Additional Tests Flashcards by CANDACE WEST

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

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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

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Which of the following requires all practitioners with clinical privileges to participate in continuing medical education?

a. CMS
b. DNV
c. AAAHC

b. DNV

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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

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Which of the following requires two peer recommendations be obtained at initial credentialing?

a. TJC
b. DNV
c. ACHC

b. DNV

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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

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Which federal legislation created the National Practitioner Data Bank?

a. HIPAA
b. HCQIA
c. HEDIS

b. HCQIA

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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How many peer references does ACHC require at initial appointment?

a. One
b. Two
c. Three

a. One

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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

According to DNV, what is the time frame required to reappoint a practitioner? a. As defined by state law, not to exceed 2 years b. As defined by state law, not to exceed 3 years c. As defined by state law or at least every 24 months

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

Which of the following accrediting bodies prohibits a hospital from relying solely on board certification in making a judgement on medical staff membership? a. TJC b. HFAP c. DNV

c. DNV

According to The Joint Commission, which of the following MUST be verified at reappointment? a. Board certification b. Licensure c. Malpractice coverage

b. Licensure

When conducting verifications for a Medicare Advantage health plan, what is the verification time frame of the malpractice claims history? a. No more than 3 months b. No more than 6 months c. No more than 9 months

b. No more than 6 months

According to The Joint Commission, a criminal background check must be obtained for which of the following practitioners? a. Medical staff members b. Advanced practice professionals c. Hospital employees

c. Hospital employees

According to The Joint Commission, which of the following is a designated equivalent source to verify licensure sanctions? a. AMA b. FSMB c. NPDB

b. FSMB

According to CMS, which of the following MUST ensure the Medical Staff Bylaws are in compliance with federal and state laws? a. Organized Medical Staff b. Medical Executive Committee c. Governing Board

c. Governing Board

According to ACHC, what time frame MUST the applicant disclose information regarding any criminal history? a. Past 7-10 years b. Past 5-8 years c. Past 1-3 years

a. Past 7-10 years

Which of the following accrediting bodies require the practitioner to disclose information regarding criminal convictions other than minor traffic violations? a. TJC b. DNV c. AAAHC

c. AAAHC

According to CMS, a Medicare Advantage health plan can obtain verification of liability coverage from which of the following sources? a. National Practitioner Data Bank b. Applicant attestation c. Risk management department

b. Applicant attestation

According to The Joint Commission, who is notified of state licensing board sanctions? a. Credentials Committee b. Governing Board c. Medical Executive Committee

c. Medical Executive Committee

According to URAC, the license verification must include which of the following elements? a. Issue date, expiration date, verification date b. Expiration date, verification date, sanctions c. Issue date, license status, expiration date

b. Expiration date, verification date, sanctions

According to NCQA, the recredentialing application must include which of the following? a. Lack of illegal drug use b. Consent to release of information c. Physical or mental health issues

a. Lack of illegal drug use

According to The Joint Commission, which of the following is a designated equivalent source for verification of licensure sanctions? a. FSMB b. FCVS c. FEHB

a. FSMB

According to NCQA, the applicant’s work history must be reviewed by the credentialing staff within how many calendar days? a. 120 b.180 c. 365

c. 365

According to URAC, eligibility criteria for the organization will be found in which of the following documents? a. Medical Staff Bylaws b. Credentialing Program Policy c. Rules and Regulations

b. Credentialing Program Policy

According to CMS, the application used by a Medicare Advantage health plan must include which of the following? a. At least 5-year relevant work history applicable to the position applying. b. At least 5-year history of open professional liability claims c. At least 5-year history of any criminal misdemeanor or felony charges

a. At least 5-year relevant work history applicable to the position applying.

