Another Sample Test (NAMSS) Flashcards
Why it is important to check that the practitioner is not currently excluded, suspended, debarred, or ineligible to participate in Federal health care programs?
The facility won’t get paid for treating patients unless service is provided by authorized provider.
Which of the following credentials must be tracked on an ongoing basis?
Licensure
According to NCQA standards, an organization that discovers sanction information, complaints, or adverse events regarding a practitioner must take what action?
Determine if there is evidence of poor quality that could affect the health and safety of its members.
What is the name of the entity that was established through the Healthcare Quality Improvement Act of 1986 to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history?
The National Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important to evaluate?
Established standards of practice such as, specialty board recommendations.
What is the main reason for periodically assessing appropriateness of clinical privileges for each specialty?
To protect patient safety by ensuring current competency, relevance to the facility, and accepted standards of care.
Which of the following specialists is most likely to perform a PTCA?
Interventional Cardiologist
PTCA= Percutaneous Transluminal Coronary Angioplasty
The Joint Commission hospital standards require that clinical privileges are hospital specific and
based on the individual’s demonstrated current competence and the procedures the hospital can support.
Which of the following would be routinely performed by a cardiologist?
Transesophageal Echocardiography
Which NCQA-required committee makes recommendations regarding credentialing decisions?
Credentialing Committee
HFAP standards require two medical staff committees to be delineated in the medical staff structure. One of them is the Medical Executive Committee. What is the other required medical staff committee?
Utilization Review Committee
If you needed to find out about what the federal government requires in regards to anti-trust issues, what law would you consult?
Sherman Anti-trust act
Peer references should be obtained from
practitioners in the the same professional discipline as the applicant
Patrick v Burgett is an important case because it
illustrates the potential for antitrust liability arising out of peer review activities
If a medical staff member has privileges and/or medical staff appointment revoked, he/she must be
provided due process
Access to credentials files should be
described fully in an access policy
Which of the following bodies approves clinical privileges?
Governing Body or Board
What primary source verification is required by NCQA prior to provisional credentialing?
Licensure and 5 year malpractice history or NPDB
According to the Joint Commission standards, initial appointments to the medical staff are made for a period of
Not to exceed two years
According to the Joint Commission standards, temporary privileges may be granted by
The CEO on the recommendation of the medical staff president or authorized designee
According to the Joint Commission Standards, which of the following items must be verified with a primary source?
Licensure, training, experience and competence
According to NCQA standards, a copy of which of the following is acceptable verification of the document?
DEA certificate
According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians?
Federation of State Medical Boards
According to the Joint Commission standards, which of the following is considered a designated equivalent source for verification of board certification?
The American Board of Medical Specialties
Which of the following organizations have been recognized by the Joint Commission and NCQA to provide primary source verification of medical school graduation and residency training for U.S. graduates?
American Medical Association Masterfile
According to NCQA standards, the application attestation statement must affirm that the application
is correct and complete
According to the Joint Commission standards, medical staff bylaws should define
the structure of the medical staff
According to the Joint Commission hospital standards, professional criteria for the granting of clinical privileges must include at least
relevant training or experience, ability to perform privileges requested, current licensure, and competence.
The Joint Commission hospital standards require medical staff bylaws to include
A mechanism for selection and removal of officers
According to NCQA standards, which of the following is an approved source for verification of board certification?
State licensing agency if state agency conducts primary verification of board status
According to the Joint Commission hospital standards, which of the following is a required component of the reappointment process?
documentation of the applicant’s health status (Health Attestation)
According to URAC’s health network standards, each applicant within the scope of the credentialing program submits an application that includes at least which of the following:
State licensure information, including current license(s) and history of licensure in all jurisdictions
According to AAAHC, which must be monitored on an ongoing basis?
Current licensure
According to the Joint Commission, a nurse practitioner functioning independently and providing a medical level of care must:
Be granted clinical privileges
According to the Joint Commission, which of the following is an acceptable source for verification for medical education of an international graduate?
Education Commission for Foreign Medical Graduates
When evaluating compliance with the required time-frame for re-credentialing, NCQA counts the re-credentialing period to the:
Month
NCQA standards require the organization to verify board certification at recredentialing:
In all cases
To whom does the AAAHC give the responsibility for approving and ensuring compliance with policies and procedures related to credentialing, quality improvement, and risk management?
Governing body
In order for a healthcare facility to participate in the Medicare and Medicaid programs it must comply with the:
Medicare Conditions of Participation
According to The Joint Commission hospital standards, which of the following is an element of a self-governing medical staff?
The medical staff determines the mechanism for establishing and enforcing criteria for assigning oversight responsibilities to practitioners with independent privileges.
Robert’s Rules of Order is an example of:
Parliamentary procedure
The medical staff application should provide a chronological history of
The applicant’s education, training, and work history.
In order to participate in a managed care plan, a provider must be accepted to the plan’s
Provider panel
In order for a physician to practice medicine in any state in the United States, he/she must possess
Current state licensure
Which of the following is considered post-graduate education?
