Health Care > EXAM > CPCS STUDY TOOL ALL SOLUTION 100% CORRECT SPRING FALL-2023/24 EDITION GUARANTEED GRADE A+ (All)

CPCS STUDY TOOL ALL SOLUTION 100% CORRECT SPRING FALL-2023/24 EDITION GUARANTEED GRADE A+

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Why it is important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs? a. A facility could lose its accredit... ation if it does not do so. b. It is required by Medicare Conditions of Participation. c. The facility won't get paid for treating patients unless service is provided by authorized provider. c. The facility won't get paid for treating patients unless service is provided by authorized provider. Which of the following credentials must be tracked on an ongoing basis? a. Post graduate education completed b. Closed medical malpractice claims c. Licensure c. Licensure According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action? a. Determine if there is evidence of poor quality that could affect the health and safety of its members. b. Immediately take action ro remove the provider from its panel. c. Notify the practitioner that he/she is under investigation and initiate the hearing process. a. Determine if there is evidence of poor quality that could affect the health and safety of its members. What is the name of the entity that was established through the Health Care Qualit}T Improvement Act of 1986 to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history? a. Emergency Medical Treatment and Active Labor Act b. The National Practitioner Data Bank c. The Patient Safety and Quality Improvement Act b. The National Practitioner Data Bank When developing clinical privileging criteria, which of the following is important to evaluate? a. How many providers are in that specialty. b. Established standards of practice such as, specialty board recommendations. c. Whether or not the quality department can support the FPPE process. b. Established standards of practice such as, specialty board recommendations. What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty? a. It's required by accreditation standards. b. It is required by the Medicare Conditions of Participation. c. To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care. c. To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care. Which of the following specialists is most likely to perform a PTCA? a. OB/GYN b. Urologist c. lnterventional Cardiologist c. lnterventional Cardiologist The Joint Commission hospital standards require that clinical privileges are hospital specific and a. Based on the individual's demonstrated current competence and the procedures the hospital can support. b. Based on board certification. c. Based on the privileges the individual is currently approved to perform at other hospitals. a. Based on the individual's demonstrated current competence and the procedures the hospital can support. Which of the following would be routinely performed by a cardiologist? a. Hysterectomy b. Transesophageal Echocardiography c. Urethral dilation b. Transesophageal Echocardiography Which NCQA-required committee makes recommendations regarding credentialing decisions? a. Medical Executive Committee b. Quality Care Committee c. Credentialing Committee c. Credentialing Committee HFAP standards require three medical staff committees to be delineated in the medical staff structure. Two of them are the Medical Executive Committee and the Utilization of Osteopathic Methods & Concepts Committee (required for hospitals with ten or more DOs who admit patients and provide direct patient care). What is the other required medical staff committee? a. Credentials Committee b. Investigational Review Board c. Utilization Review Committee c. Utilization Review Committee If you needed to find out about what the Federal Government requires in regards to anti-trust issues, what law would you consult? a. Healthcare Quality Improvement Act b. Medicare Conditions of Participation c. Sherman Anti-trust Act c. Sherman Anti-trust Act Peer references should be obtained from: a. Practitioners who have referred patients to the provider b. Former hospital administrators c.Practitioners in the same professional discipline as the applicant c.Practitioners in the same professional discipline as the applicant Patrick v. Burgett is an important case because it: a. Showed that a hospital can assert that peer review is performed at the state's request. b. Illustrates that the governing body is the ultimate authority. c. Illustrates the potential for antitrust liability arising out of peer review activities. c. Illustrates the potential for antitrust liability arising out of peer review activities. If a medical staff member has privileges and/or medical staff appointment revoked, he/she must be: a. Granted temporary privileges. b. Provided due process. c. Offered a leave of absence from the medical staff. b. Provided due process. Access to credentials files should be: a. Available to all members of the organization's staff. b. Described fully in an access policy. c. Available to any physician on the staff. b. Described fully in an access policy. Which of the following bodies approves clinical privileges? a. Peer Review Committee b. Medical Executive Committee c. Governing Body or Board c. Governing Body or Board What primary source verification is required by NCQA prior to provisional credentialing? a. Licensure and 5 year malpractice history or NPDB b. Education and Training c. Ability to perform privileges requested a. Licensure and 5 year malpractice history or NPDB According to The Joint Commission standards, initial appointments to the medical staff are made for a period of: a. Two years b. Three years c. Not to exceed two years c. Not to exceed two years According to The Joint Commission standards, temporary privileges may be granted by: a. The department chair b. The CEO W' c. The CEO on the recommendation of the medical staff president or authorized designee c. The CEO on the recommendation of the medical staff president or authorized designee According to The Joint Commission Standards, which of the following items must be verified with a primary source? 