CPMSM Study Questions 2024: Comprehensive Guide with Answers, Exams of Management of Health Service

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CPMSM Study Questions 2024| ACTUAL 200 EXAM

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HFAP –

Correct Answer-Refers to a CVO as a Professional Credentialing Organization (PCO) HFAP Appointment time frame – Correct Answer- 2 years TJC Appointment time frame - Correct Answer-No longer than every 2 years NCQA Appointment time frame - Correct Answer- 3 years (to the month) URAC Appointment time frame - Correct Answer- 3 years AAAHC Appointment time frame - Correct Answer- 3 years Attestation Statement - Correct Answer-TJC and Medicare do not specifically address, URAC allows electronic signature, all others require. Board Certification Verification - Correct Answer-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 - Correct Answer-HFAP may request every 2 years. TJC requires documentation. No others require. TJC views of Competence - Correct Answer-Monitoring of provider competence must be ongoing. URAC and NCQA views of Competence - Correct Answer-Monitoring of provider competence must be ongoing and organization must have policies for monitoring in place. HFAP view of Competence - Correct Answer-Competence can be monitored by proof of procedures performed. This can be done by the provider providing their procedure logs. AAAHC view of Competence - Correct Answer-Competence can be monitored by provided documentation of competency. Medicare view of Competence - Correct Answer-Governing body must verify character, competence, judgement, education, and training.

Felony Conviction - Correct Answer-Only addressed by a question or statement of provider application by NCAQ, HFAP, and AAAHC NCQA and URAC on Education - Correct Answer-Only highest level of education verified. TJC and Medicare - Correct Answer-Does no address Medicare and Medicaid sanctions. NPDB - Correct Answer-NCQA and URAC do not require it but it is an acceptable verification of sanctions. All other organizations require. Site Visit - Correct Answer-NCQA is the only organization that requires a site visit under certain circumstances. Temporary Privileges - Correct Answer-AAAHC and Medicare do not specifically address. Temporary Privileges granting requirements - Correct Answer-This type of privilege can be granted by the CEO upon recommendation from the Chief of Staff or authorized designee as long as license, malpractice coverage, and NPDB have been verified. NCQA specifically says Provisional (Temporary) Privileges - Correct Answer-Can be granted by Chief Medical Official as long as their is a policy in place, the application is clean, and the privileges can be granted for no more than 60 days.

Work History - Correct Answer-URAC and Medicare do not address, NCAQ: History must be verified and any gaps of 6 months or greater require explanation. TJC & HFAP Work History - Correct Answer-require the question to be asked: Has the provider ever been terminated or suspended and NPDB must be compared to answer of the above question. AAAHC Work History - Correct Answer-Any interruptions in employment must be accounted for. Health Status Form - Correct Answer-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 - Correct Answer-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 - Correct Answer-TJC, HFAP, AAAHC require groups/organizations to have the plan documented and in place. DEA Verification - Correct Answer-Copies can be accepted, ensure there are no challenges to the certificate. Licensure - Correct Answer-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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-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) - ✔✔ Correct Answer-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 - Correct Answer-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 - ✔✔ Correct Answer-- 10 credentialing and 10 re-credentialing

• Pre-delegation Audit
• look at files, policies, and procedures
• Must provide semi annual reports Meeting Management - Correct Answer-Parliamentary procedures and Robert's Rules of Order Standing Committee - Correct Answer-Meets regularly and has ongoing responsibilites Adhok Committee - ✔✔ Correct Answer-Works on a specific task or duty, works independently, and reports back to group. Once task is complete the committee is disbanded. Task Force - ✔✔ Correct Answer-Committee comprised of experts used to analyze or solve a problem Continuous Quality Committee - Correct Answer-Meets regularly to address specific quality indicators. Meeting Minutes must include - ✔✔ Correct Answer-conclusions, recommendations, and actions taken. President - ✔✔ Correct Answer-Has same voting rights as other group members

Ex Officio - ✔✔ Correct Answer-Member by virtue of some other office they hold/held and have same voting rights as rest of the group. Once a Motion is stated it becomes part of the - Correct Answer-Assembly Proxy - Correct Answer-Can allow if allowed by state, federal laws, and bylaws. Board Meetings - ✔✔ Correct Answer-Can be held electronically as long as bylaws allow. Privileged Motions - ✔✔ Correct Answer-Are used to set aside the (main) pending motion to give immediate attention to an item/topic. Subsidiary Motion - Correct Answer-applies to pending motions and is lower ranking.

