CPCS/CPMSM
Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - Answer- Yes
According to the Joint Commission, who may amend the medical staff bylaws? - Answer- Governing Body
Failure to meet the established qualifications and criteri...
CPCS/CPMSM
Are limitations of the clinical privileges of a psychiatrist for more than 30 days
reportable to the NPDB? - Answer- Yes
According to the Joint Commission, who may amend the medical staff bylaws? -
Answer- Governing Body
Failure to meet the established qualifications and criteria for appointment should be
reported to whom? - Answer- The applicant
NCQA requires the MCO to obtain a minimum of ???? years of work history? -
Answer- 5 years
According to NCQA what policy must an organization have in place to obtain
approval to enter into a delegated agreement? - Answer- Credentialing policies
How often does the OIG report to the NPDB? - Answer- Monthly
Hospitals must query the NPDB when: - Answer- Initial appt, granting of privileges,
every two years
NCQA requires verifications must be less than how many days old? - Answer- 180
days
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, Sate 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?
What source may be used? - Answer- Back to medical school. NPDB.
Is an internet verification from a website not contracted by the primary source that
attests to the accuracy and timeliness of the information considered a complete
verification by NCQA? - Answer- No
What accreditation bodies require privileges to be distributed to essential department
personnel? - Answer- Joint Commission/CMS
T/F - The Joint Commission and NCQA do not require criminal background checks. -
Answer- True - the only organization that requires background checks is HFAP.
Is a payment made by an insurance company reportable to the NPDB? - Answer-
Yes
Who is the best person to consult when releasing adverse information in a
verification request from another organization? - Answer- Legal Counsel
According to CMS, who in the organization may make decisions regarding approval
of credentialing applications? - Answer- Governing Board
What are the six elements of a written delegation agreement? - Answer- 1. Mutually
agreed upon
2. Describes responsibilities of organization and delegated entity
3. Describes delegated activities
4. Requires semi-annual reporting to the organization
5. Describes the process by which the organization evaluates the delegated entities
performance
6. Describes remedies available to the organization if the delegated entity does not
fulfil its obligations including revocation of delegated agreement
According to NCQA, what providers are NOT required to be credentialed when
working in an independent relationship? - Answer- Locums Tenens, Hospital based
practitioners (i.e. Anesthesia, Pathology, Radiology, etc.)
How many peer references does HFAP require at initial appointment? - Answer- 1
T/F - Denial of a medical license application by a state medical board is not
reportable to the NPDB? - Answer- True
What two accreditors state: a hospital may not rely solely on board certification when
considering practitioner for medical staff membership? - Answer- HFAP, CMS
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