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CPMSM STUDY GUIDE MATERIAL EXAM
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CPMSM STUDY GUIDE MATERIAL EXAMWhat are the four models of HMOs? ANSWER Staff Model
Group Model
Network Model
Independent Practice Association (IPA)
What are the four categories of committees? ANSWER Standing
Ad Hoc
Task force
Continuous quality improvement team
How many medical staff members make up a Bylaws Committee? - Answer: 5
At least five active medical personnel.
How many medical staff members make up a Credentials Committee? - Answer: 5
At least five active medical personnel.
How many medical personnel must serve on an Infection Control Committee? -
Answer three.
At least three active medical personnel
,How many medical staff members must be on a Medical Records Committee? -
ANSWER 1.
There is at least one active medical staff.
How often should the Medical Records Committee meet? - Answer: At least
quarterly.
How many medical staff members must be on the Pharmacy & Therapeutics
Committee? - Answer: 5
At least five active medical personnel.
How often should the Pharmacy and Therapeutics Committee meet? - Answer: At
least quarterly.
How many medical personnel must serve on a Utilisation Review Committee? -
ANSWER 1.
There is at least one active medical staff.
How frequently should the Utilisation Review Committee meet? - Answer: Every
other month.
What is the procedure for obtaining, verifying, and evaluating the qualifications of
a health care practitioner who want to perform patient care services in or for a
hospital? - Answer Credentialing
What are the three reasons for credentialing? - Answer: Patient Safety
,Risk Management
Required by agencies.
Which three accreditors have received "deemed status"? - Answer: TJC, HFAP,
DNV.
Which two organisations provide accreditation to managed care organisations? -
ANSWER: NCQA, URAC
Who is the primary accreditor for ambulatory care facilities? - ANSWER AAAHC
Physicians who work as hospitalists for a facility but are not included in the
provider directory are not covered by the credentialing rules under this
accreditation. - ANSWER URAC
Which accreditation do the following practitioners require *not* to be credentialed
for?
-only inpatient care for members of the organisation in a hospital setting.
- Practice entirely in a free-standing setting for members guided to the facility.
-Pharmacists employed by a PBM (pharmacy benefits management) organisation
for UM functions
locum tenens working for fewer than 90 days.
-rental network practitioners offering out-of-area care - ANSWER NCQA
What are the Medicare CoP's minimum criteria for appointment to the medical staff
and awarding medical staff privileges? - Answer: CCJET
character
, competence
judgement
experience
training
CMS standards demand that medical staff bylaws provide the following
information for each group of medical personnel? - Answer the obligations and
privileges.
Do clinicians with recommend and follow status have admitting/ordering privileges
in the hospital? - Answer No.
For TJC, does "privileges" relate to each category's tasks and prerogatives, or
clinical privileges to offer care? - ANSWER Duties and Prerogatives
Which accreditor requires an applicant to submit a declaration stating that there are
no health issues that might impair his or her ability to offer care? TJC's ANSWER
Which accreditor has *no* specified requirements for professional practice
questions in the application or reapp? - ANSWER DNV
Which clause must be included in the delegation of credentialing agreement for
Medicare-deemed facilities? - ANSWER Follow Medicare regulations.
How frequently must the delegate organisation send a report to Credentials
regarding a URAC facility? - Answer annually.
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