CPMSM Exam Questions and Accurate Answers, Exams of Nursing

Download CPMSM Exam Questions and Accurate Answers and more Exams Nursing in PDF only on Docsity! CPMSM EXAM QUESTIONS CPMSM EXAM QUESTIONS WITH GUARANTEED ACCURATE ANSWERS |VERIFIED HFAP - ACCURATE ANSWERS✔✔ Refers to a CVO as a Professional Credentialing Organization (PCO) HFAP Appointment time frame - ACCURATE ANSWERS✔✔ 2 years TJC Appointment time frame - ACCURATE ANSWERS✔✔ No longer than every 2 years NCQA Appointment time frame - ACCURATE ANSWERS✔✔ 3 years (to the month) URAC Appointment time frame - ACCURATE ANSWERS✔✔ 3 years AAAHC Appointment time frame - ACCURATE ANSWERS✔✔ 3 years Attestation Statement - ACCURATE ANSWERS✔✔ TJC and Medicare do not specifically address, URAC allows electronic signature, all others require. Board Certification Verification - ACCURATE ANSWERS✔✔ Not specifically required (only highest level of education) has to be verified within 180 days per NCQA or 120 days if CVO is verifying. CME - ACCURATE ANSWERS✔✔ HFAP may request every 2 years. TJC requires documentation. No others require. TJC views of Competence - ACCURATE ANSWERS✔✔ Monitoring of provider competence must be ongoing. URAC and NCQA views of Competence - ACCURATE ANSWERS✔✔ Monitoring of provider competence must be ongoing and organization must have policies for monitoring in place. HFAP view of Competence - ACCURATE ANSWERS✔✔ Competence can be monitored by proof of procedures performed. This can be done by the provider providing their procedure logs. Health Status Form - ACCURATE ANSWERS✔✔ All organizations require a current statement of ability to perform as a provider. HFAP requires it to be documented from references. Views on Allied Health Professionals - ACCURATE ANSWERS✔✔ NCQA: Credentials all providers the same URAC: Adds that they must be listed in directory TJC & AAAHC: Say that MCO must distinguish providers as those with and without the need for supervision Medicare: Can grant privileges with or without Medical Staff rights. Disaster Plan - ACCURATE ANSWERS✔✔ TJC, HFAP, AAAHC require groups/organizations to have the plan documented and in place. DEA Verification - ACCURATE ANSWERS✔✔ Copies can be accepted, ensure there are no challenges to the certificate. Licensure - ACCURATE ANSWERS✔✔ Medicare: does not specifically address sanctions URAC: states that it has to be verified in a 6 month time frame. NCQA: Verified within 180 days (or 120 for CVO) All organizations require that the monitoring of licensure be ongoing. Malpractice - ACCURATE ANSWERS✔✔ AAAHC, TJC, Medicare: Not fully addressed but states if bylaws require verification or proof of coverage, documentation must be obtained. All other organizations require proof and verification. Malpractice History - ACCURATE ANSWERS✔✔ NCQA: Pulled and verified with in the correct time frames (180 days or 120 days if CVO) URAC: 6 month time frame All require at minimum to verify history for the last 5 years. Accountable Care Organization - ACCURATE ANSWERS✔✔ Pt Centered and includes offices, hospitals, nursing homes. The healthcare organization is characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for patients. Patients are assigned to specific providers. EMTALA - ACCURATE ANSWERS✔✔ Emergency Medical Treatment and Active Labor Act -Must be an emergency -Must screen to see if it is a true emergency -Stabilize pt prior to transfer -Must have "on call" list. (Medicare does not specify hoe many days must be covered) Security Rule - ACCURATE ANSWERS✔✔ The Security Standards for the Protection of Electronic Protected Health Information, commonly known as the HIPAA. Security Rule, establishes national standards for securing patient data that is stored or transferred electronically. Sherman Antitrust Act (1980) - ACCURATE ANSWERS✔✔ Known as "competition law" states -Can not monopolize services -Must have exclusive contract to limit practitioners -Can not pay practitioners for using your services, or "incentivizing" provider to use your facilities or services. PSQIP - ACCURATE ANSWERS✔✔ The Patient Safety and Quality Improvement Act of 2005: Pub.L. 109-41, 42 U.S.C. ch. 6A subch. VII part C, established a system of patient safety organizations and a national patient safety database. To encourage reporting and broad discussion of adverse events, near misses, and dangerous conditions, it also established privilege and confidentiality protections for Patient Safety Work Product. The PSQIA was introduced by Sen. Jim Jeffords. It passed in the Senate July 21, 2005 by unanimous consent, and passed the House of