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CPMSM ULTIMATE STUDY SET
COMPREHENSIVE ACTUAL EXAM 700
QUESTIONS WITH DETAILED AND
VERIFIED ANSWERS ALREADY
GRADED A+ LATEST VERSION
"What is HIPDB? - CORRECT ANSWER=> Healthcare Integrity and Protection Data Base; created in 1996
by HIPAA to reduce healthcare fraud and abuse"
"Relationship Hospital and Medical Staff - CORRECT ANSWER=> ● Can be a complex interdependent
relationship ● Has changed because of ambulatory surgery centers ● Most physicians on the medical staff are not employees although that number is growing ● The ability to work in the hospital most resembles a limited "license" granted to the physician to practice in the hospital under a given set of rules called the Medical Bylaws."
"Medical Staff Bylaws - CORRECT ANSWER=> 1. Establish the rights and responsibilities of the medical
staff members and the governing body (hospital)
- Provide the governance structure of the medical staff"
"Bylaws must... - CORRECT ANSWER=> ○ Be approved by the governing body
○ Statement of duties and privileges of category medical staff ○ Organization ○ Qualifications ○ Admission H and P requirements ○ Updated examination after admission"
"Statutory, Regulatory and Accreditation - CORRECT ANSWER=> 1. Medicare Conditions of
Participation (COP)
- Accreditation Requirements
- Health Care Quality Improvement Act of 1986(HCQIA)
- The Americans with Disabilities Act of 1990 (ADA)
- State Licensure Laws"
"Medicare COPs - CORRECT ANSWER=> ● These are standards that all hospitals must achieve in order
to receive reimbursement under Medicare ● Requirements that there be an organized medical staff operating under written bylaws and responsible to the governing body of the hospital ● Examples of COPs affecting the medical staff ○ Examine the credentials of candidates ○ Ensure maintenance of competence with periodic appraisals ○ Must adopt and enforce bylaws"
"Accreditation Requirements - CORRECT ANSWER=> Medicare accepts the accreditation of following to
satisfy CMS requirements: ○ Joint Commission ○ DNV ○ Center for Improvement in Healthcare Quality ○ American Osteopathic Association's Healthcare Facilities Accreditation Program"
"Three Parts of HCQIA - CORRECT ANSWER=> 1. Provisions relating to immunity from damages for
those involved in professional review activities
- Requirements that health care entities and insurance carriers report information relating to the competence of physicians to a National Practitioner Data Bank (NPDB)
- Requirements that health care entities request information from NPDB for all physicians who apply for appointment to medical staff privileges"
"NPDB - CORRECT ANSWER=> ● Accumulates and disseminates data pertaining to adverse peer review
actions that could have an impact on the granting of clinical privileges ● Must report: ○ Any professional review action ○ Surrender of clinical privileges when under review ○ Any revisions to the above"
"State Licensure Laws - CORRECT ANSWER=> ● Application ($302.00)
● Exam Scores ● Transcripts ● Post graduate training ● Disciplinary inquiry ● Employment activity ● License verification from another state ● AMA physician profile ● Continuing medical education requirements and verification ● Disciplinary actions ● Dissemination of information regarding issues of importance to licensees (Zika, opioid epidemic)"
"Legal/Business Issues and Hospital/Medical Staff - CORRECT ANSWER=> ● Corporate Negligence
● Medicare COP infer that other factors should also be taken into consideration but that "after analysis of all the criteria, if all criteria are met except for board certification, the hospital has the discretion to decide not to select that individual to the medical staff""