'ff' a. Proof of professional liability insurance b. Licensure, training, experience, and competence c. Date oflast hepatitis test b. Licensure, training, experience, and competence According to NCQA standards, a copy of which of the following is acceptable verification of the document? a. DEA certificate b. Licensure Iff ' c. Board certification a. DEA certificate According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians? a. Federation of State Medical Boards b. American Board of Medical Specialties c. Education Commission on Foreign Medical Graduates Profile a. Federation of State Medical Boards According to The Joint Commission standards, which of following is considered a designated equivalent source for verification of board certification? a. The American Board of Medical Specialties b. Education Commission on Foreign Medical Graduates Profile c. Federation of State Medical Boards a. The American Board of Medical Specialties Which of the following organizations have been recognized by The Joint Commission and NCQA to provide primary source verification of medical school graduation and residency training for U.S. graduates? a. American Medical Association Masterfile b. National Practitioner Data Bank c. Education Commission on Foreign Medical Graduates Profile a. American Medical Association Masterfile According to NCQA standards, the application attestation statement must affirm that the application: ' a. Is correct and complete. b. Was actually completed by the provider. c. Was signed in the presence of a notary public. a. Is correct and complete. According to The Joint Commission standards, medical staff bylaws should define: a. The structure of the medical staff. b. Mechanism for appointment/reappointment of physician employed non-independent practitioners. c. A requirement that departments meet on at least a quarterly basis. a. The structure of the medical staff. According to The Joint Commission hospital standards, professional criteria for the granting of clinical privileges ' must include at least: a. Relevant training or experience, ability to perform privileges requested, current licensure, and competence. b. Verification of all current and prior malpractice suits filed and settlements made. ' c. Letters of reference from the Chief Executive Officer of all current and prior hospital affiliations. a. Relevant training or experience, ability to perform privileges requested, current licensure, and competence The Joint Commission hospital standards require medical staff bylaws to include: a. A mechanism for selection and removal of officers. • b. A requirement that all quality of care information be reviewed by the medical staff president. ' c. A mechanism for removal of the hospital's chief executive officer. a. A mechanism for selection and removal of officers. • According to NCQA standards, which of the following is an approved source for verification of board certification? a. State licensing agency if state agency conducts primary verification of board status b. Viewing of the original board certificate c. Health Care Integrity Protection Data Bank a. State licensing agency if state agency conducts primary verification of board status According to The Joint Commission hospital standards, which of the following is a required component of the reappointment process? a. Documentation of the applicant's health status b. Verification of residency training c. Medicare/Medicaid sanctions query a. Documentation of the applicant's health status According to URAC's health network standards, each applicant within the scope of the credentialing program submits an application that includes at least which of the following: a. State licensure information, including current license(s) and history of licensure in all jurisdictions b. A listing of all current and past hospital affiliations c. Copies of all current licensure a. State licensure information, including current license(s) and history of licensure in all jurisdictions According to AAAHC, which must be monitored on an ongoing basis? a. Current licensure b. Medical malpractice liability coverage c. Hospital and other healthcare facility affiliation a. Current licensure According to The Joint Commission, a nurse practitioner functioning independently and providing a medical level of care must: a. Be granted delineated clinical privileges. b. Be directly supervised by an active physician staff member. c. Participate in medical staff quality assessment activities. a. Be granted delineated clinical privileges. According to The Joint Commission, which of the following is an acceptable source for verification for medical education of an international graduate? a. Federation of State Medical Boards b. Education Commission for Foreign Medical Graduates c. National Practitioner Data Bank b. Education Commission for Foreign Medical Graduates When evaluating compliance with the required time-frame for recredentialing, NCQA counts the recredentialing period to the: a. Week b. Month c. Year b. Month NCQA standards require the organization to verify board certification at