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CPCS > Study Session 2/26/2025 > Flashcards

Study Session 2/26/2025 Flashcards

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1
Q

There is no specific requirement for verification of work history. The standards require, at the time of appointment to membership and initial granting of privileges verification of relevant training or experience be obtained from the PSV whenever feasible

a. NCQA
b. TJC
c. ACHC

A

TJC

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2
Q

A minimum of five years of relevant work history must be obtained through the practitioner’s application or curriculum vitae

a. NCQA
b. ACHC
c. DNV

A

NCQA

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3
Q

Verification of employment history should be obtained for hospital-employed physicians and non-physician practitioners

a. TJC
b. DNV
c. ACHC

A

ACHC

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4
Q

Qualifications shall include primary source verification of experience

a. DNV
b. AAAHC
c. Medicare

A

DNV

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5
Q

Not specifically addressed, but application must include hospital affiliations and privileges

a. Medicare
b. URAC
c. ACHC

A

URAC

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6
Q

Sample application for Privileges requests explanation for a break in the continuity of medical education internship, residency, hospital affiliations medical practice etc…

a. AAAHC
b. DNV
c. TJC

A

AAAHC

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7
Q

Work History not specifically addressed

a. Medicare
b. AAAHC
c. DNV

A

Medicare

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8
Q

Which accreditations indicate that the NPDB’s continuous query is acceptable for ongoing monitoring?

a. TJC, NCQA, ACHC, DNV, URAC, and AAAHC
b. TJC, ACHC, DNV, and AAAHC
c. TJC, NCQA, URAC and AAAHC

A

TJC, NCQA, URAC and AAAHC

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9
Q

An organization may conduct a one-time ______ _______ of practitioners who are applying for the first time, prior to the initial credentialing.

a. Locum Tenens
b. Provisional Credentialing
c. Temporary Privileges

A

Provisional Credentialing

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10
Q

Which data bank maintains a database containing primary source information from the American Academy of Physician Assistants (AAPA) and provides profiles for credentialing verification?

a. FSMB
b. AOA
c. AMA

A

AMA

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11
Q

According to TJC, when is a query of the National Practitioner Data Bank (NPDB) required?

a. Only when a provider is initially credentialed
b. When clinical privileges are initially granted, renewed, or requested, including temporary privileges
c. Only if a complaint has been filed against the provider

A

When clinical privileges are initially granted, renewed, or requested, including temporary privileges

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12
Q

Within ___ hours, email notifications are received of a reporting being received by the NPDB on a practitioner.

a. 18
b. 24
c. 36

A

24

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13
Q

Who only requires to have the applicant document work history, but does not necessarily verify the work history??

a. DNV and NCQA
b. Managed Care plans
c. DNV

A

Managed Care plans

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14
Q

What standard states that an NPDB query is required at initial, and reappointment and the use of Continuous Query is acceptable?

a. TJC
b. ACHC
c. AAAHC

A

AAAHC

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15
Q

____________ are only required to have the applicant document work history, but do not necessarily verify the work history.

a. Hospitals
b. Managed Care plans
c. Ambulatory Care centers

A

Managed Care plans

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16
Q

Per TJC, what is an acceptable method for ongoing NPDB monitoring?

a. Manual re-query every year
b. Use of continuous query
c. Query only after malpractice claims

A

Use of continuous query

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17
Q

____ is the only accrediting body that states verification of healthcare employment and work history is required.

a. DNV
b. NCQA
c. ACHC

A

ACHC

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18
Q

Who states this regarding work history: Ensure the criteria for selection are individual character, competence, training, experience, and judgement?

a. Medicare
b. TJC
c. ACHC

A

Medicare

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19
Q

The ____________ is an information clearinghouse designed to collect and release information related to the professional competence and conduct of physicians, dentists, and other health care practitioners.

a. FSMB
b. AMA
c. NPDB

A

NPDB

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20
Q

For granting temporary privileges, locum tenens or similar temporary staff may be used for a period not to exceed ______________.

a. 6 months
b. 120 days
c. 180 days

A

6 months

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21
Q

Per NCQA, how soon must information from the NPDB be reviewed once it is released by the reporting entity?

a. Within 30 days
b. Within six months
c. No specific timeframe is required

A

Within 30 days

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22
Q

For _____, temporary privileges are permitted for urgent patient care need or when application is complete without any negative or adverse info and cannot exceed 120 days. Granting of the temp privileges is on recommendation of member MEC, MS president or Medical Director.

a. ACHC
b. TJC
c. DNV

A

DNV

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23
Q

TJC states that temporary privileges cannot exceed _____ days.

a. 180
b. 60
c. 120

A

120

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24
Q

Due to the time limits on Temporary Privileges, it is important to _________ _________ of the expiration date for all providers with these privileges.

