Medical Staff Credentials and Verification, Exams of Medicine

Download Medical Staff Credentials and Verification and more Exams Medicine in PDF only on Docsity! CPCS Study Guide Questions and Answers (Graded A) Why is it important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs? - ANSWER-The facility won't get paid for treating patients unless service is provided by authorized provider Which of the following credentials must be tracked on an ongoing basis? a. Medical school b. Post graduate education c. Closed medical malpractice claims d. Licensure - ANSWER-Licensure According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action? - ANSWER-Determine if there is evidence of poor quality that could affect the health and safety of its members What is the name of the entity that was established through the Health Care Quality Improvement Act of 1986 to restrict the ability of incompetent physicians, dentists, and other healthcare practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history? - ANSWER-The National Practitioner Databank When developing clinical privileging criteria, which of the following is important to evaluate? a. How many providers are in that specialty b. Established standards of practice such as, specialty board recommendations c. Whether or not the quality department can support the FPPE process d. The average cost to the patient - ANSWER-Established standards of practice such as, specialty board recommendations What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty? - ANSWER-To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care Which of the following specialists is most likely to perform at PTCA? a. General Surgeon b. ObGyn c. Urologist d. Interventional Cardiologist - ANSWER-Interventional Cardiologist The Joint Commission hospital standards require that clinical privileges are hospital specific and ___ a. Based on the individual's demonstrated current competence and the procedures the hospital can support b. Based on board certification c. Based on the privileges the individual is currently approved to perform at other hospitals d. Posted in a place that is accessible to all hospital employees - ANSWER-Based on the individual's demonstrated current competence and the procedures the hospital can support Which of the following would be routinely performed by a cardiologist? a. Hysterectomy b. Trans-esophageal Echocardiography c. Urethral dilation d. Renal dialysis - ANSWER-Trans-esophageal Echocardiography Which NCQA required committee makes recommendations regarding credentialing decisions? - ANSWER-Credentials Committee HFAP standards require three medical staff committees to be delineated in the medical staff structure. Two of them are the Medical Executive Committee and the Utilization of Osteopathic Methods & Concepts Committee. What is the other required medical staff committee? - ANSWER-Utilization Review Committee If you needed to find out about what the Federal Government requires in regards to anti- trust issues, what law would you consult? - ANSWER-Sherman Anti-trust Act Peer references should be obtained from: a. Practitioners who have referred patient to the provider b. Family, friends and neighbors c. Former hospital administrators d. Practitioners in the same professional discipline as the applicant - ANSWER- Practitioners in the same professional discipline as the applicant Patrick vs Burgett is an important case because it: - ANSWER-Illustrates the potential for antitrust liability arising out of peer review activities If a medical staff member has privileges and/or medical staff appointment revoked, he/she must be: a. Granted temporary privileges b. Provided due process c. Reported immediately tot he NPBD d. Offered a leave of absence from the medical staff - ANSWER-Provided due process d. A statement that the medical staff members must attend at least 25% of medical staff meetings held - ANSWER-A mechanism for selection and removal of officers According to NCQA standards, which of the following is an approved source for verification of board certification? a. National Practitioner Databank b. State licensing agency if state agency conducts primary verification of board status c. Viewing of the original board certification d. Health Care Integrity Protection Data Bank - ANSWER-State licensing agency if state agency conducts primary verification of board status According to The Joint Commission hospital standards, which of the following is a required component of the reappointment process? a. Documentation of the applicant's health status b. Verification of residency training c. Medicare/Medicaid sanctions query d. Primary source verification of malpractice suits - ANSWER-Documentation of the applicant's health status According to URAC's health network standards, each applicant within the scope fo the credentialing program submits an application that includes at least which of the following: a. State licensure information, including current license(s) and history of licensure in all jurisdictions b. A listing of all current and past hospital affiliations c. An NPDB self-query d. Copies of all current licensure - ANSWER-State licensure information, including current license(s) and history of licensure in all jurisdictions According to AAAHC, which must be monitored on an ongoing basis? a. Current licensure b. Medical malpractice liability coverage c. Health status d. Hospital and other healthcare facility affiliation - ANSWER-Current licensure According to The Joint Commission, a nurse practitioner functioning independently and providing a medical level of care must: a. Have a job description b. Be granted delineated clinical privileges c. Be directly supervised by an active physician staff member d. Participate in medical staff quality assessment activities - ANSWER-Be granted delineated clinical privileges According to The Joint Commission, what is an acceptable source for verification for medical education of an international graduate? - ANSWER-Education Commission for Foreign Medical Graduates (ECFMG) When evaluating compliance with the required time-frame for recredentialing, NCQA counts the recredentialing period to the: - ANSWER-Month NCQA standards require the organization to verify board certification at recredentiaing: a. If a practitioner has received Medicare/Medicaid sanctions b. If a practitioner is requesting a change in status c. In all cases d. If a practitioner has acquired board certification since last credentialed - ANSWER-In call cases To whom does the AAAHC give the responsibility for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management? - ANSWER-Governing body In order for a healthcare facility to participate in the Medicare and Medicaid programs it must comply with the... - ANSWER-Medicare Conditions of Participation According to The Joint Commission hospital standards, which of the following is an element of a self-governing medical staff? a. The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges b. There can be any number of organized medical staffs as long as they are approved by the governing board c. The hospital's board of directors determines the criteria for granting medical staff privileges d. The medical staff is self-governing, and as such, its organization does not have to be approved by the governing body - ANSWER-The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges Roberts Rule of order is an example of: a. Executive privilege b. Parliamentary procedure c. A code of conduct d. Bylaws - ANSWER-Parliamentary procedure The medical staff application should provide a chronological history of: a. The applicant's education, training, and work history b. CME activities and completion of residency c. Marriages since medical school d. Leadership positions held - ANSWER-The applicants, education, training, and work history In order to participate in a managed care plan, a provider must be accepted to the plan's... - ANSWER-Provider panel In order for a physician to practice medicine in any state in the United States, he/she must possess... - ANSWER-Current state licensure Which of the following is considered post-graduate education? a. Medical school b. College c. Board Certification d. Residency training - ANSWER-Residency training Which of the following elements may not be used to evaluate credentials of applicants? a. Gender b. Licensure c. Post-graduate training d. Board certification - ANSWER-Gender The release of liability statement signed by the applicant for medical staff appointment should include: a. The name of the department chairman for all past hospital appointments b. A statement providing immunity to those who respond in good faith to requests for information c. A statement of correctness of the information provided d. Primary source verification - ANSWER-A statement providing immunity to those who respond in good faith to requests for information Primary source verification is: a. Receiving information directly from the issuing source b. Required by the health care quality improvement act c. Considered economic credentialing d. Delegated credentialing - ANSWER-Receiving information directly from the issuing source Unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice are examples of - ANSWER-Red flags When documenting telephone conversation regarding primary source verification, what should be documented? - ANSWER-Name of person Organization contacted Date of call What was discussed Who conducted the interview According to HFAP standards, when confirming malpractice coverage, the organization must: a. Query the NPDB b. Obtain the claim history with each carrier over the last five years