recredentialing: a. If a practitioner has received Medicare/Medicaid sanctions. b. If a practitioner is requesting a change in status. c. In all cases. c. In all cases. To whom does the AAAHC give the responsibility for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management? a. Medical staff b. Credentials committee c. Governing body c. Governing body In order for a healthcare facility to participate in the Medicare and Medicaid programs it must comply with the: a. Medicare Conditions of Participation b. The Joint Commission of Accreditation ofHealthcare Organizations standards c. National Committee for Quality Assurance (NCQA) standards a. Medicare Conditions of Participation According to The Joint Commission hospital standards, which of the following is an element of a self-governing medical staff? a. The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges. b. There can be any number of organized medical staffs as long as they are approved by the governing body. c. The hospital's board of directors determines the criteria for granting medical staff privileges. a. The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight Robert's Rule of order is an example of a. Parliamentary procedure b. A code of conduct c. Bylaws a. Parliamentary procedure The medical staff application should provide a chronological history of: a. The applicant's education, training, and work history. b. CME activities and completion of residency. c. Leadership positions held. a. The applicant's education, training, and work history. In order to participate in a managed care plan, a provider must be accepted to the plan's: a. Provider panel b. Medical staff c. Medical team a. Provider panel In order for a physician to practice medicine in any state in the United States, he/she must possess: a. Malpractice insurance with limits of at least $1 million per occurrence and $3 million annual aggregate. b. Appropriate board certification. c. Current state licensure. c. Current state licensure. Which of the following is considered post-graduate education? a. Medical school b. Board Certification c. Residency training c. Residency training Which of the following elements may not be used to evaluate credentials of applicants? a. Gender b. Licensure c. Board certification a. Gender The release of liability statement signed by the applicant for medical staff appointment should include: a. A statement providing immunity to those who respond in good faith to requests for information. b. A statement of the correctness of the information provided. c. Primary source verification. a. A statement providing immunity to those who respond in good faith to requests for information. Primary source verification is: a. Receiving information directly from the issuing source. b. Required by the health care quality improvement act. c. Considered economic credentialing. a. Receiving information directly from the issuing source. Unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice are examples of: a. Red flags. b. Medicare sanctions. c. Events reportable to the National Practitioner Data Bank. a. Red flags. When documenting a telephone conversation regarding primary source verification what should be documented? a. Who answered the call. b. Name of person and organization contacted, date of call, what was discussed and who conducted the interview. c. The reason for the call b. Name of person and organization contacted, date of call, what was discussed and who conducted the According to HFAP standards, when confirming malpractice coverage the organization must: a. Obtain the claim history with each carrier over the last five years b. Have evidence of professional liability insurance, which includes certificate showing amounts of coverage c. Require the applicant to attest that he/she has never been sued b. Have evidence of professional liability insurance, which includes certificate showing amounts of coverage Which of the following providers is considered a primary care physician (PCP)? a. Gastroenterologist b. Family medicine practitioner c. Orthopedic surgeon b. Family medicine practitioner Which body has the obligation to the community to assure that only appropriately educated, trained and currently competent practitioners are granted medical staff membership and clinical privileges? a. Governing Body b. The Joint Commission on Accreditation of Healthcare Organizations c. State licensing Board a. Governing Body When credentialing and privileging practitioners it is appropriate to: a. Handle each applicant on a case-by-case basis. b. Follow a routine process for each applicant. c. Give preferential treatment to those providers whose specialty is primary care. b. Follow a routine process for each applicant. Medical liability insurance should be held in what limits? a. $500,000 per occurrence and $1,000,000 annual aggregate b. $1,000,000 per occurrence and $3,000,000 annual aggregate c. As specified by the medical staff and board of directors c. As specified by the medical staff and board of directors Which of the following would be an appropriate question to ask an applicant for medical staff? a. How many children to you have? b. 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? c. Have you been diagnosed with AIDS or a sexually transmitted disease? b. 