a. Log in
b. Keep track
c. Data entry

25
Which two accreditations do not reference temporary privileges, but do have a process for provisional credentialing? a. NCQA, ACHC b. NCQA, URAC c. DNV, URAC
NCQA, URAC
26
Per NCQA, if sanction reports are not published, the organization must query the source within how many months from the last credentialing cycle? a. 9-12 months b. 12-18 months c. 12-24 months
12-18 months
27
NCQA standards require files to contain all but what one for consideration of provisional credentialing? a. PSV of current, valid license and NPDB b. PSV of five years of malpractice history c. Complete application and signed attestation
PSV of current, valid license and NPDB
28
How does URAC define a “clean application”? a. No malpractice claims and all personal references received b. All sections are completed, it is signed and dated, all necessary support documentation is present, the provider meets the credentialing criteria, and there are no issues to report as defined in the organization’s credentialing plan. c. Application is complete and signed, there are no malpractice claims, and no issues to report as defined in the organization’s credentialing plan
All sections are completed, it is signed and dated, all necessary support documentation is present, the provider meets the credentialing criteria, and there are no issues to report as defined in the organization’s credentialing plan.
29
Per __________, bylaws provide for the granting of temporary privileges: * For care of specific patients * Locum tenens * Emergency or Disaster * Prudent a. DNV b. ACHC c. URAC
ACHC
30
Organizations must ensure that provisional credentialing status does not extend for more than ___ calendar days. a. 180 b. 120 c. 60
60
31
Per Medicare CoPs, are healthcare organizations required to report actions to the NPDB? a. Only for criminal actions b. Yes, for any limitation, revocation, or constraint on privileges c. No, reporting is optional
Yes, for any limitation, revocation, or constraint on privileges
32
There are two accrediting bodies that state NPDB should be queried on Initial Appointment and Reappointment, but only one of these two states that Continuous Query is acceptable. a. DNV b. ACHC c. AAAHC
AAAHC
33
Per URAC, can NPDB be used as a source for verifying malpractice history? a. Yes, NPDB is an acceptable source b. No, only malpractice carriers can provide this data c. Only if the practitioner consents
Yes, NPDB is an acceptable source
34
While it is the practice of many hospitals to verify all past hospital affiliations, some hospitals verify only the past ___________. a. 2 years b. 5-10 years c. Everything after completion of training must be verified
5-10 years
35
Although Work History is not specifically addressed for _____, they do state there must be primary source verification of experience. a. ACHC b. DNV c. AAAHC
DNV
36
Verification of employment history should be obtained for hospital-employed physicians and non-physician practitioners under which accreditation? a. TJC b. ACHC c. NCQA
ACHC
37
Verification of employment history should be obtained for hospital- employed and non-physician practitioners. a. ACHC b. AAAHC c. DNV
ACHC
38
URAC standards state provisional participation can only be for _______ a. 60 days b. 120 days c. a limited time
a limited time
39
At a DNV accredited organization, is the NPDB query mandatory for temporary privileges? a. Yes, for all temporary privileges b. No, temporary privileges are exempt c. Only if the practitioner has a history of malpractice
Yes, for all temporary privileges
40
Work history not specifically addressed, but application must include hospital affiliations and privileges. a. ACHC b. URAC c. Medicare
URAC
41
What is required at the time of appointment for work history verification according to TJC? a. Verification of relevant training or experience from the primary source b. A verbal confirmation of previous employment c. No verification is required
Verification of relevant training or experience from the primary source
42
How does NCQA handle verification of work history? a. Primary source verification for the last 10 years b. A minimum of five years of relevant work history through the practitioner’s application or CV c. No verification required
A minimum of five years of relevant work history through the practitioner’s application or CV
43
Per NCQA, PSV or work history is not required however, what must be documented when reviewing work history on the application or CV? a. A signed letter from the practitioner b. Documentation of review with staff signature or initials and date of review c. A notarized affidavit
Documentation of review with staff signature or initials and date of review
44
What is the required clarification process for gaps over one year according to NCQA? a. A simple explanation on the CV b. No clarification needed if a valid license is present c. Written clarification including start and end dates
Written clarification including start and end dates
45
Per NCQA, what is the time limit for verification of work history? a. 180 / 120 days b. Prior to credentialing decision date c. 365 / 305 days
365 / 305 days
46
At an ACHC accredited organization what should be obtained and verified for work history? a. A minimum of five years of relevant work history b. PSV of experience c. History of medical staff appointments and affiliations where privileges have been granted
History of medical staff appointments and affiliations where privileges have been granted
47
For DNV, what must hospital bylaws include regarding work history? a. A clause for automatic approval of privileges b. Qualifications that include PSV of experience c. A requirement to verify only the last employer
Qualifications that include PSV of experience
48
URAC does not specifically address work history but what must be included on the application? a. Minimum of 5-7 years of work history b. Any disciplinary actions at other hospitals c. Hospital affiliations and privileges
Hospital affiliations and privileges
49
Per TJC, temporary privileges may be granted in what two cases? **Critical thinking, take some guesses
Urgent patient care need New applicants awaiting medical staff review
50
Who can grant temporary privileges according to The Joint Commission? a. The Chair of the credentialing committee b. The CEO or designee, upon recommendation of the medical staff president c. The governing board directly
The CEO or designee, upon recommendation of the medical staff president
51
What is the maximum duration for temporary privileges under The Joint Commission standards? a. 60 days b. 90 days c. 120 days
120 days
52
Under the TJC, which of the following is NOT a requirement for granting temporary privileges? a. Current licensure b. Board certification c. Verification of competence
Board certification
53
Under NCQA, how long can a practitioner remain in provisional credentialing status? a. 30 days b. 90 days c. 60 days
60 days
54
What must be included in a provisional credentialing file for NCQA? a. Peer recommendations only b. Approval from the medical director or credentialing committee c. Just a signed application
Approval from the medical director or credentialing committee
55
At an ACHC accredited hospital, which type of privileges can be granted during an emergency or disaster? a. Full staff privileges b. Temporary privileges c. Provisional clinical privileges without verification
Temporary privileges
56
Per TJC, what must be queried and evaluated before granting temporary privileges? a. Only personal references b. Specialty board c. NPDB
NPDB
57
Per ACHC, how many references are required to grant temporary privileges? a. One recent reference from a previous facility or department chair b. Three references, including peer reviews c. No references are required if NPDB is clear
One recent reference from a previous facility or department chair
58
Per NCQA, how must malpractice history be verified for provisional credentialing? a. A query from the malpractice carrier or NPDB b. A written statement from the practitioner c. Self-disclosure only
A query from the malpractice carrier or NPDB

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