Representatives on July 27, 2005 with 428 Ayes, 3 Nays, and 2 Present/Not Voting CVO Audits - ACCURATE ANSWERS✔✔ -10 credentialing and 10 re- credentialing -Pre-delegation Audit -look at files, policies, and procedures -Must provide semi annual reports Meeting Management - ACCURATE ANSWERS✔✔ Parliamentary procedures and Robert's Rules of Order reports results and recommendations to the Medical Staff and Board of Directors. Bylaws - ACCURATE ANSWERS✔✔ Documents approved by the Medical Staff and Governing Board that set the laws and guidelines for the governance of the Medical Staff. Credentials Committee - ACCURATE ANSWERS✔✔ This committee reviews and evaluates the training, scope of practice, competency, ability to perform privileges requested of each initial appointment, reappointment, and modifications of clinical privileges and makes recommendations to the Medical Executive Committee. This committee provides oversight for FPPE and OPPE. Should meet regularly. Utilization Management or Utilization Review Committee - ACCURATE ANSWERS✔✔ Ensures that all of the patient care given by the facility/providers is appropriate and provided effectively. Normally monitors topics such as: appropriateness of admission to the Hospital, delays in use of, or over use of ancillary services, delays in consultations and referrals, lengths of stay, and discharge planning. It is important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal healthcare programs - ACCURATE ANSWERS✔✔ because the facility will not get paid for treating patients unless service is provided by an authorized provider. According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must - ACCURATE ANSWERS✔✔ first determine if there is evidence of poor quality that could affect the health and safety of its members. Health Care Quality Improvement Act of 1986 - ACCURATE ANSWERS✔✔ Created the National Provider Data Bank to restrict the ability of incompetent providers to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history. When Developing clinical privileging criteria - ACCURATE ANSWERS✔✔ it is important to evaluate the established standards or practice such as, specialty board recommendations Periodically assessing appropriateness of clinical privileges for each specialty - ACCURATE ANSWERS✔✔ is important to protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care. TJC hospital standards require - ACCURATE ANSWERS✔✔ clinical privileges to be based on the individual's demonstrated current competence and the procedures the hospital can support. The only NCQA required committee - ACCURATE ANSWERS✔✔ Credentials Committee The 3 committees required by HFAP Standards - ACCURATE ANSWERS✔✔ 1. Medical Executive Committee 2. Utilization of Osteopathic Methods and Concepts Committee (if there are 10 or more DO's on the Medical Staff. 3. Utilization Review Committee Peer References - ACCURATE ANSWERS✔✔ Should be obtained from practitioners in the same professional discipline as the applicant. Patrick V. Burgett - ACCURATE ANSWERS✔✔ Illustrates the potential for antitrust liability arising our of peer review activities not performed in good faith. Due Process - ACCURATE ANSWERS✔✔ If a medical staff member has privileges and / or medical staff appointment revoked he/she must be provided: Access Policy - ACCURATE ANSWERS✔✔ Access to Credentials files should be fully described in an access policy. Governing Body or Board - ACCURATE ANSWERS✔✔ Is the final approval of clinical privileges. Credentials Committee > Med Exec Med Exec > Board/Governing Body According to TJC a Nurse Practitioner - ACCURATE ANSWERS✔✔ functioning independently and providing a medical level of care must be granted delineated clinical privileges Education Commission of Foreign Medical Graduates - ACCURATE ANSWERS✔✔ Acceptable source for verification for medical education of an international graduate. NCQA requires board cert verification - ACCURATE ANSWERS✔✔ In all cases (appointment and reappointment) AAAHC gives responsibility to: - ACCURATE ANSWERS✔✔ the governing body for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management. Medicare Conditions of participation (MCoP) - ACCURATE ANSWERS✔✔ In order for a healthcare facility to participate in the Medicare and Medicaid programs it must comply with: According to TJC's self governing medical staff standard - ACCURATE ANSWERS✔✔ the medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges. A good rule of thumb for a Medical Staff application - ACCURATE ANSWERS✔✔ is for the application to provide a chronological history of the