Healthcare Credentialing and Privileging Standards, Exams of Medicine

Download Healthcare Credentialing and Privileging Standards and more Exams Medicine in PDF only on Docsity! CPCS 2024-Practice Exam-2 Questions and Answers 100% Correct URAC standards require primary source verification of which two elements when initially credentialing a provider? - ANSWER-a. State licensure & Board certification or highest level of education. b. Medical malpractice claims & Professional liability coverage c. Health status & Ability to perform privileges requested True/False: AOA-HFAP standards allow a hospital to accept the credentialing and privileging decision of another organization (credentialing/privileging by proxy for teleradiology services)? - ANSWER-True. In credentialing/privileges for telemedicine, The Joint Commission allows the originating site to use credentialing and privileges information from the distant site if these three requirements are met: - ANSWER-1. The distant site is TJC accredited. 2. The originating site has evidence of an internal review of the practitioner's performance of these privileges and sends to the distant site information that is useful to assess the practitioner's quality of care, treatment, and services for use in privileging and performance improvement. 3. The practitioner is privileged at the distant site for those services to be provided at the originating site. CMS Conditions of Participation for Hospitals require that criteria for selection of medical staff include evaluation of what five things? - ANSWER-1. Character. 2. Competence. 3. Training. 4. Experience. 5. Judgment. NCQA requires verification of which three factors prior to provisionally credentialing a provider? - ANSWER-1. Current signed application with attestation. 2. PSV of a current, valid license to practice. 3. PSV of past 5 years of malpractice claims or settlements from the malpractice carrier or NPDB. AAAHC requires a provider to be recredentialed every three years except under what circumstance? - ANSWER-1. Unless the state law requires otherwise. 2. Provider cannot be reached due to military or maternity leave or sabbatical (per live class only) AAAHC standards require PSV of a number of elements on initial application. What are some of the elements? - ANSWER-1. NPDB query 2. Current state license 3. DEA 4. Education and training 6. Experience review 7. Peer evaluation for clinical competency 8. Proof of medical liability coverage What specialty is most likely to be granted privileges for balloon endometrial ablation? - ANSWER-a. Otolaryngologist b. Gynecologist or OB/GYN. c. Ophthalmologist AOA-HFAP standards require what document(s) to describe the qualifications and criteria that must be met by a candidate in order for the medical staff to recommend appointment and privileges to the governing body? - ANSWER-a. Privilege laundry list document b. Core privileging document c. Bylaws or appended credentialing manual. In an MCO, a review board or governing body may review a credentialing decision after the Credentialing Committee approval. What date does NCQA use when assessing performance against timeliness requirements for PSV? - ANSWER-a. The decision date of the Credentialing Committee meeting or medical director sign off. b. The date the credentialing material was submitted to the credentialing committee c. They date on which the provider originally completed the application True/False: According to TJC standards, if a medical staff appointee does not return his/her application in a timely fashion and the result is that the appointment will lapse, temporary privileges can be granted. - ANSWER-False. Temporary privileges cannot be granted for this circumstance. Name The Joint Commission approved designated equivalent source for verification of actions against a physician's medical license. - ANSWER-a. NPDB/HIPDB b. Excluded Parties List System maintained by the GSA C. The Federation of State Medical Boards (FSMB). According to The Joint Commission standards, temporary privileges may be granted by the: - ANSWER-a. CEO b. CEO on the recommendation of the medical staff president or authorized designee. c. Department Chair Name the federal law that was enacted for the purpose of encouraging good faith professional review activities. - ANSWER-a. HCQIA. b. ADA