CPCS FINAL EXAM 1 2023

CPCS FINAL EXAM 1 2023 What two accreditors state: a hospital may not rely solely on board certification when considering practitioner for medical staff membership? - ANSWER HFAP, CMS According to JC & HFAP name four approved sources PSV for Medical Education - ANSWER Medical School, AMA, ECFMG, AOA According to NCQA practitioners must be notified of credentialing decision within how many days? - ANSWER 60 Days The DHHS mails a copy of the NPDB report to the named provider. If the provider wishes to dispute the reports accuracy, the provider has how many days to do so? - ANSWER 60 Days According to URAQ, within how many days must the practitioner be notified of credentialing decisions? - ANSWER 10 Days How many days does a practitioner have to dispute an NPDB report accuracy - ANSWER 60 Days Which accrediting body requires five year verification of malpractice history - ANSW ER NCQA What is commonly used source for verifying malpractice history - ANSWER NPDB According to the JC a fair hearing and appeals process as described in the medical staff bylaws is available to whom? - ANSWER Medical staff members and non-membe rs holding clinical privileges T/F Only the highest of training must be verified according to NCQA - ANSWER True According to the Joint Commission a peer recommendation should address what six competencies? - ANSWER Medical knowledge\nTechnical & clinical skill\nclinical judgment\ninterpersonal skills\ncommunication skills\nprofessionalism Telemedicine - according to JC what two options are available for credentialing a t he original site? - ANSWER Full credentialing, use of the distant sites credentialing According to JC what is included in the process of planning and implementing privileges? - ANSWER Develop & approve procedure list\nProcess the application\nEvaluate applicant specific information\nSubmit recommendatio ns to governing body for applicant specific delineated privileges\nNotify the app licant, relevant personnel\nMonitor the use of privileges Are payments made by a physician in a malpractice claim reportable to the NPDB? - ANSWER No Who requires Peer References - ANSWER JC, HFAP, AAAHC Who reappoints - ANSWER JC, HFAP, NCQA, URAC Who requires an attestation? - ANSWER NCQA, URAC, AAAHC Who requires education verification? - ANSWER JC, HFAP, URAC, AAAHC Who requires statement regarding felony convictions? - ANSWER HFAP, NCQA, AAAHC Attestation must state that the information submitted is complete & correct - ANSWE R NCQA, AAAHC Attestation must state that the information submitted is complete & accurate - ANSWE R URAC Attestation must include inquiry regarding illegal drug use? - ANSWER NCAQ Attestation must include inquiry regarding inability to perform essential functions ? - ANSWER NCQA Attestation must include inquiry regarding history or loss or limitations of licensure or privileges or disciplinary actions? - ANSWER NCQA Attestation must include inquiry regarding current malpractice coverage? - ANSWER NCQA Attestation must include inquiry regarding felony convictions? - ANSWER NCQA Applicant must attest to limitations on ability to perform functions of the po sition with or without accomodation, if any - ANSWER NCQA Applicant must attest to lack of present illegal drug use - ANSWER AAAHC Applicant must attest to history or loss of license and felony convictions, if any - ANSWER AAAHC Applicant must attest to history of loss or limitations of privileges or disciplinary a ctions, if any - ANSWER AAAHC Applicant must attest to current malpractice insurance coverage? - ANSWER AAAHC Who requires a malpractice history for applicants? - ANSWER JC, HFAP, NCQA, URAC, AAAHC Who must have a process in place to address complaints? - ANSWER JC, HFAP, NCQA, URAC Who requires Board Certification? - ANSWER None Who requires criminal background checks? - ANSWER HFAP Who requires applicant ID - ANSWER JC Who requires an NPDB - ANSWER JC, HFAP, NCQA, AAAHC Who requires current competence? - ANSWER JC, HFAP, CMS How often does the OIG report to the NPDB? - ANSWER Monthly Are limitations of the clinical privileges of a psychiatrist for more than 30 days repo rtable to the NPDB? - ANSWER Yes According to the JC, who may amend the medical staff bylaws? - ANSWER Governing Body Failure to meet the established qualifications and criteria for appointment sho uld be reported to whom? - ANSWER The applicant NCQA requires the MCO to obtain a minimum of ???? years of work history? - ANSWER Five Years According to NCQA what policy must an organization have in place to obtain approval to enter into a delegated agreement? - ANSWER Credentialing policies Hospitals must query the NPDB when: - ANSWER Initial appointment\ngranting of priveleges\nevery two years NCQA requires verifications must be less than how many days old? - ANSWER 18 0 What is the verification time limit on malpractice history according to the NCQA? - ANSWER 180 days Time limited credential must be verified by the CVO within how many days prior to submission to the client? - ANSWER 120 days According to AAAHC, for initial appointments, in addition to licensure and education, what verification is required? - ANSWER 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? - ANSWER NCQA Who is required to query the NPDB - ANSWER Hospitals Is disciplinary action taken against the license of a dentist reportable to the NPDB? - ANSWER 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? - ANSWER 3 years According to NCQA verification of Medicare/Medicaid sanctions can be queried by any of what sources? - ANSWER 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? - ANSWER Annually How far back does the Joint Commission require evaluation of malpractice history? - ANSWER Back to Medical School According to JC, what source may be used to verify malpractice history? - ANSWER NPDB Is an internet verification from a website not contracted by the primary source th at attest to the accuracy and timeliness of the information considered a complete verificatio n by NCQA? - ANSWER No What accreditation bodies require privileges to be distributed to essential departme nt personnnel? - ANSWER Joint Commission - CMS Who requires background checks? - ANSWER HFAP (the only organization that requires) Is a payment made by an insurance company reportable to the NPDB? - ANSWER Yes According to NCQA what providers are NOT required to be credentialed when working in an independent relationship? - ANSWER Locum Tenens\nHospital based practitioners (i.e., anesthesia, pathology, radiology, etc.) Is denial of a medical license application by a state medical board reportable to the