Additional Tests Flashcards
According to URAC, how often MUST the organization conduct an oversight audit when the credentialing is delegated to another organization?
a. At least annually
b. At least every two years
c. At least every three years
c. At least every three years
According to ACHC, how often must a reappraisal of membership and privileges occur?
a. Every 24 months or sooner if required by state law or regulation
b. Every 36 months, to the month not the day, of the previous credentialing decision
c. No later than 3 years to the month of the initial credentialing approval
a. Every 24 months or sooner if required by state law or regulation
Which of the following requires all practitioners with clinical privileges to participate in continuing medical education?
a. CMS
b. DNV
c. AAAHC
b. DNV
According to CMS, what criteria are used by the governing board for the selection of medical staff members?
a. Character, competence, judgement, experience and training
b. Character, communication, judgement, education and training
c. Citizenship, character, judgement, experience and training
a. Character, competence, judgement, experience and training
Which of the following requires two peer recommendations be obtained at initial credentialing?
a. TJC
b. DNV
c. ACHC
b. DNV
Which regulatory agency standards must be followed for a hospital to bill for
Medicare/Medicaid services?
a. Healthcare Quality Improvement Act
b. CMS Managed Care Manual
c. CMS Conditions of Participation
c. CMS Conditions of Participation
Which federal legislation created the National Practitioner Data Bank?
a. HIPAA
b. HCQIA
c. HEDIS
b. HCQIA
According to TJC, which of the following is required to make a recommendation to the
Governing Board?
a. Credentials Committee
b. Medical Executive Committee
c. Department Chairperson
b. Medical Executive Committee
According to NCQA, the application process is located in which of the following documents?
a. Policies and Procedures
b. Medical Staff Bylaws
c. Governing Board Bylaws
a. Policies and Procedures
According to NCQA, which of the following MUST be verified to grant provisional credentialing?
a. Board certification
b. Five-year malpractice claims history
c. License sanctions
b. Five-year malpractice claims history
According to CMS, a Medicare Advantage health plan can provisionally credential a practitioner who meets which of the following criteria?
a. Practitioner completed training within the last 12 months
b. Practitioner is pending DEA registration
c. Practitioner meets all credentialing requirements within 90 days
a. Practitioner completed training within the last 12 months
According to NCQA, which of the following sources can be contacted for verification of
state licensure?
a. FSMB
b. AMA
c. State licensing board
c. State licensing board
According to NCQA, what is an approved source to conduct ongoing monitoring of licensure sanctions for podiatrists?
a. CIN-BAD
b. AMA
c. NPDB
c. NPDB
According to NCQA, which of the following credentials MUST be verified at the time of recredentialing?
a. Lifetime board certification
b. Professional liability coverage
c. Hospital privileges
a. Lifetime board certification
According to The Joint Commission, which of the following credentials MUST be verified at reappointment?
a. State licensure
b. DEA registration
c. Board certification
a. State licensure
According to CMS, which of the following has final authority to make decisions regarding approval of membership and privileges?
a. Organized Medical Staff
b. Medical Executive Committee
c. Governing Board
c. Governing Board
Which of the following procedures would be performed by an Otolaryngologist?
a. Pressure Equalization Tube Surgery
b. Transurethral Ablation Surgery
c. Oophorectomy Surgery
a. Pressure Equalization Tube Surgery
According to NCQA, which of the following requires ongoing monitoring between
credentialing cycles?
a. State licensure
b. Licensure sanctions
c. Board certification
b. Licensure sanctions
According to The Joint Commission, which of the following resources can be used to verify board certification?
a. AMA
b. AOA
c. ABMS
c. ABMS
A practitioner has recently completed his post-graduate training fellowship in Interventional Cardiology and is not board certified. According to NCQA, which level of education must be verified for compliance?
a. Fellowship
b. Residency
c. Medical school
b. Residency
According to URAC, an organization MUST verify which of the following at recredentialing
a. Lifetime board certification
b. Five-year malpractice claims history
c. State licensure
c. State licensure
Which of the following documents would outline the History and Physical process?
a. Medical Staff Bylaws
b. Policies and Procedures
c. Rules and Regulations
c. Rules and Regulations
According to NCQA, which of the following work history gaps would require a written explanation?
a. One year
b. Six months
c. One month
a. One year
How many peer references does ACHC require at initial appointment?
a. One
b. Two
c. Three
a. One
According to URAC, how often MUST state licensure be verified?
a. Upon expiration
b. No less than every two years
c. No less than every three years
c. No less than every three years
Which of the following documents dictates the qualifications and criteria for appointment to the medical staff?
a. Rules and Regulations
b. Medical Staff Bylaws
c. Department Policies and Procedures
b. Medical Staff Bylaws
According to NCQA, failure to meet the established qualifications and criteria for appointment should be reported to whom?
a. Applicant
b. NPDB
c. State licensing board
a. Applicant
According to The Joint Commission, the AMA Physician Masterfile can be used as a designated equivalent source to verify which of the following?
a. Puerto Rican medical school
b. Board certification
c. DEA registration
a. Puerto Rican medical school
According to the Joint Commission, the granting of privileges is based on which of the following?
a. Department Chairperson recommendation
b. Credentials Committee recommendation
c. Medical Executive Committee recommendation
c. Medical Executive Committee recommendation
Within what time frame MUST practitioners in an AAAHC accredited organization be reappointed?
a. As defined in state law and federal law, not to exceed three years
b. As defined in state law and organizational policy, not to exceed two years
c. As defined in state law and organizational policy, not to exceed three years
a. As defined in state law and federal law, not to exceed three years
According to URAC, the credentialing application MUST include which of the following?
a. Current photo
b. Release of information
c. Date of birth
b. Release of information
According to CMS, who MUST grant final approval of the Medical Staff Bylaws?
a. Governing Board
b. Organized Medical Staff
c. Medical Executive Committee
a. Governing Board
According to The Joint Commission, which of the following documents MAY be used to verify current competence?
a. Board certification
b. Malpractice claims history
c. Hospital verification
c. Hospital verification
According to The Joint Commission, which of the following is an approved source for verification of foreign education and training?
a. FCVS
b. ECFMG
c. FSMB
b. ECFMG
According to NCQA, which of the following can be used to verify DEA registration?
a. AMA
b. FSMB
c. NPDB
a. AMA
According to NCQA, how often MUST the organization conduct an oversight audit when the credentialing is delegated to another organization?
a. Every 3 years
b. Every 2 years
c. Every year
c. Every year
Which accrediting body requires an attestation of the practitioner’s identity?
a. CMS
b. TJC
c. ACHC
b. TJC
According to URAC, which of the following can be used to conduct ongoing monitoring of license sanctions?
a. FSMB
b. State licensing board
c. AMA
b. State licensing board
According to URAC, within how many days MUST the practitioner be notified of the Credentials Committee decision?
a. 10 business days or as required by state law, whichever is less
b. 30 calendar days or as required by state law, whichever is less
c. 60 calendar days or as required by state law, whichever is less
b. 30 calendar days or as required by state law, whichever is less