Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - correct answer Yes
According to the Joint
... [Show More] Commission, who may amend the medical staff bylaws? - correct answer Governing Body
Failure to meet the established qualifications and criteria for appointment should be reported to whom? - correct answer The applicant
NCQA requires the MCO to obtain a minimum of ???? years of work history? - correct answer 5 years
According to NCQA what policy must an organization have in place to obtain approval to enter into a delegated agreement? - correct answer Credentialing policies
How often does the OIG report to the NPDB? - correct answer Monthly
Hospitals must query the NPDB when: - correct answer Initial appt, granting of privileges, every two years
NCQA requires verifications must be less than how many days old? - correct answer 180 days
What is the verification time limit on malpractice history according to the NCQA? - correct answer 180 days
Time limited credential must be verified by the CVO within how many days prior to submission to the client? - correct answer 120 days
According to AAAHC, for initial appointments, in addition to licensure and education, what verification is required? - correct answer Experience and hospital affiliation
What accreditation body states "the NPDB is an acceptable source for sanctions or limitations on licensure, Medicaid/Medicare sanctions and malpractice history? - correct answer NCQA
Who is required to query the NPDB? - correct answer Hospitals
Is disciplinary action taken against the license of a dentist reportable to the NPDB? - correct answer Yes
Under HCQIA, a hospital failure to report an adverse privilege action lasting longer than 30 days may cause the organization to lose HCQIA immunity for how many years? - correct answer 3 years
According to NCQA, verification of Medicare/Medicaid sanctions can be queried by any of what sources? - correct answer AMA, FSMB, HIPDB, OIG, Sanctions Report, NPDB, Sate Agency
According to NCQA, how often must an organization conduct an audit of the credentialing process delegated to another organization? - correct answer Annually
How far back does the Joint Commission require evaluation of malpractice history? What source may be used? - correct answer Back to medical school. NPDB.
Is an internet verification from a website not contracted by the primary source that attests to the accuracy and timeliness of the information considered a complete verification by NCQA? - correct answer No
What accreditation bodies require privileges to be distributed to essential department personnel? - correct answer Joint Commission/CMS
T/F - The Joint Commission and NCQA do not require criminal background checks. - correct answer True - the only organization that requires background checks is HFAP.
Is a payment made by an insurance company reportable to the NPDB? - correct answer Yes
Who is the best person to consult when releasing adverse information in a verification request from another organization? - correct answer Legal Counsel
According to CMS, who in the organization may make decisions regarding approval of credentialing applications? - correct answer Governing Board
What are the six elements of a written delegation agreement? - correct answer 1. Mutually agreed upon
2. Describes responsibilities of organization and delegated entity
3. Describes delegated activities
4. Requires semi-annual reporting to the organization
5. Describes the process by which the organization evaluates the delegated entities performance
6. Describes remedies available to the organization if the delegated entity does not fulfil its obligations including revocation of delegated agreement
According to NCQA, what providers are NOT required to be credentialed when working in an independent relationship? - correct answer Locums Tenens, Hospital based practitioners (i.e. Anesthesia, Pathology, Radiology, etc.)
How many peer references does HFAP require at initial appointment? - correct answer 1
T/F - Denial of a medical license application by a state medical board is not reportable to the NPDB? - correct answer True
What two accreditors state: a hospital may not rely solely on board certification when considering practitioner for medical staff membership? - correct answer HFAP, CMS
According to the Joint commission & HFAP, name four approved sources for PSV for medical education. - correct answer Medical School, AMA, ECFMG, AOA
According to NCQA, practitioners must be notified of credentialing decision [Show Less]