According to The Joint Commission, communication of credentialing and privileging decisions are defined in which of the following documents? a. Medical Staff Policies b. Rules and Regulations c. Medical Staff Bylaws

c. Medical Staff Bylaws

When credentialing a practitioner for a Medicare Advantage health plan under the CMS standards, which of the following must be verified for a practitioner who is not board certified? a. Medical degree b. Internship c. Residency

c. Residency

NCQA requires that the malpractice insurance face sheet include which of the following? a. Effective and expiration dates b. Coverage amounts and carrier c. Signed attestation and coverage

a. Effective and expiration dates

According to NCQA, which of the following may be used for licensure sanction monitoring? a. NPDB b. FEHB c. AMA

a. NPDB

According to URAC, what additional documentation must be obtained when the organization relies on the verification activities of the state licensing board? a. Contractual relationship between the issuing agency and the state licensing board b. Confirmation from the state licensing board that they primary source verify the credential c. Confirmation from the issuing agency that the state licensing board verifies the credential

b. Confirmation from the state licensing board that they primary source verify the credential

AAAHC requires peer review data to be evaluated how often during each reappointment cycle? a. Two times b. Three times c. Periodically

c. Periodically

To evaluate a practitioner’s care, which of the following is required by CMS? a. Practice evaluation b. Periodic appraisal c. Scorecard reports

b. Periodic appraisal

According to ACHC, when credentialing a physician assistant, which of the following documents must be submitted with the reappointment application? a. Collaborative agreement b. Supervisory agreement c. 7- to 10-year criminal history

b. Supervisory agreement

According to DNV, what mechanism is implemented in the medical staff bylaws when a practitioner is terminated from participation in Medicare/Medicaid programs? a. Summary suspension of privileges b. Voluntary resignation of privileges c. Automatic suspension of privileges

c. Automatic suspension of privileges

The NPDB Guidebook states that a hospital must submit a report if an action adversely affects a practitioner’s privileges for longer than which timeframe? a. 14 days b. 30 days c. 60 days

b. 30 days

According to CMS, when granting telemedicine privileges using the credentialing and privileging decisions of the distant-site hospital, what must the originating hospital supply during the reappraisal of clinical privileges? a. Verification of current licensure in the originating state b. Peer review and quality outcomes at the originating site c. Renewal of the contract for telemedicine services

b. Peer review and quality outcomes at the originating site

According to NCQA, the Credentialing Committee discussions and decisions must be conducted under which of the following mechanisms? a. Email communications b. Video conference with audio c. Fax communications

b. Video conference with audio

According to AAAHC, how often must members of the medical or dental staff apply for reappointment? a. Every three years from the month of the initial credentialing approval date b. Every three years from the date of the previous credentialing decision counted to the month not the day c. Every three years or more frequently if required by state law or organizational policy

c. Every three years or more frequently if required by state law or organizational policy

Per The Joint Commission, at what interval must licensure be verified? a. Expiration and granting, renewal, and revision of privileges b. Initial appointment, reappointment, and monthly ongoing monitoring c. Between credential cycles and when sanctions or limitations are applied

a. Expiration and granting, renewal, and revision of privileges

According to AAAHC, an organization must assess which of the following prior to delegating credentialing to a CVO? a. Quality of the credentialing process b. Use of compliant applications c. Processing time frame of 180 days

a. Quality of the credentialing process

AAAHC requires the confirmation and updating of date-sensitive information take place at which times? a. Appointment/reappointment b. Appointment/reappointment and upon expiration c. Appointment/upon expiration

b. Appointment/reappointment and upon expiration

According to AAAHC, the application must include which of the following? a. Formal statement releasing the organization from any liability from credentialing decisions b. Disclosure of conviction of criminal offenses including minor traffic violations c. Attestation of a minimum 5-year work history in mm/yy format with no gaps

a. Formal statement releasing the organization from any liability from credentialing decisions

According to The Joint Commission, which of the following requires verification upon expiration? a. State license b. DEA or CDS registration c. Malpractice coverage

a. State license

According to URAC, what is the sample size for conducting credential file audits for delegation? a. 8/30 rule b. 5% or 50 - whichever is less c. 10% but not <10 or >30

c. 10% but not <10 or >30

According to DNV, how many peer recommendations must be obtained during the initial application process? a. One b. Two c. Three

b. Two

According to The Joint Commission, which of the following must be reviewed during the reappointment process? a. Practitioner’s performance within the hospital b. Practitioner’s performance from all hospital affiliations c. Practitioner’s performance from fellowship program

a. Practitioner’s performance within the hospital

According to The Joint Commission, which document must define the membership appointment process? a. Credentialing Policies and Procedures b. Rules and Regulations c. Medical Staff Bylaws