"Geographic Proximity Requirements - CORRECT ANSWER=> ● How far do you live from the hospital
● Consider the size of the local market ● Consider response time to take care of patients ● Should they apply equally or not given the acuity with which patients must be seen at the ED ● Is it being used to keep physicians from competing: antitrust concerns"
"Number of Admissions - CORRECT ANSWER=> ● The hospital is generally allowed to base its
reappointment to the medical staff on the number of contacts the physician has with the patients that the hospital serves. This can be admissions or procedures done ● Claim is that the physician cannot be adequately evaluated related to competence if he has not performed a requisite number of cases"
"On-Call Coverage Issues - CORRECT ANSWER=> ● EMTALA requires that hospitals maintain an on call
list of physicians who can stabilize patients who present to ED ● Obligation for call is generally found in the bylaws ● Call can entail uncompensated care and increased malpractice risk ● Compensation for call"
"Integration of Hospital and Physician Groups - CORRECT ANSWER=> ● Integrate: avoid some AKA and
Stark considerations, avoid administrative burdens, cost efficiencies, better coordination of care and improved quality and lower cost ● Employee/physicians are members of the medical staff and employees ● All rules applicable to employees apply and all rules applicable to medical staff apply ● Hospital is responsible for negligence of physician not just negligent credentialing"
"Hospital based Physicians - CORRECT ANSWER=> ● Hospitalists, intensivists, other hospital based
physicians ● Increased risk of vicarious liability to the hospital ● Compensation must be carefully considered because it cannot be outside fair market value because of AKA ● Hospitalist's responsibilities for admitting, ED call, consulting responsibilities must be clearly outlined in the bylaws"
"Impact of ACOs - CORRECT ANSWER=> ● When a hospital forms an ACO and begins to use selection
criteria that exclude some medical staff members based on quality such action could give rise to claims against the hospital for antitrust and other issues ● Disparate selection and retention policies ● Should hospital bylaws include quality of care measures"
"Credentialing Procedure (two step process): - CORRECT ANSWER=> ○ Credentials Committee - collect
and verify and evaluate the applicant for appointment or re-appointment to the medical staff. Look at medical education, licensure requirements, confirm liability insurance, other background information - you are being credentialed and asking for specific clinical privileges. ○ Governing Body of the Hospital (Medical Executive Committee) - grants final approval"
"Categories of Medical Staff Membership - CORRECT ANSWER=> 1. Active Medical Staff - full and
unrestricted appointment
- Associate or Provisional Medical Staff - There is a probationary period before becoming active medical staff typically 6 -12 months
- Consulting Medical Staff - A specialist or subspecialist who only consults on selected patients with an active staff member
- Courtesy Medical Staff - A physician who consistently performs a limited number of procedures at a hospital. Don't take call. 5 Affiliate Medical Staff - Because of hospitalists certain primary care physicians drop active privileges, but because of managed care contracting still need to be medical staff members
- Honorary Medical Staff - A method of recognizing the contributions of a retiring physician who has been a long term member of the medical staff
- Emergency Department Medical Staff - Can only screen and treat patients in the ED. Usually they are independent contractors contracting with the hospital and will have limited privileges of voting etc."
