CPMSM Study Group - 1st half | Questions with 100% Correct Answers | Verified 2023, Exams of Economics

Download CPMSM Study Group - 1st half | Questions with 100% Correct Answers | Verified 2023 and more Exams Economics in PDF only on Docsity! CPMSM Study Group - 1st half | Questions with 100% Correct Answers | Verified 2023 Does not specifically addressed in the standards health status and Nondiscrimation a.TJC b.HFAP c.DNV GL D.NCQA - ✔✔️D️NV GLS How many peer references does HFAP require at initial appointment? - ✔✔️1️ According to NCQA what requires ongoing monitoring between recredentialing cycles? - ✔✔️M️edicare/Medicaid sanctions NCQA requires an attestation of good health and competence to perform essential functions. How is this achieved? - ✔✔️S️igned attestation According to TJC what two verifications must be performed before granting of privileges to satisfy an important patient care need? - ✔✔️C️urrent licensure, current competence What is the six competencies for the TJC must a peer take in consideration when review peer reference? - ✔✔️•️ Medical/Clinical knowledge; Technical and clinical skills; Clinical judgment; Interpersonal skills; Communication skills; and Professionalism T or F - In general, locum tenens practitioners are not granted medical staff membership and are given temporary privileges to practice for a specified period. - ✔✔️T️rue For temporary privileges, what must be tracked to ensure practitioners are not practicing after their temporary privileges have expired? License Board certification Time limit All of the above privileges to practice for a specified period of time. - ✔✔️T️ime limit Per TJC, for disaster privileges, PSV of medical licensure must begin as soon as the immediate situation is under control or within ___________ hours from the time the volunteer LIP begins working at the hospital? 48 72 24 100 - ✔✔️7️2 Which of the following providers is not considered an independent AHP? Nurse midwife Physician assistant Registered nurse Nurse practitioner - ✔✔️R️egistered nurse In telemedicine, the site where the patient is located at the time the service is provided is considered to be ___________ site? Distant site Originating site Telemedicine site None of the above - ✔✔️O️riginating site In telemedicine, which site is responsible for overseeing the safety and quality of services offered to patients? Originating site Distant site Telemedicine site All of the above - ✔✔️O️riginating site practitioner has the right to review references, recommendations, or other peer-review information. - ✔✔️F️alse. The standard does not require the organization to allow a practitioner to review references, recommendations, or other peer-review protected information. Which accreditors specifically address and/or allow the use of a Credentials Committee? All, including CMS All, excluding CMS NCQA and URAC only CMS only - ✔✔️B️ Note: TJC and AAAHC do not address Credentials Committee in the standards, but they are allowed. No mention of Credentials Committee in CoP. Which accreditors define that the governing body has the ultimate authority and responsibility for oversight and delivery of care rendered by credentialed and privileged practitioners? TJC, HFAP, DNV, and AAAHC NCQA and URAC TJC, NCQA, HFPA, DNV, and AAAHC TJC and DNV - ✔✔️A️ Which accreditor allows for expedited credentialing through a committee delegated by the governing body that contains at least 2 voting governing body members? HFAP DNV URAC TJC - ✔✔️D️ Which accreditors require recredentialing at least every 3 years, to the month? AAAHC and URAC URAC and NCQA NCQA and TJC DNV and URAC - ✔✔️B️ TJC - NTE 2 years HFAP - no less frequently than every 24 months DNV - NTE 3 years AAAHC - NTE 3 years Which accreditor requires primary source verification of OIG Medicare/Medicaid Exclusions at reappointment? AAAHC NCQA DNV HFAP - ✔✔️C️ Which accreditor specifically mentions in the standards that the recredentialing process includes a review of information collected during the OPPE process? TJC HFAP DNV AAAHC - ✔✔️A️ T/F Performance Improvement refers to the tracking of results and processes related to improving the quality of care being delivered - ✔✔️T️rue T/F In regards to enrollment, "providers" are individual professionals that are licensed or certified to provide medical care or behavioral healthcare services. - ✔✔️F️alse. Practitioners are individual professionals that are licensed or certified to provide medical care or behavioral healthcare services. Providers are institutions or facilities that provide healthcare services, such as hospitals, surgery centers, home health or durable medical equipment. What are the benefits of enrollment for practitioners and providers? Allows practitioners and providers to increase their patient base and grow their practice Allows practitioners and providers to be paid directly by the payer to receive in-network reimbursement rates A and B None of the above - ✔✔️C️ Note: Benefit for patients - Once enrolled with a payer, the practitioner or provider can be listed in a member directory which tells a potential patient that the practitioner or provider has been credentialed by the payer and can be selected to receive healthcare services. What is the purpose of CAQH ProView? It is a program used by Medicare/Medicaid for enrolling a provider. It is the preferred credentialing software used by NCQA and URAC. It is a website used by practitioners and providers to view progress of their enrollment. It is the primary method used by many commercial payers to collect credentialing