c. Medical Staff Bylaws

DNV requires that Medical Executive Committee minutes reflect the attendance of which two senior management members or their designees? a. CEO and CFO b. CEO and CNO c. CEO and COO

b. CEO and CNO

According to DNV, what body has the authority to determine which categories of practitioners are eligible candidates for appointment to the medical staff? a. Governing Board b. Medical Executive Committee c. Organized medical staff

a. Governing Board

What components must be included in a telemedicine quality review from the originating site? a. Connectivity and video issues b. Privilege and licensure information c. Adverse events and complaints

c. Adverse events and complaints

According to DNV, which of the following must be evaluated in relation to the granting of clinical privileges at reappointment? a. Two peer recommendations b. Continuing medical education c. Ongoing professional practice evaluation

b. Continuing medical education

According to The Joint Commission, who recommends criteria for membership and privileges? a. Credentials Committee b. Organized medical staff c. Medical Executive Committee

b. Organized medical staff

According to NCQA, which of the following requires verification from the primary source? a. Hospital affiliations b. DEA or CDS c. Licensure

c. Licensure

According to The Joint Commission, which of the following is viewed to verify the practitioner requesting approval is the same practitioner identified in the credentialing documents? a. Current picture hospital ID card b. Attestation from program director c. Practitioner’s birth certificate

a. Current picture hospital ID card

According to NCQA, the application must contain which of the following? a. Current and signed release of information b. Current and signed attestation c. Current and signed signature card

b. Current and signed attestation

According to ACHC, what information must be obtained from previous or current hospital affiliations? a. Confirmation of appointment, privilege history, any pending investigations or disciplinary actions b. Confirmation of appointment dates, specialty, current status c. Confirmation of appointment dates, current status, any disciplinary actions

a. Confirmation of appointment, privilege history, any pending investigations or disciplinary actions

According to NCQA, how frequently must an organization conduct an oversight audit once a group is approved for delegated credentialing? a. Every year b. Every two years c. Every three years

a. Every year

According to AAAHC, the practitioner must disclose the following on the reappointment application? a. Refusal or cancellation of professional liability coverage b. Conviction of criminal offense including minor traffic violations c. Voluntary or involuntary resignation of hospital membership

a. Refusal or cancellation of professional liability coverage

According to The Joint Commission, which of the following must be queried when clinical privileges are initially granted, at time of renewal of privileges, and when a new privilege is requested? a. ABMS b. AMA c. NPDB

c. NPDB

According to DNV, which of the following must be included in the reappointment application to ensure completeness? a. Continuing education related to the request for clinical privileges b. Two peer recommendations in the same discipline c. Attestation of hospital affiliations with admitting privileges

a. Continuing education related to the request for clinical privileges

According to URAC, a professional liability claims history disclosed on the recredentialing application must include which of the following? a. Pending claims b. Dismissed claims c. Claim settlements

c. Claim settlements

According to ACHC, at reappointment which of the following must be reviewed to assess competency when granting clinical privileges to an active practitioner at a facility? a. Clinical and medical record routine peer review b. Peer reference evaluations c. Procedure logs from other facilities

a. Clinical and medical record routine peer review

According to CMS, the Medicare Advantage health plan must verify information within which of the following timeframes? a. No more than two months old on the date of approval b. No more than three months old on the date of approval c. No more than six months old on the date of approval

c. No more than six months old on the date of approval

Agencies that maintain specific credential information that is identical to the primary source are referred to as what? a. Approved secondary source b. Designated equivalent source c. Acceptable agent source

b. Designated equivalent source

At a minimum, the CMS Conditions of Participation require which of the following credentials be examined at reappointment? a. Evidence of current licensure, a request for clinical privileges, documented experience b. Evidence of current licensure, DEA registration, a request for clinical privileges c. Evidence of current licensure, professional liability coverage, documented experience

a. Evidence of current licensure, a request for clinical privileges, documented experience

According to AAAHC, the governing board makes decisions regarding the granting of clinical privileges based on which of the following? a. Evidence of privileges at another hospital b. Focused professional practice evaluation c. Professional peer evaluation

c. Professional peer evaluation

According to TJC, temporary privileges are granted for no more than how many days? a. 90 b.120 c. 180

b.120