"Categories of Medical Staff - CORRECT ANSWER=> ● Temporary Medical Staff - those physicians who
provide coverage for a physician on leave or work of a specialist on a specific project ● Telemedical Staff - those physicians who practice telemedicine in the hospital from a remote location via telecommunication media"
"Privileging - CORRECT ANSWER=> Evaluation of the specific education and experience to determine if
the applicant has the requisite education, experience and clinical skill to safely perform the requested procedures"
"Corrective Action: Peer Review - CORRECT ANSWER=> ● Because of the threat of "negligent
credentialing" or "corporate negligence" hospitals have the affirmative duty to select and retain only competent practitioners. ● Joint Commission requires the medical staff the take a leadership role in performance improvement activities ● Medicare COPs require performance related improvement activities aimed at practitioners. ● HCQIA outlines corrective action policies and offers immunity to peer reviewers from monetary damages"
"Corrective Action Peer Review - General Categories of Concerns - CORRECT ANSWER=> ○ Clinical
competence ○ Professional competence - disruptive behavior that affects quality ○ Physical and Mental Impairment
● The names of the Hearing Committee members are released to the physician and may be challenged ● Is either before an arbitrator, panel or Hearing Officer - act like a judge making rulings of procedure and evidence ● Discovery ● Presentation of evidence ● Decision"
"Fair Hearing Procedure: Appellate Review - CORRECT ANSWER=> There is a mechanism for internal
appellate review that may or may not be a complete redo of the hearing"
"VA Board of Medicine - CORRECT ANSWER=> "
"Major Group For Physicians - CORRECT ANSWER=> AMA"
"Education Requirements for Physicians - CORRECT ANSWER=> 1. 4 years undergraduate degree
- 4 years medical school
- 3-7 years of residency training
- eligible medical licenses"
"Residency Programs - CORRECT ANSWER=> 1. National Resident Matching Program
- Chief Resident
- Depending on states resident are not licensed physicians (some states offer temp licenses)"
"National Resident Matching Program - CORRECT ANSWER=> Clearinghouse that matches the
preferences of new graduates with hospital residencies"
"Chief Resident - CORRECT ANSWER=> Supervises, manage and teach"
"Board Certification (Physicians) - CORRECT ANSWER=> 1.After residency, physicians can become
board certified in their specialty (May require additional training and testing , American Board of Medical Specialties (ABMS) , and Written and oral exam)
- Recertification every 7-10 years
- Six Core Competencies:"
"Six Core Competencies - CORRECT ANSWER=> 1. Practice-based learning and improvement
- Patient Care and Procedural Skills
- System-based practice
- Medical Knowledge
- Interpersonal and Communication Skills
- Professionalism"
"Continuing Medical Education - CORRECT ANSWER=> 1. State Medical Boards determine length and
type of hours required (Ohio - 100 Hours of CME every 2 years)"
"Joint Commission's Standards Indicate - CORRECT ANSWER=> A single organized medical staff with
overall responsibility for the quality of services provided by those with clinical privileges and is accountable to a governing body"
"Physicians Appointment Process - CORRECT ANSWER=> 1.Application
2.Reviewed and Verified 3.Submitted to dep head 4.Forwarded to medical staffs credential committee
- Executive Committee reviews
- Sends rec to B.O.D.
- B.O.D. reviews app
- CEO notifies physician
- Privilege Delineation
- Once Appointed has two categories for membership"
"Privilege Delineation - CORRECT ANSWER=> procedures that the physician can perform at the
hospital"
"Active or Attending Staff - CORRECT ANSWER=> Full rights and privileges"
"Associate Staff - CORRECT ANSWER=> incomplete privileges, may be working toward active staff"
"Provisional Staff - CORRECT ANSWER=> new staff in prob period, supervised"
"Courtesy Staff - CORRECT ANSWER=> does not often admit patients"
"Consulting Staff - CORRECT ANSWER=> does not admit
called into consult only"
"Temporary Staff - CORRECT ANSWER=> privileges for specific amount of time
