CPHQ - Certified Professional in Healthcare Quality Regulatory and Accreditation Questions and Answers

Question 1

A hospital accredited by The Joint Commission (TJC) is considered to have met the requirements for Medicare and Medicaid participation.
This is a direct result of TJC possessing which of the following?

Accepted Answer

Deeming authority granted by CMS

Answer

A reciprocal agreement with the state health department

Answer

Baldrige Performance Excellence Framework recognition

Answer

ISO 9001 certification for quality management systems

Question 2

A health plan is preparing for an external review that requires the submission of data from a large, standardized set of performance measures, including "Effectiveness of Care" and "Use of Services." This activity is MOST characteristic of preparing for accreditation with which body?

Accepted Answer

The National Committee for Quality Assurance (NCQA)

Answer

The Joint Commission (TJC)

Answer

The Agency for Healthcare Research and Quality (AHRQ)

Answer

The Occupational Safety and Health Administration (OSHA)

Question 3

A patient experiences an unexpected, serious adverse outcome resulting in permanent harm. According to The Joint Commission's Sentinel Event Policy, what is the MOST appropriate immediate action for the healthcare organization to undertake?

Accepted Answer

Conduct a comprehensive systematic analysis, such as a Root Cause Analysis (RCA).

Answer

Report the event to the state medical board within 24 hours.

Answer

Immediately suspend the privileges of all clinical staff involved.

Answer

Wait for a formal claim to be filed before beginning an internal investigation.

Question 4

During an accreditation survey, a surveyor selects a patient's medical record and uses it as a roadmap to trace the patient's experience throughout the hospital, interviewing staff and observing care processes in various departments. This survey process is known as:

Accepted Answer

An individual tracer

Answer

A system tracer

Answer

A periodic performance review (PPR)

Answer

A Failure Mode and Effects Analysis (FMEA)

Question 5

A hospital is found to have significant deficiencies during a survey, placing it out of compliance with a Centers for Medicare & Medicaid Services (CMS) Condition of Participation (CoP). What is the MOST severe potential consequence for the hospital?

Accepted Answer

Termination of its Medicare and Medicaid provider agreement.

Answer

A mandatory financial contribution to a national patient safety fund.

Answer

Public censure by the Department of Health and Human Services.

Answer

A requirement to achieve ISO 9001 certification within one year.

Question 6

A company specializing in pharmacy benefit management (PBM) and direct-to-consumer telehealth services wants to demonstrate its commitment to quality and operational integrity. Which of the following accreditation bodies is MOST specifically focused on these types of healthcare services?

Accepted Answer

URAC (Utilization Review Accreditation Commission)

Answer

The Joint Commission (TJC)

Answer

The Commission on Accreditation of Rehabilitation Facilities (CARF)

Answer

The National Committee for Quality Assurance (NCQA)