Incidental Motion - ✔✔ Correct Answer-arise out of questions to Main/Pending Motion and normally must be addressed or answered to continue on with Main Motion. Rescind (Unclassified Motion) - Correct Answer-To take from the table, revoke, cancel, or repeal. Ratify (Unclassified Motion) - Correct Answer-Sign or give formal consent to, making it officially valid. Medical Executive Committee (MEC) - Correct Answer-Receives and acts upon reports and recommendations from the other Medical Staff Committees, special committees and officers of the staff concerning performance improvement and quality assessments. MEC reports results and recommendations to the Medical Staff and Board of Directors. Bylaws - Correct Answer-Documents approved by the Medical Staff and Governing Board that set the laws and guidelines for the governance of the Medical Staff. Credentials Committee - Correct Answer-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 - Correct Answer-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 - Correct Answer- 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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-it is important to evaluate the established standards or practice such as, specialty board recommendations

Periodically assessing appropriateness of clinical privileges for each specialty - Correct Answer-is important to protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care. TJC hospital standards require - Correct Answer-clinical privileges to be based on the individual's demonstrated current competence and the procedures the hospital can support. The only NCQA required committee - Correct Answer-Credentials Committee The 3 committees required by HFAP Standards - Correct Answer-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 - Correct Answer-Should be obtained from practitioners in the same professional discipline as the applicant. Patrick V. Burgett - Correct Answer-Illustrates the potential for antitrust liability arising our of peer review activities not performed in good faith. Due Process - Correct Answer-If a medical staff member has privileges and / or medical staff appointment revoked he/she must be provided: Access Policy - Correct Answer-Access to Credentials files should be fully described in

an access policy. Governing Body or Board - Correct Answer-Is the final approval of clinical privileges. Credentials Committee > Med Exec Med Exec > Board/Governing Body According to TJC Standards - Correct Answer-Initial appointments to the medical staff are made for a period of time not to exceed two years. TJC requires the following items to be PSV - Correct Answer-Licensure, Training, experience, and competence Federation of State Medical Boards - Correct Answer-According to NCQA standards, is an acceptable source for primary source verification of Medicare and Medicaid Sanction activity. The American Board of Medical Specialties - Correct Answer-According to The Joint Commission standards, the ABMS is considered a designated equivalent source for verification of board certification.

American Medical Association Mater File - Correct Answer-Is recognized by TJC and NCQA to provider primary source verification of medical school graduation and residency training for U.S. graduates. NCQA attestation statement must include - Correct Answer-affirmation that the application is correct and complete. According to TJC standards the Medical Staff Bylaws - Correct Answer-Should define the structure of the Medical Staff According to TJC standards, professional criteria for granting of clinical privileges must include at least - Correct Answer-Relevant training or experience, ability to perform privileges requested, current licensure, and competence TJC Standards require the Medical Staff Bylaws to - Correct Answer-include a mechanism for selection and removal of officers According to NCQA standards an appropriate verification source for verification of board certification - Correct Answer-state licensing agency, if state agency conducts primary verification of board status. TJC requires for Re-Appointment to the medical staff - Correct Answer-Primary source verification of malpractice suits URAC's health network standards state - Correct Answer-each applicant within the scope of the credentialing program submits an application that includes at least

• State licensure information, including current license(s) and history of licensure in all jurisdictions. According to AAAHC current Licensure - Correct Answer-must be monitored on an ongoing basis According to TJC a Nurse Practitioner - Correct Answer-functioning independently and providing a medical level of care must be granted delineated clinical privileges Education Commission of Foreign Medical Graduates - Correct Answer-Acceptable source for verification for medical education of an international graduate. NCQA requires board cert verification - Correct Answer-In all cases (appointment and reappointment) AAAHC gives responsibility to: - Correct Answer-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) - Correct Answer-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 - Correct Answer-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 - Correct Answer-is for the application to provide a chronological history of the applicant's education, training, and work history. Provider Panel - Correct Answer-In order to participate in a managed care plan, a provider must be accepted to the plan's. Current State Licensure - Correct Answer-In order for any provider to practice medicine in any state he/she must first possess a Residency Training - Correct Answer-Is considered post-graduate education. Discrimination of any type - Correct Answer-Can not be used to evaluate credentials Release of Liability Statement - Correct Answer-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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-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: - Correct Answer-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 - Correct Answer-when credentialing and privileging practitioners it is appropriate to follow a routine process for each applicant.