applicant's education, training, and work history. Provider Panel - ACCURATE ANSWERS✔✔ In order to participate in a managed care plan, a provider must be accepted to the plan's _________________. Current State Licensure - ACCURATE ANSWERS✔✔ In order for any provider to practice medicine in any state he/she must first possess a Residency Training - ACCURATE ANSWERS✔✔ Is considered post- graduate education. Discrimination of any type - ACCURATE ANSWERS✔✔ Can not be used to evaluate credentials Release of Liability Statement - ACCURATE ANSWERS✔✔ Release statement signed by the applicant for medical staff appointment should include a statement providing immunity to those who respond in good faith to request for information. PSV by Telephone conversation - ACCURATE ANSWERS✔✔ When documenting a telephone conversation regarding primary source verification the name of the person and organization contacted, date of call, what was discussed and who conducted the interview should be included. Red Flags - ACCURATE ANSWERS✔✔ Unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice are examples of According to HFAP standards on Malpractice Coverage - ACCURATE ANSWERS✔✔ When confirming malpractice coverage the organization must have evidence of professional liability coverage, which includes a certificate showing amounts of coverage. The governing body is obligated to: - ACCURATE ANSWERS✔✔ assure to the community that only appropriately educated, trained, and currently competent practitioners are granted medical staff membership and clinical privileges. Follow a routine process - ACCURATE ANSWERS✔✔ when credentialing and privileging practitioners it is appropriate to follow a routine process for each applicant. Medical liability insurance coverage limits - ACCURATE ANSWERS✔✔ Coverage amounts should be held at the amounts specified by the medical staff, bylaws, or board of directors. However the industry standard for coverage limits is 1 million per occurrence and 3 milling annual aggregate. An appropriate question that can be asked by the medical staff - ACCURATE ANSWERS✔✔ Do you have any medical conditions, The governing body of a hospital sets the organizations policy that supports quality patient care - ACCURATE ANSWERS✔✔ by developing the mission, vision, policies and by laws that govern the hospital's operations. CEO responsibilities - ACCURATE ANSWERS✔✔ Keeping the medical staff informed about the hospital's plans, organizational changes, board polices, and decisions affecting providers and their patients. Medical Director or Vice President of Medical Affairs - ACCURATE ANSWERS✔✔ Title that describes a physician employed or contracted by the hospital as a top-level management employee to act as a liaison between the medical staff and hospital administration. Providing and evaluating patient care - ACCURATE ANSWERS✔✔ is a function of the Medical Staff Bylaws Language for committees - ACCURATE ANSWERS✔✔ Should pay special consideration to the composition, duties, and frequency of meetings. Internist and Hospitalist - ACCURATE ANSWERS✔✔ A hospitalist could be an internist, but an internist is not necessarily a hospitalist. These two medical specialties are more similar than different. Hospitalists and internists both practice medicine and treat patients, provide the same level of care to hospitalized patients, diagnose and treat acute illnesses or perform various medical procedures while the patient is hospitalized. Hospitalists, however, confine their practice exclusively to the hospital and often have specialized training in nonmedical subjects related to that field. Internal Medicine - ACCURATE ANSWERS✔✔ Internal medicine is a primary care field. Although some internists specialize in adolescent medicine, most internists care only for adult patients who have a variety of diseases, including chronic medical problems such as diabetes or acute problems such as pneumonia. Internal medicine has a number of subspecialties, such as infectious disease, rheumatology, gastroenterology and cardiovascular disease. Internists might see patients in the hospital or perform procedures there, but they spend most of their days in an office or clinic, where they see multiple patients, many of whom they care for over an extended period of months or years Hospitalist - ACCURATE ANSWERS✔✔ Hospital medicine developed in response to changes in reimbursement practices and demands on primary care physicians. Many physicians are unwilling to care for uninsured patients or take hospital calls, and teaching hospitals have restricted the hours that