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CPCS > Study Session 3/18/2025 > Flashcards

Study Session 3/18/2025 Flashcards

1
Q

This organization defines board eligibility as “the period of time between when a physician completes an ACGME-accredited residency program and when initial certification in a specialty or subspecialty is achieved.”

a. Medicare CoP
b. AMA
c. ABMS

A

ABMS

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2
Q

According to this standard, licensure must be verified with the primary source at the time of appointment and initial granting of clinical privileges, on expiration, and reappointment or renewal or revision of clinical privileges by a letter or computer printout obtained from the appropriate licensing board or from any state licensing board if in a federal service.

a. NCQA
b. TJC
c. ACHC

A

TJC

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3
Q

The following are different aspects that influence the credentialing process for CVO’s

a. Contracts, Accreditation Standards, CMS Regulations, Policies & Procedures, Federal / State Laws and Regulations
a. Accreditation Standards, CMS Regulations, Governance Documents including Bylaws and Policies, Federal / State Laws, Policies & Procedures, Contractual Agreements
c. CMS Regulations, Federal / State Laws and Regulations, HEDIS CAHPS, Policies & Procedures, Standard of Care

A

Contracts, Accreditation Standards, CMS Regulations, Policies & Procedures, Federal / State Laws and Regulations

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4
Q

According to this standard, applicants must provide clinical activity documentation and competency to be used in consideration of privileges requested.

a. URAC
b. ACHC
c. TJC

A

ACHC

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5
Q

According to this standard, residency/fellowship training must be verified prior to the credentialing decision.

a. Medicare CoP
b. AAAHC
c. NCQA

A

NCQA

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6
Q

Which 2 accreditations allow the AMA Master File to be used as PSV for Board Certification verifications?

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

A

URAC and NCQA

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7
Q

__________ states that tapes purchased from the state boards can be used for licensing verifications.

a. URAC
b. NCQA
c. ACHC

A

URAC

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8
Q

What type of CVO contracts with many outside organizations?

a. Independent
b. Organization specific
c. Ambulatory Care

A

Independent

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9
Q

Who states the organization shall have delineated surgical privileges established by the organization’s department of surgery and medical staff and approved by the governing body for each practitioner that performs surgical tasks?

a. DNV
b. Medicare CoPs
c. AAAHC

A

DNV

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10
Q

TJC allows which two sources to be used as DES for verification of Residency/Fellowship?

a. State Licensing Board / Sealed Transcripts
b. AMA / AOA
c. ABMS / ECFMG

A

AMA / AOA

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11
Q

Verification of board certification is not applicable to nurse practitioners or other health care professionals unless the organization communicates board certification status to its members, such as in a directory.

a. NCQA
b. URAC
c. AAAHC

A

NCQA

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12
Q

License sanctions must be verified and documented on initial appointment and continually monitored thereafter at a minimum at expiration, initial appointment and reappointment. Information on licensure revocation, suspension, voluntary relinquishment, probationary status, or other conditions/limitations, and complaints or adverse action reports from licensure board are reviewed on initial and reappointment.

a. ACHC
b. TJC
c. AAAHC

A

AAAHC

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13
Q

What are the main factors in hospital credentialing?

a. CMS, Accreditation Standards, ISO 9001 QMS, Standard of care (Legal Aspect)
b. Federal/State Laws & Regulations, Accreditation Standards, ISO 9001 QMS, Standard of care (Legal Aspect)
c. Federal/State Laws & Regulations, Accreditation Standards, CIHQ, Standard of care (Legal Aspect)

A

Federal/State Laws & Regulations, Accreditation Standards, ISO 9001 QMS, Standard of care (Legal Aspect)

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14
Q

Under the factors that influence hospital credentialing, what falls under the Federal/State Laws and Regulations portion?

a. HCQIA, HEDIS, State Licensing
b. HEDIS, HCQIA, Medicare CoPs
c. HCQIA, Medicare CoPs, State Licensing

A

HCQIA, Medicare CoPs, State Licensing

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15
Q

In a solo medical or dental practice, the provider’s credentials file and granting of privileges must be reviewed by an outside physician or dentist (as applicable) at least every three years (or as required by state law or organization) with documentation provided to the organization.

a. ACHC
b. DNV
c. AAAHC

A

AAAHC

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16
Q

PSV includes direct contact with program, AMA Physicians Profile (MDs), AOA Official Osteopathic Physician Profile (DOs). Need documentation regarding training and education sufficient to support requested privileges.

a. ACHC
b. DNV
c. TJC

A

ACHC

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17
Q

What is CIHQ and whose credentialing does this influence?

a. Center for Information in Hospital Quality; Hospitals & Ambulatory / Med / Surg Centers
b. Center for Innovation in Healthcare Quality; CVOs & Ambulatory Med/Surg Centers
c. Center for Improvement in Healthcare Quality; Hospitals & CVOs

A

Center for Improvement in Healthcare Quality; Hospitals & CVOs

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18
Q

The credentialing application must include information on the practitioner’s hospital affiliations or privileges, if applicable. Verification is not required.

