Study Session 3/12/2025

Question 1

Any organization required certifications must be primary source verified initially and at reappointment.

a. TJC
b. ACHC
c. DNV

Answer 1

DNV

Question 2

The governing body must ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification

a. Medicare
b. DNV
c. AAAHC

Answer 2

Medicare

Question 3

Not specifically required but if the organization requires certification or recertification, verification should be performed

a. ACHC
b. TJC
c. NCQA

Answer 3

TJC

Question 4

If a practitioner claims to be board certified, the organization must verify it

a. NCQA
b. AAAHC
c. TJC

Answer 4

NCQA

Question 5

Verify from primary or secondary source

a. DNV
b. AAAHC
c. Medicare

Answer 5

AAAHC

Question 6

Board certification must be reviewed for each applicant reapplicant during the review and approval process

a. ACHC
b. TJC
c, NCQA

Answer 6

ACHC

Question 7

Verify board certification if applicable. This is required for initial credentialing only, unless the board certification no record of the verification in the practitioner’s record

a. URAC
b. NCQA
c. ACHC

Answer 7

URAC

Question 8

The ABMS has _______ member boards, which certify more than ________ specialties and subspecialties.

a. 35, 150
b. 24, 145
c. 22, 125

Answer 8

24, 145

Question 9

All member boards require a written exam and many also require an oral exam. Obstetrics and gynecology, neurological surgery, orthopedic surgery, pathology, physical medicine and rehab, radiology, and urology boards have an additional requirement for ____________ years of clinical experience.

a. 1 or 2
b. 3
c. 5

Answer 9

1 or 2

Question 10

What accrediting body states that you must verify board certification on application, reappointment, at expiration and on an ongoing basis (at a minimum at expiration, initial appointment and reappointment)?

a, TJC
b. NCQA
c. AAAHC

Answer 10

AAAHC

Question 11

The ________ query can serve for verification for actions against the physician’s medical license

a. FACIS
b. State licensing board
c. FSMB

Answer 11

FSMB

Question 12

What accreditation body states that the following must be obtained for sanctions: PSV from State licensing agency/agencies, NPDB and in addition to a query of the FSMB Disciplinary Action Databank or Fraud and Abuse Control Information Systems?

a. DNV
b. ACHC
c. AAAHC

Answer 12

ACHC

Question 13

Evidence of a current DEA certificate or state controlled dangerous substance certificate is submitted with the application, if applicable. The organization may either collect a copy of the certificate or the certificate number. *Verification time limit: 6 months.

a. TJC
b. DNV
c. URAC

Answer 13

URAC

Question 14

Most hospitals and healthcare organizations require proof of _______________with a specifiedminimum face value.

a. liability insurance
b. property taxes
c. tail coverage

Answer 14

liability insurance

Question 15

Proof of liability insurance must be included on application. A cover sheet or attestation from the insurance company is sufficient to prove attainment of liability coverage.

a. URAC
b. AAAHC
c. NCQA

Answer 15

URAC

Question 16

CR3 Element A Factor 3 & 4 If a practitioner claims to be board certified, the organization must verify it. Verification of board certification meets the requirement for verification of education and residency training

a. NCQA
b. URAC
c. AAAHC

Answer 16

NCQA

Question 17

If applicable, verify on an ongoing basis; at a minimum, at expiration, appointment and reappointment. Verify from primary or secondary source.

a. AAAHC
b. ACHC
c. URAC

Answer 17

AAAHC

Question 18

MS 6 Interpretive Guidelines state that the medical staff bylaws shall provide a mechanism for consideration of automatic suspension of clinical privileges in instances of revocation/ restriction of professional license

a. DNV
b. Medicare
c. ACHC

Answer 18

DNV

Question 19

The application form must include specific questions regarding the dates and amount of a practitioner’s current malpractice insurance or the organization may obtain a copy of the insurance face sheet fromthe malpractice carrier.

a. URAC
b. NCQA
c. ACHC

Answer 19

NCQA

Question 20

Before recommending privileges, the medical staff evaluates any evidence of an unusual pattern or an excessive number of professional liability actions resulting in a final judgment against the applicant.

a. DNV
b. TJC
c. ACHC

Answer 20

TJC

Question 21

How many member boards does ABMS have and how many boards specialty does AOA certify?

a. 45 (ABMS), 24 (AOA)
b. 24 (ABMS), 16 (AOA)
c. 12 (ABMS), 45 (AOA)

Answer 21

24 (ABMS), 16 (AOA)

Question 22

Which standards specify that the Medical Staff cannot base their decision solely on board certification?