usually there to treat one patient"
"Closed Medical Staff - CORRECT ANSWER=> 1. Medical staff closely monitors and restricts new
application
- Based on quality of need for patient care within the hospital and community"
"Examples of Closed Medical Staff - CORRECT ANSWER=> Lab, ED, Pathology
Hospitals sign contractural agreement with physicians or group to provide exclusive services"
"American Nurses Association (ANA) - CORRECT ANSWER=> Promote policy and legislation, establish
standards, and public code of ethics for nurses"
"National League of Nursing (NLN) - CORRECT ANSWER=> promote standards and innovations in
nursing educations"
"Types of Nurses - CORRECT ANSWER=> ADN - 2 year
BSN - 4 year APN - beyond BSN Must be licensed by state board"
"Types of APNs - CORRECT ANSWER=> MSN
RNP - registered nurse practitioner (adv. health assessment, and adv. pharmacology) NP - advanced clinical focus CRNAs"
"Roles of Nurses - CORRECT ANSWER=> 1. Provide direct patient care
- Coordinate care
- Research and evaluate effective ways to treat patients
- Documentation
- Medication management
- Communication"
"Outlook on nurses - CORRECT ANSWER=> 1. 62% nurses work in hospitals
- by 2020 80% of nursing should have BSN (current 55%)"
"Benefits of more BSNs - CORRECT ANSWER=> 1. More responsibility
- Supervisory roles
- Higher salaries
- Advanced training on critical thinking and problem solving
- Improved patient outcomes"
"Cons of more BSNs - CORRECT ANSWER=> 1. Slightly higher pay for organizations
- Expensive for additional schooling
- May sway potential candidates into other professions"
"Need of Providers - CORRECT ANSWER=> - 2.3 million health care workers needed by 2025
- 425,000 home health aides
- 100,000 dr (8000-45000 in pc and 30,000-65,000 in non-pc)
- 110,000 clinical lab techs
- need million nurses"
"why to have appropriate staffing levels - CORRECT ANSWER=> 1. Reduces hospital-related mortality
- Reduces failure to rescue
- Reduces length of stay
- Improve quality and outcomes"
"ACA Strains to the workforce - CORRECT ANSWER=> 1. Population demographics
- Distribution shortfall
- Disproportionate ratio of pcp to specialist
- Higher intensity of care
- Scope of practice variability
- Education Pipeline"
"Population Demographics - CORRECT ANSWER=> Aging population and change in care needs"
"Distribution shortfall - CORRECT ANSWER=> - 10% of dr and 18% of NPs practice in rural locations
- 25% populations lives in rural area
- Rural population are poorer and more likely to participate in government assistance"
"Disproportionate ratio of PCP to specialist - CORRECT ANSWER=> - only 1/3 dr. work as pcp
- more specialist = increased costs and decreased quality of care
- ACA relies on PCMH model and free preventive care ( newly insured population needs 8,000 additional pcps)"
"Higher intensity of care - CORRECT ANSWER=> Patient Acuity
- aging population
- rise in chronic conditions
- 2025 50% of population will have one CD"
"Scope of practice variability - CORRECT ANSWER=> scope of practice laws vary widely"
"Education pipeline - CORRECT ANSWER=> Demand still outweighs supply"
"Med school pipeline - CORRECT ANSWER=> -insufficient number of instructors, limited clinical sites
budgets -medicals are increasing enrollment by 30%
of medicare funded GME slots, insufficient to complete training process
- lack of residency slots prevents grad and prac med"
"Nursing School pipeline - CORRECT ANSWER=> 80,000 students being turned away each year bc hard
to get or keep nursing faculty, and aging faculty"
- rural locations will bear the burnt of the shortage
- longer wait times"
"Medicaid Expansion - CORRECT ANSWER=> -More individuals covered
- more seeking care at hospitals
- increased reimbursement/profits
- decreased uncompensated care
- crucial factor"
"new agenda - CORRECT ANSWER=> improve education
remove barriers to access promote efficient care delivery improve practice environment"
"Improve Education - CORRECT ANSWER=> - Educational financing should reflect a better balance
between primary care and specialty practices,
- increasing graduates of all health professionals
- providing financial incentives for faculty."