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 governing body delegates the responsibility of credentialing, recredentialing, and privileging to a. The medical staff office b. The medical staff c. The credentials committee b. The medical staff Who should have access to medical staff meeting minutes? a. Governing Body members Who should have access to medical staff meeting minutes? b. Personnel as documented in a records access policy and procedure c. Hospital President b. Personnel as documented in a records access policy and procedure In addition to conclusions, recommendations made, and actions taken, which of the following should always be documented in meeting minutes: a. Date and location of next scheduled meeting b. Any required follow-up to occur. c. Complete transcription of all discussion that occurred b. Any required follow-up to occur. Active, Associate, Courtesy, Honorary, Consulting are all examples of: a. Committees b. Medical staff officers c. Membership categories c. Membership categories Changes in medical staff bylaws are not final until formally approved by the: a. Medical staff president b. Governing body c. Hospital CEO b. Governing body What is the only hospital medical staff committee required by The Joint Commission hospital standards? a. Medical executive committee b. Pharmacy and therapeutics committee c. Utilization review committee a. Medical executive committee The Healthcare Quality Improvement Act: a. Provides immunity for health care entities that do not report information to the National Practitioner Data Bank. b. Provides qualified immunity from antitrust liability arising out of peer review activities that are conducted in good faith. c. Creates an exception to the Doctrine of Ostensible Agency. b. Provides qualified immunity from antitrust liability arising out of peer review activities that are conducted in good faith. If you have a question regarding whether or not information regarding a practitioner should be released to a third party, which of the following would be the best person to ask? a. Chief of Staff b. Information Systems Director c. Organization's attorney c. Organization's attorney Prior to releasing information to a third party regarding a practitioner, the organization should acquire: a. A signed consent and release form b. Approval from the organization's attorney c. Informed consent a. A signed consent and release form You are working at an AAAHC accredited facility and you want to introduce the concept of utilizing a credentials verification organization. If the CVO is not accredited by a nationally recognized organization you must: b. Perform an assessment of the capability and quality of the CVO's work c. Perform an assessment of their turn-around times b. Perform an assessment of the capability and quality of the CVO's work Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? YES According to the Joint Commission, who may amend the medical staff bylaws? Governing Body Failure to meet the established qualifications and criteria for appointment should be reported to whom? The applicant NCQA requires the MCO to obtain a minimum of _____years of work history? Five years According to NCQA what policy must an organization have in place to obtain approval to enter into a delegated agreement? Credentialing policies How often does the OIG report to the NPDB? Monthly Hospitals must query the NPDB when: Initial appt, granting of privileges, every two years NCQA requires verifications must be less than how many days old? 180 What is the verification time limit on malpractice history according to the NCQA? 180 days Time limited credential must be verified by the CVO within how many days prior to submission to the client? 120 days According to AAAHC, for initial appointments, in addition to licensure and education, what verification is required ? Experience and hospital affiliation What accreditation body states "the NPDB is an acceptable source for sanctions or limitations on licensure, Medicaid/Medicare sanctions and malpractice history"? NCQA Who is required to query the NPDB? Hospitals Is disciplinary action taken against the license of a dentist reportable to the NPDB? Yes Under HCQIA, a hospital failure to report an adverse privilege action lasting longer than 30 days may cause the organization to lose HCQIA immunity for how many years? 3 years According to NCQA verification of Medicare/Medicaid sanctions can be queried by any of what sources? AMA, FSMB, HIPDB, OIG, Sanctions Report, NPDB, State Agency According to NCQA, how often must an organization conduct an audit of the credentialing process delegated to another organization? Annually How far back does the Joint Commission require evaluation of malpractice history? What source may be used? Back to medical school NPDB Is an internet verification from a website not contracted by the primary source that attests to the accuracy and timeliness of the information considered a complete verification by NCQA? No What accreditation bodies require privileges to be distributed to essential department personnel? Joint Commission/CMS T/F the Joint Commission and NCQA do not require criminal background checks. True - the only organization that requires background checks is HFAP Is a payment made by an insurance company reportable to the NPDB? Yes Who is the best person to consult when releasing adverse information in a verification request form another organization? Legal Counsel According to CMS, who in the organization may make decisions regarding approval of credentialing applications? Governing board What are the six elements of a written delegation agreement? 1. Mutually agreed upon 2. Describes responsibilities of organization and delegated entity 3. Describes delegated activities 4. Requires semi-annual reporting to the organization 5. Describes the process by which the organization evaluates the CONTINUED... [Show More]

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