Medical liability insurance coverage limits - Correct Answer-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 - Correct Answer-Do you have any medical conditions, treated or untreated, that would negatively affect your ability to provide the services or perform the privileges you are requesting. The Medical Staff - Correct Answer-The governing board delegates the responsibility of credentialing, recredentialing, and privileging Access to staff meeting minutes - Correct Answer-Personnel as documented in a records access policy and procedure. Meeting Minutes should include - Correct Answer-In addition to conclusions, recommendations, and actions taken, meeting minutes should include any required follow up to occur. Active Staff - Correct Answer-Physicians, dentist, osteopaths, and podiatrists who regularly provide patient care. Active staff pay dues, participate in special organizational and administrative functions, attend meetings, and may vote, hold office, and serve on committee's. Courtesy Staff - Correct Answer-physicians and dentists who meet certain qualifications of the medical staff of a hospital but who admit patients only occasionally or act as

consultants. They are ineligible to participate in medical staff activities. Honorary Staff (also referred to as Emeritus Staff) - Correct Answer-physicians and dentists, usually retired, who are recognized by the hospital medical staff for their noteworthy contributions but who may not admit patients to the hospital or participate in medical staff activities. Consulting Staff - Correct Answer-specialists affiliated with a hospital who serve in an advisory capacity to the attending staff. Governing Body - Correct Answer-Changes in medical staff bylaws are not final until the medical staff has voted in favor of the changes, and Med exec forwards the recommendation to the: The only Committee required, according to TJC standards - Correct Answer-Medical Executive Committee If you have a questions regarding whether or not information regarding a practitioner should be released to a third party, - Correct Answer-The organizations Attorney is the best resource to consult.

A signed consent and release form - Correct Answer-Prior to releasing information to a third party regarding a practitioner, the organization should acquire: Chief Executive Officer, Governing Body, and Medical Staff - Correct Answer-The three major sources of authority in the traditional structure of the hospital organization. The governing body of a hospital sets the organizations policy that supports quality patient care - Correct Answer-by developing the mission, vision, policies and by laws that govern the hospital's operations. CEO responsibilities - Correct Answer-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 - Correct Answer-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 - Correct Answer-is a function of the Medical Staff Bylaws Language for committees - Correct Answer-Should pay special consideration to the composition, duties, and frequency of meetings. Internist and Hospitalist - Correct Answer-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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-a term used to describe interns and residents in medical education programs of teaching hospitals. Procedure rights of Fair Hearing - Correct Answer-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 - Correct Answer-Landmark case that set aside the Charitable Immunity Doctrine and established the Corporate Negligence doctrine, also known as negligent credentialing. "Anti-Dumping Law" - Correct Answer-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 - Correct Answer-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. Healthcare Quality Improvement Act (HCQIA) - Correct Answer-defines the elements of due process that must be followed in order for an organization to have peer review protection. Centers for Medicare and Medicaid Services - Correct Answer-The code of Ethics includes the language "shall share knowledge, foster educational opportunities, and encourage personal and professional growth through continued self-improvement and applications of current advancements in the profession"? Medical Staff President or Chief of Staff - Correct Answer-Is responsible for enforcing the medical staff bylaws, rules, and regulations, and procedural guidelines of the medical staff including imposing sanctions for non compliance.

Department - Correct Answer-Term that defines a functional unit of the hospital, so designated because of the clinical service it performs Department Chair - Correct Answer-Each department of the Hospital, usually has its own department committee that consists of all of the practitioners that fall within that specialty. That department will elect a representative to be the spokesperson for that group of providers. That spokesperson will recommend criteria for clinical privileges of the department. The AMA's PRA Category 1 Credit System - Correct Answer-The CME standard for licensing boards and specialty organizations nationwide and is recognized by the U.S. Jurisdictions State Operations Manual - Appendix A Survey Protocol, Regulations and Interpretive Guidelines for Hospitals - Correct Answer-Document that surveyors for the Centers of Medicare and Medicaid Services reference when surveying a hospital. Average Length of Stay (ALOS) - Correct Answer-One measure of hospital utilization review. Accreditation - Correct Answer-Recognition that is granted to an institution (such as a health care provider or health plan) by a professional association or non-governmental agency demonstrating that the institution meets pre-established standards. Certification - Correct Answer-Recognition that is granted to an individual

health care worker by a professional association or nongovernmental agency demonstrating the individual's competency relative to a pre-determined set of criteria Clinical Practice Guideline - Correct Answer-A standard of care based 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 - Correct Answer-Variations in access to care and in health outcomes due to factors such as race, ethnicity, gender, and socioeconomic status. Evidence-based care - Correct Answer-Health care that applies the best available research (evidence) when making decisions about a patient's care. Morbidity - Correct Answer-The incidence of disease, or how frequently a condition or illness occurs in a given population Patient experience - Correct Answer-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 - Correct Answer-Health care that recognizes and incorporates the distinct wishes and needs of individual patients, with an emphasis on patient values and preferences. Quality measure - Correct Answer-A tool that is used to measure performance against a recognized standard of care Standard of Care - Correct Answer-Care that is delivered in accordance with clinical practice guidelines or other evidence-based care protocols. HCAHPS - Correct Answer-The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a formal public reporting initiative that measures patients' perspectives on hospital care Complaints - Correct Answer-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.