180 days
c. 5 years

Answer 21

180 days

Question 22

Query of the NPDB is required by these 3 accreditations on initial and reappointment.

a. DNV, ACHC, URAC
b. NCQA, URAC, TJC
c. ACHC, DNV, AAAHC

Answer 22

ACHC, DNV, AAAHC

Question 23

The ________ is NCQA-certified as a CVO and also meets TJC and URAC standards. It is also recognized as an ABMS display agent.

a. AMA
b. PDC
c. DEA

Answer 23

PDC

Question 24

PDC

Answer 24

Physician Data Center

Question 25

Access to this information is available online through the ___________. Data that was formerly maintained in the EPLS was integrated into SAM in 2012. a. OIG b. GSA c. SAM

Answer 25

SAM

Question 26

EPLS

Answer 26

Excluded Parties List System

Question 27

According to NCQA, if a practitioner is board certified, verification of ____ or ____ board certification meets this element because specialty boards verify education and training. a. AMA and ECFMG b. ABMS and AOA c. AMA and AOA

Answer 27

ABMS and AOA

Question 28

Not every motion can be made at any given time. Rather, motions are proposed, considered, and disposed of in a priority known as ___________. This is done to allow a body to consider each motion without confusion. When a motion is being considered, any motion higher on the list of precedence may be proposed, but no motion of lower precedence may be proposed. Motions are considered and voted on in reverse order to their proposal. The motion last proposed (and highest on the list) is considered and disposed of first. a. Procedure b. Classification c. Precedence

Answer 28

Precedence

Question 29

What standard states that bylaws provide a mechanism for immediate and automatic suspension of privileges due to termination or revocation of Medicare / Medicaid status; must be Primary Source verified at initial, re-appointment, and temporary privileges. a. AAAHC b. TJC c. DNV

Answer 29

DNV

Question 30

According to NCQA Organizations are responsible for ongoing monitoring of Medicare/Medicaid sanctions between credentialing cycles. Information must be reviewed within ______ days for release by the reporting entity. If reports are not published o a regular basis, organizations must query the sources at least every 6 months. If reports are not published the organization must query the sources within 12-18 months from the last credentialing cycle. a. 120 days b. 60 days c. 30 days

Answer 30

30 days

Question 31

What is the purpose of the FSMB? a. Offers standard provider profiles containing reports of sanctions related to physicians as reported by individual state licensing boards and some international licensing agencies, the DHHS and federal regulatory agencies. b. A provision by which a health care organization may appoint an authorized agent to query on its behalf, such as a CVO c. A continuous Monitoring Service

Answer 31

Offers standard provider profiles containing reports of sanctions related to physicians as reported by individual state licensing boards and some international licensing agencies, the DHHS and federal regulatory agencies

Question 32

What is the purpose of the ECFMG? a. This database provides PSV of an International Medical Graduate's certification status b. Notifies hospitals they have already been credentialed by the state c. Required to get into a US Medical School

Answer 32

This database provides PSV of an International Medical Graduate's certification status

Question 33

Medical or professional schools can be verified through direct contact with the school or by query of designated equivalent sources such as _______ or ______ profiles for U.S. graduates and ECFMG for foreign medical graduates. a. CAQH or Availity b. Availity or AMA c. AOA or AMA

Answer 33

AOA or AMA

Question 34

When you want to close a debate, what do you say? a. I move to close debate b. I move to adjourn c. I move the previous question

Answer 34

I move the previous question

Question 35

Which two standards do not specifically address Medicare / Medicaid Sanctions? a) URAC and NCQA b) AAAHC and Medicare c) TJC and Medicare

Answer 35

TJC and Medicare

Question 36

Whenever a practitioner's privileges are limited, revoked, or in any way constrained, the hospital must, in accordance with State and/or Federal laws or regulations, report those constraints to the appropriate State and Federal authorities, registries, and/or data bases, such as the National Practitioner Data Bank. a. NCQA b. TJC c. Medicare

Answer 36

Medicare

Question 37

What four standards require query of NPDB? a. TJC, NCQA, AAAHC, and Medicare b. NCQA, ACHC, URAC, and AAAHC c. TJC, ACHC, DNV, and AAAHC

Answer 37

TJC, ACHC, DNV, and AAAHC

Question 38

This is a list of individuals and firms excluded by Federal government agencies from receiving federal contracts or federally approved subcontracts and from certain types of federal financial and nonfinancial assistance and benefits. a. NPDB b. SAM c. FCVS

