Supplemental Questions

Question 1

Medicare requires practitioners to perform what process every 3-5 years?

Answer 1

Revalidation

Question 2

According to DNV standards, initial appointments to the medical staff are not to exceed what time period?

Answer 2

As defined by state law, not to exceed 3 years.

Question 3

True or false: TJC standards require that the applicant’s participation in continuing education is evaluated and considered on initial appointment to the medical staff.

Answer 3

False, continuing education is considered at reappointment, renewal, or revision of privileges.

Question 4

DNV requires that a provider’s participation in continuing education be evaluated when?

Answer 4

At initial appointment, reappointment, or subsequent clinical privileges.

Question 5

ACHC requires that a provider’s participation in continuing education be evaluated when?

Answer 5

At initial appointment, and may be requested every 2 years.

Question 6

According to NCQA standards, on initial application, review of information on sanctions, restrictions on licensure, and limitations on scope of practice must cover what period of time?

Answer 6

The most recent 5 year period. The time limit to verify is 180 days.

Question 7

What are the two elements of due process?

Answer 7

Substantive and procedural

Question 8

According to HCQIA, at what times must the hospital query the NPDB for a physician, dentist, or other health care practitioner?

Answer 8

When applying for a position on the medical staff (initial credentialing)

Requests for clinical privileges (initial, renewal, or new)

Every 2 years thereafter.

Question 9

What medical staff committee(s) is/are required by TJC hospital standards for the medical staff?

Answer 9

Medical Executive Committee

Question 10

Under Robert’s Rules of Order, when more than one motion is proposed, which motion takes precedence?

Answer 10

The most recent motion takes precedence.

Question 11

True or False: Voluntary surrender or restriction of clinical privileges for 14 days is reportable to the NPDB

Answer 11

False

Question 12

Which specialty is most likely to be granted privileges for surgical management of congenital septal and valvular defects?

Answer 12

Cardiovascular or cardiothoracic surgeon

Question 13

URAC standards require the organization to provide a written notification to providers within how many days of the credentialing determination?

Answer 13

10 business days

Question 14

NCQA standards require the organization to provide a written notification to providers within how many days of the credentialing determination?

Answer 14

30 calendar days

Question 15

NCQA standards require the organization to have written policies and procedures that delineate certain practitioner rights and to communicate these rights to the practitioner. Name the three rights that must be provided to applicants.

Answer 15

Right to correct erroneous information

Right to receive the status of their application upon request

Right to review information submitted to support their application.

Question 16

What is the purpose of the MAC (Medicare Administrative Contractor)?

Answer 16

Provides regional services on behalf of Medicare, including processing claims, enrolling providers, and other activities.

Question 17

True or False: ACHC standards allow a hospital to accept the credentialing and privileging decision of another organization (credentialing/privileging by proxy) for teleradiology services.

Answer 17

True

Question 18

Darling v. Charleston Memorial Community Hospital was significant in that it set aside what long standing doctrine that was applied to hospitals?

Answer 18

Charitable Immunity Doctrine

Question 19

CMS Conditions of Participation for Hospitals require that criteria for selection to the medical staff include evaluation of what 5 areas?

Answer 19

Competence, character, judgment, experience, and training (CCJET)

Question 20

NCQA requires which 3 factors prior to provisionally credentialing a provider?

Answer 20

PSV of current license,

PSV of past 5 years of malpractice claims/settlements from the malpractice carrier or the results of the NPDB query

A current and signed application with attestation.

Question 21

AAAHC requires a provider to be recredentialed every 3 years except under what circumstances?

Answer 21

Every 3 years unless state law requires more frequently or if the organization cannot recredential a pratitioner within the 36 month timeframe because they are on active military leave, maternity leave, or sabbatical.

Question 22

How often is the Department of Health and Human Services required to report exclusions from participation in Medicare, Medicaid, and other federal health care programs to the NPDB?

Answer 22

Monthly

Question 23

What specialty is most likely to be granted privileges for balloon endometrial ablation?

