TJC Hearing and CPMSM: Due
Process Test questions and
answers 2025 latest update
Appeals - answer Bylaws outline fair hearing and appeal
process.
Provides review of decisions regarding reappt, denial,
reduction or suspension of privs that involved quality of
care issues.
Outlines scheduling a hearing, hearing procedure,
stipulates composition of hearing panel.
Outlines process to appeal adverse decision to governing
body.
NCQA Hearing and Appeals - answer Practitioner is
notified of their right to review credentialing info received
(no access to peer review info).
Notified if into differs from info provided by practitioner.
(I) Given right to correct any info that is erroneous.
P&P defines appeals process if adverse decision is made
based on quality of care or service issues.
, CMS/DMV Hearing and Appeals - answer Standards silent
on provision of hearing/appeals.
CMS requires bylaws describe privilege process thus
practitioner rights to a hearing/appeal are included in
language.
National standard provide 2 levels:
1) hearing before medical staff
2) appeal to governing body
URAC Hearing and Appeals - answer Providers must be
able to obtain info re: status of
application and have
opportunity to provide
accurate info if there is a
problem.
AAAHC Hearing and Appeals - answer Governing body
must approve mechanisms for initial, reappointment, and
granting of privileges, suspending or
terminating privileges, including provisions for appeal of
such decisions.
Mechanisms must be in place to notify licensing and/or
disciplinary bodies or other authorities when privileges
are suspended or terminated.
Process Test questions and
answers 2025 latest update
Appeals - answer Bylaws outline fair hearing and appeal
process.
Provides review of decisions regarding reappt, denial,
reduction or suspension of privs that involved quality of
care issues.
Outlines scheduling a hearing, hearing procedure,
stipulates composition of hearing panel.
Outlines process to appeal adverse decision to governing
body.
NCQA Hearing and Appeals - answer Practitioner is
notified of their right to review credentialing info received
(no access to peer review info).
Notified if into differs from info provided by practitioner.
(I) Given right to correct any info that is erroneous.
P&P defines appeals process if adverse decision is made
based on quality of care or service issues.
, CMS/DMV Hearing and Appeals - answer Standards silent
on provision of hearing/appeals.
CMS requires bylaws describe privilege process thus
practitioner rights to a hearing/appeal are included in
language.
National standard provide 2 levels:
1) hearing before medical staff
2) appeal to governing body
URAC Hearing and Appeals - answer Providers must be
able to obtain info re: status of
application and have
opportunity to provide
accurate info if there is a
problem.
AAAHC Hearing and Appeals - answer Governing body
must approve mechanisms for initial, reappointment, and
granting of privileges, suspending or
terminating privileges, including provisions for appeal of
such decisions.
Mechanisms must be in place to notify licensing and/or
disciplinary bodies or other authorities when privileges
are suspended or terminated.