Answer 38

SAM

Question 39

NCQA recognizes ______________ as an acceptable verification source of license board actions for chiropractors a. FCLB b. CIN-BAD c. ABMS

Answer 39

CIN-BAD

Question 40

The __________ is a national non-profit organization representing the 70 medical and osteopathic boards of the United States and its territories a. AMA b. FSMB c. ECFMG

Answer 40

FSMB

Question 41

The ____________ database is the official government-wide system of records of debarments, suspensions and other exclusionary actions. Access to this information is available online through the System for Award Management a. GSA b. OIG c. SAM

Answer 41

GSA

Question 42

What accrediting body requires the practitioner’s history of education and professional training must be included on the application. PSV can be performed with the primary source (medical / professional school) or the state licensing board. Verification of education is not required if the practitioner is board certified a. URAC b. NCQA c. Medicare

Answer 42

URAC

Question 43

When you move to amend a motion, do you need a majority vote? Yes No

Answer 43

Yes

Question 44

When you rise to a question of privilege, do you need a majority vote? Yes No

Answer 44

No

Question 45

Who states that the application requests information regarding disciplinary actions taken or investigations pending by Medicare / Medicaid? a. DNV b. AAAHC c. ACHC

Answer 45

ACHC

Question 46

Who states that query of NPDB is required when clinical privileges are initially granted, on renewal of privileges, and when new privileges are requested (including temporary privileges)? a. DNV b. TJC c. ACHC

Answer 46

TJC

Question 47

NPDB query is required at initial and reappointments. Use of continuous query is acceptable. a. TJC b. AAAHC c. ACHC

Answer 47

AAAHC

Question 48

Bylaws provide a mechanism for immediate and automatic suspension of privileges due to the termination or revocation of Medicare or Medicaid status. a. DNV b. ACHC c. AAAHC

Answer 48

DNV

Question 49

Who does CIN-BAD contain information on? a. Cardiologists b. Chiropractors c. Controlled Substances

Answer 49

Chiropractors

Question 50

Which accreditation standard uses AMA to primary source verify U.S. or Puerto Rican medical education? a. TJC b. NCQA c. ACHC

Answer 50

TJC

Question 51

The FSMB PDC is NCQA certified as a CVO and also meets what other standards? a. TJC and URAC b. URAC and DNV c. TJC and DNV

Answer 51

TJC and URAC

Question 52

CIN-BAD is recognized by who as an acceptable verification source of license board actions for chiropractors? a. DNV b. URAC c. NCQA

Answer 52

NCQA

Question 53

According to TJC, verification of medical school completion can be obtained from the follow primary or DES: a. The school, AMA Physician Masterfile, ECFMG b. AOA Physician Database for predoctoral education accredited by the AOA Bureau of Professional Education, or AAPA Profile for physician assistant education c. All of the above

Answer 53

All of the above

Question 54

Lay on the table, previous question (end debate), limit or extend debate, postpone to a certain time, commit or refer (to committee) amend, and postpone indefinitely are examples of what kind of motion? a. Privileged motions b. Subsidiary motions c. Main motions

Answer 54

Subsidiary motions

Question 55

This organization states: MS 6 SR 11(c) Bylaws provide a mechanism for immediate and automatic suspension of privileges due to the termination or revocation of Medicare or Medicaid status. a. ACHC b. DNV c. AAAHC

Answer 55

DNV

Question 56

This following standard does not require the query of the NPDB, but can use to verify malpractice history, licensure sanctions, Medicare/Medicaid sanctions, hospital and other healthcare entity actions and professional society actions if the organization is eligible to query the NPDB. a. TJC b. NCQA c. URAC

Answer 56

URAC

Question 57

Within ___ hours, email notifications are received of a reporting being received by the NPDB on a practitioner. a. 18 b. 24 c. 36

Answer 57

24

Question 58

Education and Training verification for ___ has a limit of six months. a. DNV b. NCQA c. URAC

Answer 58

URAC

Question 59

When one wants to “kill a main motion,” they would state . . . a. I move to lay the question on the table b. I move to postpone the motion to . . . c. I move that the motion be postponed indefinitely

Answer 59

I move that the motion be postponed indefinitely

Question 60

There are two accrediting bodies that state NPDB should be queried on Initial Appointment and Reappointment, but only one of these two states that Continuous Query is acceptable. a. DNV b. ACHC c. AAAHC

Answer 60

AAAHC

Question 61

There are two accrediting bodies whose standards state that sanctions are reviewed and do not specifically state sanctions must be verified. a. URAC and AAAHC b. ACHC and TJC c. AAAHC and ACHC

Answer 61

AAAHC and ACHC