Answer 23

Gynecologist or OBGYN

Question 24

ACHC standards requires what specific document that describes 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 24

Bylaws or appended credentialing manual

Question 25

What date does NCQA use when assessing compliance with timeliness requirements for PSV?

Answer 25

The decision date of the Credentials Committee or Medical Director sign-off (on clean files) when determining whether the 180 (sanctions, CMS, etc.) or 365 (attestation signed) day requirements were met. *CVO requirements are 60 days less!

Question 26

True or False: According to TJC standards, if a medical staff appointee does not return their application in a timely fashion and the result is that the appointment will lapse, temporary privileges can be granted.

Answer 26

False, temporary privileges cannot be granted for a reappointment.

Question 27

According to HCQIA, a hospital that fails to report adverse actions may lose its immunity up to what period of time?

Answer 27

3 years

Question 28

What is the federal law that was enacted for the purpose of encouraging good faith professional review activities?

Answer 28

HCQIA (Healthcare Quality Improvement Act of 1986)

Question 29

Medical groups, IPAs, PHOs, ACOs, and CINs are all what type of healthcare entity?

Answer 29

Provider Organization

Question 30

What are the 5 main management functions?

Answer 30

Staffing, controlling, organizing, planning, influencing (SCOPI)

Question 31

Determining in advance what should be done is which management function?

Answer 31

Planning

Question 32

Determining how work in a department will be accomplished is which management function?

Answer 32

Organizing

Question 33

Motivation, coaching, and problem solving are part of which management function?

Answer 33

Influencing

Question 34

Determining numbers, training, and experience levels of employees is part of which management function?

Answer 34

Staffing

Question 35

Ensuring that events proceed as planned and objectives are achieved is part of which management function?

Answer 35

Controlling

Question 36

Health plan accreditation standards include what two bodies?

Answer 36

NCQA & URAC

Question 37

Hospital accreditation standards include what three bodies?

Answer 37

TJC ACHC/HFAP DNV

Question 38

What are the five types of Provider Organizations?

Answer 38

Medical groups Independent Practice Organizations (IPAs) Physician/Hospital Organizations (PHOs) Accountable Care Organizations (ACOs) Clinically Integrated Networks

Question 39

What are the two typical accreditation bodies of Provider Organizations?

Answer 39

NCQA & URAC

Question 41

The achievement of the organization's objectives through and with people and other resources is:

Answer 41

Management

Question 42

ACHC/HFAP requires what two committees?

Answer 42

Medical Executive Committee and Utilization Review Committee

Question 43

For ACHC/HFAP, a recommendation shall be made to the MEC within ______ days of receipt of the completed application.

Answer 43

60

Question 44

Under ACHC/HFAP, the medical staff have a process to monitor the competency of its members, known as ____________________, it is factored into the decision to maintain existing privileges, to revise existing privileges, and/or to revoke an existing privilege prior to or at the time of renewal.

Answer 44

OPPE

Question 45

Under ACHC/HFAP, ________________ is required at the time all initial privileges are granted, when any new privileges are granted following initial appointment, and/or when unacceptable levels of performance or quality of care concerns are identified.

Answer 45

FPPE

Question 46

What accrediting bodies require a Credentials Committee?

Answer 46

NCQA & URAC

Question 47

NCQA allows provisional credentialing of a provider how many times?

Answer 47

Once

Question 48

Under NCQA standards, how long can provisional status last before the full credentialing process must be completed?

Answer 48

60 days

Question 49

Under URAC, no credentialing application is submitted for initial review if it is signed and dated more than _______ days prior to Credentials Committee review.

Answer 49

180 days

Question 50

Under URAC, the organization provides written notification to providers within ________ business days of determination of credentialing

Answer 50

10

Question 51

True or False: Documents, diplomas, certificates, or transcripts provided directly by the applicant rather than by the primary or secondary source are acceptable.

Answer 51

False

Question 52

True or False: Under ACHC/HFAP, in small hospitals, designated members of the professional staff or the staff serving as a committee-of-the-whole may perform the functions of the Medical Executive Committee and the Utilization Review Committee.

Answer 52

True