CPCS Test
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Medicine
Date
Feb 20, 2024
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Uploaded by BarristerMorning9406
CPCS Self-Test
1.
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 accreditation 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.
2.
Which of the following credentials must be tracked on an ongoing basis?
a.
Post graduate education completed
b.
Closed medical malpractice claims
c.
Licensure
3.
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 to remove the provider from its panel.
c.
Notify the practitioner that he/ she is under investigation and initiate the hearing
process.
4.
What is the name of the entity that was established through the Health Care Quality
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
5.
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.
6.
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.
7.
Which of the following specialists is most likely to perform a PTCA?
a.
OB/GYN
b.
Urologist
c.
Interventional Cardiologist
8.
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.
9.
Which of the following would be routinely performed by a cardiologist?
a.
Hysterectomy
b.
Transesophageal Echocardiography
c.
Urethral dilation
10. Which NCQA-required committee makes recommendations regarding credentialing
decisions?
a.
Medical Executive Committee
b.
Quality Care Committee
c.
Credentialing Committee
11. HFAP standards require two medical staff committees to be delineated in the medical staff
structure. One of them is the Medical Executive Committee. What is the other required
medical staff committee?
a.
Credentials Committee
b.
Investigational Review Board
c.
Utilization Review Committee
12. How often does NCQA require that delegation reports be evaluated by the health plan?
a.
Monthly
b.
Quarterly
c.
Semi-Annually
13. Peer references should be obtained from:
a.
Practitioners who have referred patients to the provider
b.
Former hospital administrators c.
Practitioners in the saine professional discipline as the applicant
14. NCQA recognizes which of the following as the final approval of an applicant who does
not meet criteria for a clean file?
a.
Medical Director
b.
Credentialing Committee
c.
Board of Directors
15. 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.
Reported immediately to the National Practitioner Data Bank
16. Access to credentials files should be:
a.
Described fully in an access policy.
b.
Available to the organization's patients and potential patients.
c.
Available to any physician on the staff.
17. Which of the following bodies approves clinical privileges?
a.
Credentials Committee
b.
Medical Executive Committee c.
Governing Body or Board
18. 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
19. According to The Joint Commission standards, initial appointments to the medical staff are made for a period of:
a.
One year b.
Three years
c.
Not to exceed two years
20. According to The Joint Commission standards, temporary privileges may be granted by:
a.
The department chair
b.
The CEO on the recommendation of the medical staff president or authorized
designee
c.
The department chair and the president of the medical staff
21. According to The Joint Commission Standards, which of the following items must be verified
with a primary source?
a.
Medicare/ Medicaid Sanctions
b.
Licensure, training, experience, and competence
c.
Date of last hepatitis test
22. According to NCQA standards, a copy of which of the following is acceptable
verification of the document?
a.
DEA certificate
b.
Licensure
c.
Board certification
23. 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
24. 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
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25. 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.
National Practitioner Data Bank
b.
American Medical Association Masterfile
c.
Federation of State Medical Boards
26. According to NCQA standards, the application attestation statement must affirm that the
application
a.
Was actually completed by the provider.
b.
Was signed in the presence of a notary public.
c.
Is correct and complete.
27. According to The Joint Commission standards, medical staff bylaws should define
a.
Mechanism for appointment/ reappointment of physician employed non- independent
practitioners. b.
The structure of the medical staff.
c.
The mechanism for emergency department call schedule.
28. 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.
29. The Joint Commission hospital standards require medical staff bylaws to include
a.
A requirement that all quality of care information be reviewed by the medical staff
president.
b.
A mechanism for removal of the hospital's chief executive officer.
c.
A mechanism for selection and removal of officers.
30. According to NCQA standards, which of the following is an approved source for verification
of board certification?
a.
National Practitioner Data Bank
b.
State licensing agency if state agency conducts primary verification of board status
c.
Viewing of the original board certificate
31. 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
32. 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.
A NPDB self-query
33. According to AAAHC, which must be monitored on an ongoing basis?
a.
Current licensure
b.
Medical malpractice liability coverage
c.
Health status
34. According to The Joint Commission, a nurse practitioner functioning independently and
providing a medical level of care must:
a.
Have a job description.
b.
Be granted delineated clinical privileges.
c.
Be directly supervised by an active physician staff member.
35. According to The Joint Commission, which of the following is an acceptable source for
verification for medical education of an international graduate?
a.
Board certification
b.
Federation of State Medical Boards
c.
Education Commission for Foreign Medical Graduates
36. When evaluating compliance with the required time-frame for recredentialing, NCQA counts
the recredentialing period to the:
a.
Week
b.
Month
c.
Year
37. 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.
38. 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.
Credentials committee
b.
Governing body
c.
Medical director
39. 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 standards
c.
National Committee for Quality Assurance (NCQA) standards
40. According to The Joint Commission hospital standards, which of the following is an element of a
self-governing medical staff?
a.
The hospital's board of directors determines the criteria for granting medical staff
privileges.
b.
The medical staff is self-governing, and as such, its organization does not have to be
approved by the governing body.
c.
The medical staff determines the mechanism for establishing and enforcing criteria for
assigning oversight responsibilities to practitioners with independent privileges.