"Removing barriers to access - CORRECT ANSWER=> a.Scope-of-practice rules can contribute to the
cost and inefficiency of the health care system b.More nurse practitioners would improve timeliness of care and access"
"Promote Efficient Care Delivery - CORRECT ANSWER=> a.Strengthening the workforce supply coupled
with innovation in role and task allocation b.Efficiency and productivity will expand the workers' capacity to deliver high- quality patient care"
"Improve Practice Enironment - CORRECT ANSWER=> a.Increasing retention will require greater
incentives and benefits b.Prevent work overloads and strategies for stress management"
"Solutions - CORRECT ANSWER=> 1. Delivery innovation
- Team-based care
- Better use of tech
- Training more physicians
- ACA reauthorized loan repayment and forgiveness and scholarships
- Increases in medicare-funded GME residency slots
- Funding for workforce planning
- Increased funding for the Public Health Service"
"ACOs - CORRECT ANSWER=> - put primary care doctor in center of care delivery
- have a shared savings component
- if they save money they get it back
- piloted in medicare
- Challenge
- patients don't want to be in ACOs because of the limitations"
"PCMH - CORRECT ANSWER=> put pcp at center of care delivery"
"Training More physicians - CORRECT ANSWER=> - medical residency programs
- advocate for increased federal support for an additional 3,000 residency positions annually
- medical schools have expanded class size need greater support for graduate medical eduation"
"Ways to maintain adequate workforce - CORRECT ANSWER=> 1. Redesign workforce processes and
adopt tech
- Focus on retention
- Attract younger generation of workers
- Focus on hiring right people
- Seek Feedback
- Measure
- Reward and recognize
- Develop the workforce
- Eliminate low performers
- Provider a competitive benefits package"
"Key functions of HR - CORRECT ANSWER=> Recruitment and Retention"
"Challenges for recruiting for rural areas - CORRECT ANSWER=> 1. More money in urban
- More patients in urban
- Greater Collection with other providers
- Prefer living in urban
- Spouse's Job
- More to due in urban"
"Key activities of retention - CORRECT ANSWER=> Care, support and development of employees"
"Key functions under employee retention include: - CORRECT ANSWER=> a.Training and development
b.Managing compensation and benefits c.Assessing performance d.Providing employee assistance programs e.Offering employee suggestion programs"
"Ways to increase retention - CORRECT ANSWER=> a.Decrease workloads
b.Provide support staff c.Empower managers d.Increase salaries e.Encourage fair treatment across the professions f.Improve the orientation process
"If you needed to find out about what the Federal Government requires in regards to anti-trust issues,
what law would you consult? - CORRECT ANSWER=> Sherman Anti-trust Act"
"Peer references should be obtained from: - CORRECT ANSWER=> Practitioners in the same
professional discipline as the applicant"
"Patrick v. Burgett is an important case because it: - CORRECT ANSWER=> 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: -
CORRECT ANSWER=> Provided due process"
"Access to credentials files should be: - CORRECT ANSWER=> Described fully in an access policy"
"Which of the following bodies approves clinical privileges? - CORRECT ANSWER=> Governing body of
Board"
"What primary source verification is required by NCQA prior to provisional credentialing? - CORRECT
ANSWER=> 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: - CORRECT ANSWER=> Not to exceed two years"
"According to The Joint Commission standards, temporary privileges may be granted by: - CORRECT
ANSWER=> The CEO on 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? - CORRECT ANSWER=> Licensure, training, experience, and competence"
"According to NCQA standards, a copy of which of the following is acceptable verification of the
document? - CORRECT ANSWER=> DEA certificate"
"According to NCQA standards, which is an acceptable source for primary source verification of Medicare
and Medicaid sanction activity against physicians? - CORRECT ANSWER=> Federation of State Medical
Boards" "According to The Joint Commission standards, which of the following is considered a designated
equivalent source for verification of board certification? - CORRECT ANSWER=> The American Board of
Medical Specialties"
"Which of the following organizations have been recognized by The Joint Commission and NCQA to provide provide primary source verification of medical school graduation and residency training for U.S.