medical residents are allowed to work. The combination of these factors created a demand for physicians who could manage hospitalized patients and be available for emergencies. A hospitalist might see a patient only once in her lifetime and is more likely to be responsible for hospital-wide quality improvement efforts. William T. Ford, Ph.D., a hospitalist at Temple University Health System in Philadelphia, writes in the August 2009 issue of Today's Hospitalist that in many respects, the hospital itself is his "patient." Privileges - ACCURATE ANSWERS✔✔ a term used to describe the access granted and basic framework for the rights or activities which are specifically provided to individuals by the Medical Staff of an organization, hospital, or facility. House Staff - ACCURATE ANSWERS✔✔ a term used to describe interns and residents in medical education programs of teaching hospitals. Procedure rights of Fair Hearing - ACCURATE ANSWERS✔✔ The mechanism by which an aggrieved practitioner, one who has been the recipient of disciplinary action, is entitled to he heard and to appeal an adverse decision Darling vs Charleston Memorial Community Hosptial - ACCURATE ANSWERS✔✔ Landmark case that set aside the Charitable Immunity Doctrine and established the Corporate Negligence doctrine, also known as negligent credentialing. "Anti-Dumping Law" - ACCURATE ANSWERS✔✔ EMTALA is the Federal law enacted to stop hospitals from transferring, discharging, or refusing to treat indigent patients coming to the emergency room/department because of cost factors. Informed Consent - ACCURATE ANSWERS✔✔ Ethical issue practitioners face when explaining the risks and benefits of a particular course of treatment, allowing the patient to participate in decisions regarding treatment options, and confidentiality. on current, high-quality evidence that outlines the recommended course of care, including relevant options and their outcomes, and that is designed to help providers make the best possible care decisions. Disparities in health care - ACCURATE ANSWERS✔✔ Variations in access to care and in health outcomes due to factors such as race, ethnicity, gender, and socioeconomic status. Evidence-based care - ACCURATE ANSWERS✔✔ Health care that applies the best available research (evidence) when making decisions about a patient's care. Morbidity - ACCURATE ANSWERS✔✔ The incidence of disease, or how frequently a condition or illness occurs in a given population Patient experience - ACCURATE ANSWERS✔✔ The full range of patients' interactions with the health care system, from scheduling appointments to interactions with their providers to the course of treatment, including whether these interactions meet patient needs and health goals. Patient-centered care - ACCURATE ANSWERS✔✔ Health care that recognizes and incorporates the distinct wishes and needs of individual patients, with an emphasis on patient values and preferences. Quality measure - ACCURATE ANSWERS✔✔ A tool that is used to measure performance against a recognized standard of care Standard of Care - ACCURATE ANSWERS✔✔ Care that is delivered in accordance with clinical practice guidelines or other evidence-based care protocols. HCAHPS - ACCURATE ANSWERS✔✔ The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a formal public reporting initiative that measures patients' perspectives on hospital care Complaints - ACCURATE ANSWERS✔✔ All organizations (TJC, NCQA, HFAP, URAC, AAAHC, and Medicare) must establish a process for addressing and handling complaints. Most agree that complaints should be continually monitored for all sites and providers. A mechanism for investigating the credibility of the complaint, implementing appropriate actions and continually monitoring those actions until the deficiency is resolved should in in place and formally published in a guideline that can be reviewed by others. Patients should easily be able to retrieve information on how and with who they can file a complaint. According to TJC peer reference should include 6 items - ACCURATE ANSWERS✔✔ 1. Medical knowledge 2. Technical skill 3. Clinical judgement 4. Professionalism 5. Communication sill 6. Interpersonal skills Respondeat Superior - ACCURATE ANSWERS✔✔ Let the master speak/answer Quorum - ACCURATE ANSWERS✔✔ Minimum number of members who must be present in a meeting in order to be able to conduct business American College of Surgeons - ACCURATE ANSWERS✔✔ Were the first group to conduct hospital surveys AMA - ACCURATE ANSWERS✔✔ American Medical Association: publishes JAMA which is the largest circulation of