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

Answer 22

Medicare, ACHC, DNV

Question 23

For DEA, what is the verification time limit for NCQA?

a. 180 days
b. 120 days
c. None

Answer 23

None

Question 24

Which standard states “for telemedicine, verify licensure in state where patient is located and where the telemedicine provider is located.”

a. NCQA
b. ACHC
c. TJC

Answer 24

ACHC

Question 25

Which standard states “Verify current state license on an ongoing basis; at a minimum, at expiration, appointment and re-appointment. Verify from primary or secondary source”. a. ACHC b. AAAHC c. TJC

Answer 25

AAAHC

Question 26

Which accreditation states “Verification must come from the appropriate specialty board, State licensing agency or registry if there is documentation that primary source verification of education and training is performed. If not, the organization must also verify the highest level of education and training.” a. TJC b. NCQA c. ACHC

Answer 26

NCQA

Question 27

Licensure sanctions are not specifically addressed by which accreditation. a. DNV b. Medicare c. AAAHC

Answer 27

DNV

Question 28

Which accreditor requests information regarding actions against DEA certificate or state CDS certificate on application? a. TJC b. NCQA c. ACHC

Answer 28

ACHC

Question 29

Which two accreditations verify/evaluate the past five year history of professional liability claims / actions resulting in settlement or judgments? a. NCQA, ACHC b. NCQA, URAC c. DNV, URAC

Answer 29

NCQA, ACHC

Question 30

Who sets the timeframe limit on the number of years after training in which the applicant can apply for certification. a. American Osteopathic Association (AOA) b. Maintenance of Certification (MOC) program c. ABMS Member Board

Answer 30

ABMS Member Board

Question 31

If required, who would you verify a controlled substance registration with? a. DEA b. NASCSA (National Association of State Controlled Substances Authorities ) c. NPDB

Answer 31

NASCSA

Question 32

Malpractice insurance is provided by per __________ and by an aggregate value. a. claim b. occurrence c. incident

Answer 32

occurrence

Question 33

This organization allows use of designated equivalent sources for verification of board certification included, but not limited to: * ABMS or ABMS approved agent * The AOA Physician Database for osteopathic certification a. TJC b. ACHC c. URAC

Answer 33

TJC

Question 34

This organizations states that current license(s) and history of licensure in all jurisdictions must be included in the application. a. DNV b. TJC c. URAC

Answer 34

URAC

Question 35

What organization states if the DEA / CDS – eligible practitioner does not prescribe medications requiring DEA or CDS certificate, there must be a documented process to require and explanation as to why the practitioner does not prescribe medications? a. NCQA b. TJC c. DNV

Answer 35

NCQA

Question 36

This organization states a cover sheet or attestation from the insurance company is sufficient to prove attainment of liability coverage a. URAC b. AAAHC c. DNV

Answer 36

URAC

Question 37

What organization states an organization can rely on the verification activities of state licensing boards. If this is done, it should be noted in credentials file. a. AAAHC b. URAC c. TJC

Answer 37

URAC

Question 38

This governing body must ensure that the criteria for selection of medical staff are individual character, competence, training, experience, and judgment. a. AAAHC b. Medicare c. NCQA

Answer 38

Medicare

Question 39

What organization states if applicable, DEA / CDS should be verified on an ongoing basis; at a minimum, at expiration, appointment, and reappointment? a. AAAHC b. TJC c. ACHC

Answer 39

AAAHC

Question 40

This organization requests the past 5 year history of professional liability actions resulting in final settlements or judgments must be evaluated a. DNV b. TJC c. ACHC

Answer 40

ACHC

Question 41

Per NCQA, What must organizations do if a practitioner claims to be board certified? a. Accept the claim without verification b. Verify the certification through an approved primary source c. Only verify if requested by the medical staff

Answer 41

Verify the certification through an approved primary source

Question 42

When must licensure be verified under The Joint Commission (TJC) standards? a. Only at initial appointment b. At initial appointment, reappointment, revision, and on expiration c. Every five years

Answer 42

At initial appointment, reappointment, revision, and on expiration

Question 43

Per NCQA, what happens if a practitioner doesn’t prescribe medications requiring a DEA certificate? a. There must be a documented process explaining why b. The certificate requirement is waived since the practitioner doesn’t prescribe c. The practitioner can’t be credentialed

Answer 43

There must be a documented process explaining why

Question 44

Which source is not acceptable for verifying board certification? a. ABMS or its member boards b. AOA Official Osteopathic Physician Profile Report c. Public online physician directories

Answer 44

Public online physician directories

Question 45

Which organization recognizes the Federation of State Medical Boards (FSMB) as an equivalent source for licensure actions? a. NCQA b. AAAHC c. URAC

Answer 45

NCQA

Question 46

Per NCQA, what should organizations do if a DEA certificate is pending at the time of credentialing? a. Document the pending status and secure an alternate prescriber b. Deny the application c. Grant temporary privileges without restrictions

Answer 46

Document the pending status and secure an alternate prescriber

Question 47

Under Medicare CoPs, can a hospital base membership solely on board certification? a. Yes, certification is the only factor needed b. No, other factors like competence and experience must be considered c. Only for certain specialties