Residency training
Which of the following elements may not be used to evaluate credentials of applicants?
Gender
The release of liability statement signed by the applicant for medical staff appointment should include:
A statement providing immunity to those who respond in good faith to requests for information
Primary source verification is
Receiving information directly from the issuing source
Unexplained delays between graduation and medical school, incomplete training, and unexplained lapses in professional practice are examples of:
Red flags
When documenting a telephone conversation regarding primary source verification what should be documented?
Name of person and organization contacted, date of call, what was discussed and who conducted the interview.
According to HFAP standards, when confirming malpractice coverage the organization must:
Have evidence of professional liability insurance, which includes certificate showing amounts of coverage
Which of the following providers is considered a primary care physician (PCP)?
Family medicine practitioner
Which body has the obligation to the community to assure that only appropriately educated, trained and currently competent practitioners are granted medical staff membership and clinical privileges?
Governing body
When credentialing and privileging practitioners it is appropriate to:
Follow a routine process for each applicant
Medical liability insurance should be held in what limits?
As specified by the medical staff and board of directors
Which of the following would be an appropriate question to ask an applicant for medical staff?
Do you have any medical conditions, treated or untreated, that would negatively affect your ability to provide the services or perform the privileges you are requesting?
The governing body delegates the task of credentialing re-credentialing, and privileging to
The medical staff
Who should have access to medical staff meeting minutes?
Personnel as documented in a records access policy and procedure
In addition to conclusions, recommendations made, and actions taken, which of the following should always be documented in meeting minutes
Any required follow-up to occur
Active, Associate, Courtesy, Honorary, Consulting are all examples of:
Membership categories
Changes in medical staff bylaws are not final until formally approved by the
Governing body
What is the only hospital medical staff committee required by the Joint Commission hospital standards?
Medical executive committee
The Healthcare Quality Improvement Act:
Provides qualified immunity from antitrust liability arising out of peer review activities that are conducted in good faith.
If you have a question regarding whether or not information regarding a practitioner should be released to a third party, which of the following would be the best person to ask?
Organization’s attorney
Prior to releasing information to a third party regarding a practitioner, the organization should acquire
A signed consent and release form
You are working at an AAAHC accredited facility and you want to introduce the concept of utilizing a credentials verification organization. If the CVO is not accredited by a nationally recognized organization, you must:
Perform an assessment of the capability and quality of the CVO’s work
What are the three major sources of authority in the traditional structure of the hospital organization?
Chief executive officer, governing body, and medical staff
How does the governing body of a hospital set the organization policy that supports quality patient care?
By developing the mission, vision, policies, and bylaws that govern the hospital’s operations
Governing boards may be generally classed into which two types?
Philanthropic or corporate
Which of the following is a major responsibility of the CEO?
Keeping the medical staff informed about the hospital’s plans, organizational changes, board policies, and decisions affecting providers and their patients.
To whom is the medical staff organization accountable for the quality of the professional services provided by individuals with clinical privileges?
Governing body
Which term describes a physician employed or contracted by the hospital as a top-level management employee to act as a liaison between the medical staff and hospital administration?
Medical director
Which of the following are included in the functions of the medical staff?
Providing and evaluating patient care
Which of the following describes a committee that is assembled or appointed to perform a specific task or duty, works independently and reports back to larger committee and typically disbands after the assigned task or duty is performed or completed?
Ad hoc committee
When developing bylaws language for a committee, consideration should be given to which of the following?
Composition, duties, and frequency of meetings
The credentials committee needs guidance regarding which physicians will be allowed to perform a new procedure in the hospital. It has recommended that a committee be appointed to evaluate this issue and report back to the credentials committee. What kind of committee would be appointed?
Ad hoc committee
Which term describes a physician who provides the general medical care of hospitalized patients only and turns over the care of the patient to the primary care physician after discharge?
Hospitalist
Which term describes a category of medical staff appointment that provides a basic framework within which physicians and other health care providers carry out their duties and responsibilities?
Staff status
Which term describes interns and residents in medical education programs of a teaching hospital?
House staff
Which term describes a special classification used to reflect honor and respect for selected distinguished members of the medical community?
Honorary or emeritus staff
Which term describes privileges granted for a specific period of time to a practitioner while hospital board approval is pending?
Temporary privileges
Which document describes the organizational structure of the medical staff and defines the framework within which medical staff appointees act and interact in hospital-related activities?
Medical staff bylaws
Bylaws changes are not effective until final approval by which body?
governing body
Which term describes the mechanism by which an aggrieved practitioner, one who has been the recipient of disciplinary action, is entitled to be heard and to appeal an adverse decision?
procedural rights of fair hearing
What the landmark case set aside the charitable immunity doctrine and established the corporate negligence doctrine, also known as negligent credentialing?