application data. - ✔✔️D️ In regards to enrollment, what is a non-delegated practitioner? A practitioner that has not been credentialed through the organization; credentialing will need to be completed by the commercial payer. A practitioner that completes their own credentialing. A practitioner that has completed credentialing through the organization. A practitioner that delegates their credentialing to a CVO. - ✔✔️A️ T/F When enrolling a practitioner or provider in Medicare, a Medicare Administrative Contractor or MAC is the main point of contact. A MAC is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A/B claims. - ✔✔️T️rue MSPs should submit initial enrollment and revalidations using ________? What is the benefit to using this? - ✔✔️P️rovider Enrollment, Chain and Ownership System also referred to as PECOS. CMS encourages the submission of enrollment applications using PECOS because it results in a faster enrollment process - usually 45 days or less using PECOS as compared to 60 days if submitted by paper. Bylaws Legal cases Rules and regulations - ✔✔️A️. T/F The process articulated in the medical staff bylaws, rules, or regulations must include criteria for determining the privileges that may be granted to individual practitioners and a procedure for applying the criteria to individual practitioners that considers individual character, competence, training, and experience. - ✔✔️F️alse. Individual character, competence, training, experience and judgement are considered. T/F Per TJC, the medical staff or governing board can unilaterally amend bylaws. - ✔✔️F️alse. Neither the medical staff nor the hospital board can unilaterally change the medical staff bylaws or rules and regulations. Which accrediting/regulatory bodies do not specifically address bylaws? NCQA, URAC CMS AAAHC, DNV NCQA, URAC, AAAHC - ✔✔️D️. Which accrediting/regulatory bodies require a medical executive committee? TJC, HFAP, DNV CMS, DNV, HFAP TJC, HFAP, AAAHC DNV, AAAHC - ✔✔️A️. TJC - MEC NCQA - not addressed HFAP - MEC and URC DNV - MEC URAC - not addressed AAAHC - not addressed CMS - not addressed What are the two types of due process? Appeal and hearing Substantive and procedural Polies and procedures Liability and immunity Bonus points: What do the 2 types of due process require? - ✔✔️B️. Substantive due process requires proof that an adverse recommendation concerning a medical staff appointee be reasonable and not arbitrary, capricious or discriminatory. Procedural due process requires adherence to procedural guidelines for communication and rebuttal by the practitioner following an initial unfavorable recommendation. HCQIA provides immunity from monetary damages to physicians and hospitals engaged in ________, but only applies if standards have been met. Due process Patient care responsibilities Peer review activities Medical executive committee duties - ✔✔️C️. When are hearings are typically provided? When poor performance is identified through peer review When an application for initial appointment or reappointment to the medical staff is approved. When the results of a peer reference are negative when a recommendation is made that adversely affects a physician's clinical privileges - ✔✔️D️. Hearings are typically provided when a recommendation is made that "adversely affects" a physician's clinical privileges or medical staff appointment or when an application for initial appointment or reappointment to the medical staff is denied. The HCQIA defines "adversely affecting" as "reducing restricting, suspending, revoking, denying or failing to renew clinical privileges or membership in a health care entity." Which accrediting body does not address due process? NCQA URAC DNV AAAHC - ✔✔️B️. What is the definition of quality improvement? The use of a deliberate and defined process, which is focused on activities that are responsive to community needs and improving population health. Positive changes in capacity, process and outcomes of public health. The practice of actively using performance data to improve the public's health. The evaluation or review of the performance of colleagues by professionals with similar types and degrees of clinical expertise. - ✔✔️A️. Quality improvement in public health is the use of a deliberate and defined process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality services or processes which achieve equity and improve the health of the community. Systems performance improvement is defined as positive changes in capacity, process and outcomes of public health as practiced in government, private and voluntary sector organizations. Performance improvement can occur system-wide as well as with individual organizations that are part of the public health system. It involves strategic changes to address public health system (or organizational) weaknesses and the use of evidence to inform decision making. Performance management is the practice of actively using performance data to improve the public's health. This involves the strategic use of performance standards, measures, progress reports, and ongoing quality improvement efforts to ensure an agency achieves desired results. Ideally, these practices should be integrated into core operations, and can occur at multiple levels, including the program, organization or system level. Peer review is defined as the evaluation or review of the performance of colleagues by professionals with similar types and degrees of clinical expertise. T/F Results of peer review should be included in the information reviewed at reappointment. - ✔✔️T️rue.