41. Robert's Rules of order is an example of a.
executive privilege.
b.
Parliamentary procedure.
c.
a code of conduct.
42. 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.
Marriages since medical school.
43. In order to participate in a health plan, a provider must be accepted to the plan's
a.
Medical team
b.
Provider panel
c.
Point of service plan
44. In order for a physician to practice medicine in any state in the United States, he/she must possess
a.
Appropriate board certification.
b.
Membership on the provider panel of the majority of the state's major health plans.
c.
Current state licensure.
45. Which of the following is considered post-graduate education?
a.
College
b.
Board Certification
c.
Residency training
46. Which of the following elements may not be used to evaluate credentials of applicants?
a.
Gender
b.
Licensure
c.
Post-graduate training
47. The release of liability statement signed by the applicant for medical staff appointment should
include:
a.
The name of the department chairman for all past hospital appointments.
b.
A statement providing immunity to those who respond in good faith to requests for
information.
c.
Primary source verification.
48. Primary source verification is:
a.
Considered economic credentialing.
b.
Receiving information directly from the issuing source.
c.
Delegated credentialing.
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49. 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.
50. When documenting a telephone conversation regarding primary source verification what should
be documented?
a.
The date and time of the call only.
b.
Who answered the call.
c.
Name of person and organization contacted, date of call, what was discussed and who
conducted the interview.
51. According to HFAP standards, when confirming malpractice coverage the organization must:
a.
Query the NPDB
b.
Obtain the claim history with each carrier over the last five years
c.
Have evidence of professional liability insurance, which includes certificate showing
amounts of coverage
52. Which of the following providers is considered a primary care physician (PCP)?
a.
General surgeon
b.
Family medicine practitioner
c.
Gastroenterologist
53. 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.
Medical Staff
b.
Governing Body
c.
The Joint Commission
54. 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.
Process all applications within one week of receipt.
55. 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
56. Which of the following would be an appropriate question to ask an applicant for medical staff?
a.
How many children to you have?
b.
Are you married?
c.
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?
57. The governing body delegates the responsibility of credentialing, recredentialing, and privileging
to:
a.
The hospital administrator
b.
The medical staff office
c.
The medical staff
58. Who should have access to medical staff meeting minutes?
a.
Personnel as documented in a records access policy and procedure
b.
Medical Staff President
c.
Governing Body members
59. In addition to conclusions, recommendations made, and actions taken, which of the following
should always be documented in meeting minutes:
a.
Names and professional titles of all in attendance
b.
Date and location of next scheduled meeting
c.
Any required follow-up to occur.
60. Active, Associate, Courtesy, Honorary, Consulting are all examples of:
a.
Committees b.
Membership categories
c.
Privileges
61. Changes in medical staff bylaws are not final until formally approved by the:
a.
Medical staff
b.
Medical staff president
c.
Governing body
62. What is the only hospital medical staff committee required by The Joint Commission hospital
standards?
a.
Credentials committee
b.
Medical executive committee
c.
Utilization review committee
63. The Health Care Quality Improvement Act:
a.
Provides immunity for health care entities that do not report information to the National
Practitioner Data Bank.
b.
Keeps hospitals and physicians who perform peer review from being sued.
c.
Provides qualified immunity from antitrust liability arising out of peer review activities that
are conducted in good faith.
64. 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.
Director of Medical Records
b.
Chief of Staff
c.
Organization's attorney
65. Prior to releasing information to a third party regarding a practitioner, the organization should
acquire
a.
A picture ID of the provider
b.
A signed consent and release form
c.
Approval from the organization's attorney
66. 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:
a.
Perform an initial on-site visit of the CVO to assess their capabilities and quality of work
b.
Perform an assessment of the capability and quality of the CVO's work
c.
Perform an assessment of their turn-around times
67. Under DNV, what medical staff authority, in addition to the Chief Executive Officer, is required
for granting temporary privileges?
a.
Medical Executive Committee
b.
Member of the Executive Committee, President of the Medical Staff, or Medical Director
c.
President of the Medical Staff
68. According to the DNV, if the medical staff has an executive committee, who must attend the
meetings?
a.
Medical Staff Members and CEO
b.
Medical Staff Members only
c.
Medical Staff Members, CEO and CNO (or designee) on an ex-officio basis
69. Automatic Suspension of clinical privileges may be considered at a DNV accredited hospital for
which of the following instances?
a.
Providing an incomplete application; not disclosing three professional references
b.
Revocation/ restriction of professional license; non-compliance with completing medical
records
c.
Revocation/ restriction of professional license; non-compliance in attending all medical
staff meetings; and not utilizing all clinical privileges granted
70. According to the DNV, a History and Physical completed within 30 days prior to admission or
registration shall include an entry in the medical record which documents an examination for any
change in the patient's current medical condition. Within what time frame must this be placed in
the patient's medical record?
a.
Within 48 hours prior to the admission or registration
b.
Immediately upon admission or registration, but prior to surgery or high-risk procedures
c.
Within 24 hours after admission or registration, and prior to surgery requiring anesthesia
services or high-risk procedure
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