weekly medical journal. This association publishes a list of physician specialty codes which are the standard method in the US for identifying physician and practice specialties ABMS - ACCURATE ANSWERS✔✔ American Board of Medical Specialties: organization of approved medical boards which represent According to CMS guidelines a roster listing each practitioners specific surgical privileges should be available - ACCURATE ANSWERS✔✔ in the surgical suite and wherever surgical procedures are scheduled. According to NCQA standards for Medicare and Medicaid Sanctions - ACCURATE ANSWERS✔✔ FSMB is an acceptable source for PSV of Medicare and Medicaid sanction activity against providers Substantive and procedural - ACCURATE ANSWERS✔✔ are two distinct elements of due process If a provider is on a GSA or OIG Exclusion List - ACCURATE ANSWERS✔✔ Neither the practitioner nor the facility providing services to the patient at practitioners request can bill federal healthcare programs for care rendered. FACIS - ACCURATE ANSWERS✔✔ a database containing adverse actions against an individual and entities sanctioned in the healthcare field and includes disciplinary actions ranging from exclusions to letters of reprimand and probation Dependent Practitioners (allied health/mid levels who require supervision - ACCURATE ANSWERS✔✔ Organizations have the option of credentialing and reassessing dependent practitioners through the HR department or the med staff credentialing/reappointment process Well planned agenda - ACCURATE ANSWERS✔✔ is the first step in planning a successful meeting. According to NCQA an organization must have - ACCURATE ANSWERS✔✔ Credentialing policies in place in order to enter into a delegated agreement. According to TJC's education verification standard - ACCURATE ANSWERS✔✔ AMA physician Masterfile is an approved source of verification of a medical degree from a U.S. educational institution. Credentialing Decisions - ACCURATE ANSWERS✔✔ Practitioners should be notified with in 10 days of the credentialing decision. Release of Negative information - ACCURATE ANSWERS✔✔ A special release developed my the Med Exec Committee should be obtained for the release of negative information to another facility USMLE - ACCURATE ANSWERS✔✔ United States Medical Licensing Exam OIG - ACCURATE ANSWERS✔✔ Office of Inspector General Reasons for Audits - ACCURATE ANSWERS✔✔ Comply with requirements Negligent Credentialing Issues Tool for Performance Evaluation Everyone Makes Mistakes Audits are performed by - ACCURATE ANSWERS✔✔ Determine process to be audited Select Files Review files and log results Compile a master report of findings Share results DX - ACCURATE ANSWERS✔✔ Diagnosis Tx - ACCURATE ANSWERS✔✔ Treatment Sx - ACCURATE ANSWERS✔✔ Symptoms C & X - ACCURATE ANSWERS✔✔ with, without SOB - ACCURATE ANSWERS✔✔ Shortness of Breath CFR / eCFR - ACCURATE ANSWERS✔✔ Code of Federal Regulations / electronic Code of Federal Regulations submit to the NPDB. Also any Federal or state organization, peer review association, med society, or any group in that capacity can report information to the NPDB. If you submit a Report to the NPDB you must - ACCURATE ANSWERS✔✔ Also submit a copy of the report to the appropriate state licensing board. AMA PRA Category 2 Credit - ACCURATE ANSWERS✔✔ is defined as educational activities not designated for AMA PRA Category 1 Credit™ that: (1) comply with the AMA definition of CME; (2) comply with the AMA ethical opinions on Gifts to Physicians from Industry and on Ethical Issues in CME (i.e., are not promotional); (3) and a physician finds to be a worthwhile learning experience related to his/her practice. AMA PRA Category 1 Credit - ACCURATE ANSWERS✔✔ AMA PRA Category 1 Credit™ represents that the physician has participated in an educational activity, and completed all requirements for such an activity, that is expected to "serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public or the profession" as stated in the AMA's definition of CME. Examples of Category 1 CME - ACCURATE ANSWERS✔✔ Live Activities Enduring Materials Journal Based CME Test item writing Manuscript review Performance Improvement Internet Point of Care Learning Examples of Category 2 CME - ACCURATE ANSWERS✔✔ Teaching residents, med students, other health care professional Unstructured online searching and learning Reading authoritative Med literature Consultation with peers and medical experts Small group discussions Self assessment activities Medical Writing Preceptorship Participation Research Peer review and quality assurance participation