a. NCQA
b. AAAHC
c. URAC

A

URAC

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19
Q

In addition to contacting the primary source (the training program), the organization allows use of the following: AMA, AOA for postdoctoral education approved by the AOA Council on Postdoctoral Training.

a. ACHC
b. NCQA
c. TJC

A

TJC

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20
Q

Verification of board certification is not applicable to nurse practitioners or other health care professionals unless the organization communicates board certification to members.

a. URAC
b. NCQA
c. DNV

A

NCQA

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21
Q

License sanctions must be verified and documented on initial appointment and continually monitored thereafter at a minimum at expiration, initial appointment and reappointment.

a. NCQA
b. URAC
c. AAAHC

A

AAAHC

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22
Q

This organization allows use of designated equivalent sources for verification of board certification included, but not limited to: * ABMS or ABMS approved agent * The AOA Physician Database for osteopathic certification

a. TJC
b. ACHC
c. URAC

A

TJC

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23
Q

What are the two types of CVOs?

a. Organization specific and Independent
b. State and Federal
c. County and Hospital specific

A

Organization specific and Independent

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24
Q

What organization states relevant training is verity with primary or secondary source on initial appointment.

a. AAAHC
b. DNV
c. TJC

25
These guidelines reference individual Character, Competence, Training, Experience, Judgment when it comes to establishing criteria for privileging a. URAC b. Medicare CoP c. DNV
Medicare CoP
26
This standard requires, at the time of appointment to membership and initial granting of privileges, verification of relevant training or experience be obtained from the primary source(s), whenever feasible a. DNV b. ACHC c. TJC
TJC
27
Hospitals, health plans, and other healthcare organizations may require board certification as a criterion for: a. Appointments, privileges, or participation b. Appointments, privileges, or expirations c. Initials, Appointments, or Reappointments
Appointments, privileges, or participation
28
Under ______________, a hospital may not rely solely on the fact that a physician is board certified in making a judgement on medical staff membership? a. TJC b. DNV c. ACHC
ACHC
29
Verification of board certification may come from the specialty board directly or via the state licensing agency if it performs PSV of board certification. a. ACHC b. NCQA c. URAC
NCQA
30
What is the verification time limit for URAC? a. 30 days b. 3 months c. 6 months
6 months
31
To assist in this process, the ABMS encourages those responsible for credentialing to utilize an _________ reverification date which is provided by each Member Board. a. monthly b. annually c. yearly
annually
32
A __________ is the authority a government agency grants an individual to practice a profession. a. privilege b. license c. certification
license
33
The __________ query can serve for verification for actions against a physician's medical license. a. NPDB b. FSMB c. FACIS
FSMB
34
License Sanctions are not specifically addressed under __________. a. TJC b. DNV c. AAAHC
DNV
35
The medical staff defines the scope of privileges for all practitioners under ___________. a. TJC b. AAAHC c. URAC
TJC
36
All patients must be under the care of a member of the medical staff or under the care of a practitioner who is directly under the supervision of a member of the medical staff under ____________. a. URAC b. TJC c. DNV
DNV
37
Application includes information on hospital affiliations or privileges, if applicable. a. URAC b. AAAHC c. NCQA
URAC
38
Contract Management, Client Services, Financial Management and Network Administration make up this type of Medical Environment. a. Hospital b. Managed Care c. CVO
Managed Care
39
For these two accreditation bodies, _____ and _____ no specific sources for verification of Board Certification are specifically stated. a. DNV and AAAHC b. TJC and DNV c. ACHC and AAAHC
DNV and AAAHC
40
If recognized by the particular organization, this accreditation body allows board certification to be PSV with non ABMS / AOA Boards in the US. a. DNV b. TJC c. NCQA
NCQA
41
Regulation of medical licensure is a _____ function. a. CMS b. State c. Federal
State
42
________ and ______ mention reviewing a five-year licensure history. a. ACHC and NCQA b. URAC and DNV c. NCQA and URAC
NCQA and URAC
43
Who states for privileges there must be determination of clinical procedures, treatments to be offered, qualifications required and a process for evaluating the applicant’s qualifications? a. ACHC b. AAAHC c. DNV
AAAHC
44
One body states “verify highest level of education / training” and another states “verify the highest level of credentials attained.” Which one says “verify highest level of education / training?” a. NCQA b. TJC c. URAC
URAC
45
Key word: who uses "Jurisdictions"
URAC
46
Key word: who uses "Physicians & Dentists"
AAAHC
47
Key word: who uses "Comparative"
DNV
48
Key word: who uses "Problematic"
ACHC
49
Key word: who uses "Waived"
NCQA
50
Key word: who uses "Flexibility"
Medicare CoP
51
Key word: who uses "Proctoring"
DNV
52
Key word: who uses "Consumers"
URAC
53
Key word: who uses "Illegal Drug Use"
NCQA
54
Key word: who uses "Quarterly"
URAC
55
Key word: who uses "Paid by"
NCQA
56
Key word: who uses "Summarized"
ACHC
57
Key word: who uses "Feasible"
TJC
58
OSHA
Occupational Safety & Health Administration

CPCS (31 decks)

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