Answer 47

No, other factors like competence and experience must be considered

Question 48

Under TJC, what is evaluated before recommending clinical privileges? a. Only board certification status b. Challenges to, or voluntary / involuntary relinquishment of, any license c. The number of years in practice

Answer 48

Challenges to, or voluntary / involuntary relinquishment of, any license

Question 49

How often must board certification be verified, according to ACHC? a. At initial credentialing and reappointment b. Every five years c. Only once, unless issues arise

Answer 49

At initial credentialing and reappointment

Question 50

What is the minimum time frame for verifying licensure under NCQA standards? a. Prior to the credentialing committee’s decision b. Within 30 days of the decision c. After the practitioner begins seeing patients

Answer 50

Prior to the credentialing committee’s decision

Question 51

What is the time limit for verifying board certification under NCQA? a. 90 days b. 180 days before the credentialing decision c. 365 days

Answer 51

180 days before the credentialing decision

Question 52

How often must ongoing licensure verification occur, at minimum, under AAAHC? a. Every 5 years b. Annually c. At expiration, appointment, and reappointment

Answer 52

At expiration, appointment, and reappointment

Question 53

Per URAC, If a physician holds multiple certifications, which one must be verified? a. The certification related to the specialty they will practice b. The most recent certification c. All certifications, regardless of specialty

Answer 53

The certification related to the specialty they will practice

Question 54

Per ACHC, for telemedicine, what must organizations verify about licensure? a. Verify Licensure in both the patient’s state and the provider’s state b. Verify only the provider’s home state license c. Verify only the state the patient resides in

Answer 54

Verify Licensure in both the patient’s state and the provider’s state

Question 55

Per NCQA, what should organizations do if a board provides “lifetime” certification? a. Verify that the certification is still valid and document the verification date b. No further verification is needed c. Require recertification every 10 years

Answer 55

Verify that the certification is still valid and document the verification date

Question 56

Per NCQA, which database can be used to verify sanctions or limitations on licensure? a. National Practitioner Data Bank (NPDB) b. American Medical Association (AMA) database c. U.S. Department of Health and Human Services (USD-HHS)

Answer 56

National Practitioner Data Bank (NPDB)

Question 57

Which entity can act as a primary source for board certification verification? a. AMA Physician Masterfile b. State medical societies c. NPDB

Answer 57

AMA Physician Masterfile

Question 58

What accreditation states practitioner’s credentialing application must include state licensure information, including current license and history of licensure in all jurisdictions and at least five years of license sanction history if applicable. a. URAC b. NCQA c. AAAHC

Answer 58

URAC

Question 59

Can an organization rely on state licensing boards for verification? a. Yes, if the state board conducts primary source verification b. No, state boards are never considered primary sources c. Only for osteopathic certifications

Answer 59

Yes, if the state board conducts primary source verification

Question 60

What action is required if a license is revoked, suspended, or restricted under DNV standards? a. Automatic suspension or restriction of clinical privileges b. A warning letter is issued to the practitioner c. The practitioner can continue working while appealing the decision

Answer 60

Automatic suspension or restriction of clinical privileges

Question 61

Per NCQA, organizations are responsible for the ongoing monitoring of sanctions or limitations on licensure between recredentialing cycles. How soon must organizations verify licensure information after it’s released by a reporting entity? a. Within 90 days b. Within 30 days of release c. Within 6 months

Answer 61

Within 30 days of release

Question 62

At a DNV accredited hospital what happens if a practitioner fails to maintain the required malpractice coverage? a. Automatic suspension of clinical privileges b. A 90-day grace period is granted c. They must complete additional training

Answer 62

Automatic suspension of clinical privileges

Question 63

Which standard states, for practitioners who will be starting at a later date, a letter from the insurance company with the future start date and description of the liability coverage is acceptable. a. NCQA b. URAC c. AAAHC

Answer 63

URAC

Question 64

Per DNV, How much malpractice coverage is required? a. As specified by the medical staff bylaws or governing body b. A minimum of $500,000 c. It varies by state law, not by hospital policy

Answer 64

As specified by the medical staff bylaws or governing body

Question 65

Per URAC, what information must be included on the insurance cover sheet? a. Practitioner’s name, coverage amount, and expiration date b. A list of previous claims c. Only the insurance carrier’s name

Answer 65

Practitioner’s name, coverage amount, and expiration date

Question 66

Per NCQA, What is required if a practitioner has federal tort coverage? a. No documentation needed since it’s Federal b. A copy of the federal tort letter or practitioner attestation of coverage c. A letter from their employer or the Department of Justice (DOJ)

Answer 66

A copy of the federal tort letter or practitioner attestation of coverage

Question 67

Can future dated malpractice coverage be accepted under URAC? a. Yes, if coverage starts by the practitioner’s employment date b. No, only active coverage is valid c. Only for telemedicine providers

Answer 67

Yes, if coverage starts by the practitioner’s employment date