graduates? - CORRECT ANSWER=> American Medical Association Masterfile"
"According to NCQA standards, the application attestation statement must affirm that the application: -
CORRECT ANSWER=> Is correct and complete"
"According to The Joint Commission standards, medical staff bylaws should define: - CORRECT
ANSWER=> 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: - CORRECT ANSWER=> Relevant training or experience, ability to
perform privileges requested, current licensure, and competence"
"The Joint Commission hospital standards require medical staff bylaws to include: - CORRECT
ANSWER=> 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? - CORRECT ANSWER=> 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? - CORRECT ANSWER=> 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: - CORRECT ANSWER=>
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? - CORRECT ANSWER=> Current
licensure" "According to The Joint Commission, a nurse practitioner functioning independently and providing a
medical level of care must: - CORRECT ANSWER=> 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? - CORRECT ANSWER=> Education Commission for
Foreign Medical Graduates" "When evaluating compliance with the required timeframe for recredentialing, NCQA counts the
recredentialing period to the: - CORRECT ANSWER=> Month"
"NCQA standards require the organization to verify board certification at recredentialing: - CORRECT
ANSWER=> In all cases"
"According to HFAP standards, when confirming malpractice coverage the organization must: -
CORRECT ANSWER=> 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)? - CORRECT ANSWER=>
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? -
CORRECT ANSWER=> Governing Body"
"When credentialing and privileging practitioners it is appropriate to: - CORRECT ANSWER=> Follow a
routine process for each applicant"
"Medical liability insurance should be held in what limits? - CORRECT ANSWER=> As specified by the
medical staff and board of directors" "Is it appropriate to ask an applicant to the medical staff about medical conditions that would affect
ability to provide care? - CORRECT ANSWER=> Yes"
"The governing body delegates the responsibility of credentialing, recredentialing, and privileging to: -
CORRECT ANSWER=> The medical staff"
"Who should have access to medical staff meeting minutes? - CORRECT ANSWER=> Personnel as
documented in a records access policy and procedure" "In addition to conclusions, recommendations made, and actions taken, what should always be
documented in meeting minutes? - CORRECT ANSWER=> Any required follow-up to occur"
"Active, Associate, Courtesy, Honorary, and Consulting are all examples of: - CORRECT ANSWER=>
Membership categories"
"Changes in medical staff bylaws are not final until formally approved by: - CORRECT ANSWER=>
Governing Body" "What is the only hospital medical staff committee required by The Joint Commission hospital standards?
- CORRECT ANSWER=> Medical Executive Committee"
"The Healthcare Quality Improvement Act: - CORRECT ANSWER=> Provides qualified immunity from
antitrust liability arising out of peer review activities that are conducted in good faith"
"ABMS - CORRECT ANSWER=> American Board of Medical Specialties"
"AMA - CORRECT ANSWER=> American Medical Association"
"CAP - CORRECT ANSWER=> College of American Pathologists"
"CLIA - CORRECT ANSWER=> Clinical Laboratory Improvement Amendments of 1988"
"CFR - CORRECT ANSWER=> Code of Federal Regulations"
"COPs - CORRECT ANSWER=> Conditions of Participation"
"CFCs - CORRECT ANSWER=> Conditions for Coverage"
"DNV - CORRECT ANSWER=> Det Norske Veritas (The Norwegian Truth)"
"IQRS - CORRECT ANSWER=> Integrated Querying and Reporting System"
"FMEA - CORRECT ANSWER=> Failure Mode and Effects Analysis"
"FPPE - CORRECT ANSWER=> Focused Professional Practice Evaluations"
"HCQIA - CORRECT ANSWER=> Health Care Quality Improvement Act of 1986"
"HFAP - CORRECT ANSWER=> Healthcare Facilities Accreditation Program"
"HIPDB - CORRECT ANSWER=> Healthcare Integrity Protection Data Bank"
"HMO - CORRECT ANSWER=> Healthcare Management Organization"
"ICE - CORRECT ANSWER=> Industry Collaboration Effort"
"IEC - CORRECT ANSWER=> Independent Ethics Committee"
"IOS - CORRECT ANSWER=> International Organization for Standardization"
"IRB - CORRECT ANSWER=> Institutional Review Board"
"MCO - CORRECT ANSWER=> Managed Care Organization"
"MOS - CORRECT ANSWER=> Measures of Success"
"MQSRA - CORRECT ANSWER=> Mammography Quality Standards Act (1992)"