Darling vs Charleston Memorial Community Hospital
What is the name of the act, known as the Federal “anti-dumping” law, which was enacted to stop hospitals transferring, discharging, or refusing to treat indigent patients coming to the emergency department because of cost factors?
Emergency Medical Treatment and Active Labor Act (EMTALA)
In a hospital setting, the need for informed consent, explaining the risks and benefits of a particular course of treatment, allowing the patient to participate in decisions regarding treatment options, and confidentiality are all examples of what?
Ethical issues
Which act mandates regulations that prohibit disclosure of health information except as authorized by the patient or specifically permitted by the regulation?
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Which act defines the elements of due process that must be followed in order for an organization to have peer review protection?
Healthcare Quality Improvement Act (HCQIA)
The Code of Ethics for which organization includes the language, “shall share knowledge, foster educational opportunities, and encourage personal and professional growth through continued self-improvement and applications of current advancements in the profession”?
NAMSS Certification Commission
What term is used to describe the evaluation or review of the performance of colleagues by professionals with similar types and degrees of clinical expertise?
Peer review
Which medical staff officer is responsible for enforcing the medical staff bylaws, rules and regulations, and procedural guidelines of the medical staff including imposing sanctions for noncompliance?
Medical staff president or chief of staff
Which term defines a functional unit of the hospital, so designated because of the clinical service it performs?
Department
Which of the following is a responsibility of the department chairman?
Recommending criteria for clinical privileges in the department
Which of the following is a Joint Commission requirement element for the process for managing LIP health?
Education of LIP and organization staff regarding recognizing illness and impairment issues specific to LIPs
In the case of Frigo vs Silver Cross Hospital, the podiatrist who performed surgery on Ms. Frigo did not meet initial criteria or revised criteria for Level II surgical privileges, but was granted privileges regardless. What was the legal concept under which the jury found Silver Cross Hospital to be negligent?
Breach of duty/Corporate Negligence
Which term below describes the achievement of the organization’s objectives through and with people and other resources?
Management
Which continuing medical education system has become the CME standard for licensing boards and specialty organizations nationwide and is recognized by U.S. jurisdictions?
The AMA’s PRA category 1 credit system
If you needed to find out about what the Federal Government requires in regards to anti-trust issues, what law would you consult?
Sherman Anti-trust Act
Average Length of Stay (ALOS) figures are used for which of the following purposes?
One measure of hospital utilization review
Expenses that may vary directly with the quantity of work being performed are _____ costs.
Variable
In a Joint Commission accredited hospital, applications for initial appointment to the medical staff must be acted on:
as specified in the medical staff bylaws
Joint Commission standards require hospital-sponsored educational activities to be prioritized and that, when developing these programs, they relate to
the type and nature of care, treatment, and services offered by the hospital
According to CMS’s CoPs for hospitals, when utilizing telemedicine, the hospital must have evidence of an internal review of the distant-site physician’s or practitioner’s performance of these privileges and must send the distant-site hospital such performance information for use in the periodic appraisal of the distant-site physician or practitioner. At a minimum, this information must include
all adverse events that result from the telemedicine services provided by the distant-site physician or practitioner to the hospital’s patients and all complaints the hospital has received about the distant-site physician or practitioner.
According to Joint Commission Standards, who must inform the patient about unanticipated outcomes of care, treatment, and services related to sentinel events?
Responsible licensed independent practitioner or his or her designee
Which document contains a listing of drugs and pharmaceuticals maintained for use in the hospital?
formulary
According to Joint Commission standards, the qualifications and competence of a non-employee individual, other than a PA or APRN, who is brought into the hospital by an LIP to provide care, treatment, must be assessed by
the hospital
According to NCQA, the health plan must notify an initial applicant of the Credentialing Committee’s decision within
60 days
NCQA requires that an organizations policies and procedures describe specific credentialing system controls, including which of the following?
unique user IDs and passwords
NCQA requires that re-credentialing of practitioners and providers occur:
at least every three years
Under NCQA standards, when credentialing activities are delegated by a health plan, the right to approve, terminate or suspend individual practitioners or providers is retained by:
the health plan
You are working at a AAAHC-accredited facility and are credentialing a new applicant. In addition to verifying licensure, DEA, education, training and malpractice insurance, what other credentials are required to be primary or secondary source verified according to AAAHC standards?
Peer references and NPDB
According to URAC’s health network standards, each applicant within the scope of the credentialing program submits an application that includes at least which of the following:
State licensure information, including current license (s) and history of licensure in all jurisdictions
Before granting of initial privileges Joint Commission standards require the organization to verify current licensure, certification, or registration and training with the primary source. Which of the following is an additional Joint Commission requirement for new applicants?
The applicant must attest that he or she has no health problems that could affect his or her ability to perform the requested privileges.
You are working at a Joint Commission accredited hospital. You are processing a reappointment for medical staff membership and you find that the practitioner has not performed any procedures at your facility since her last reappointment. The appointment is due to expire in one month. What should you do?
Ask the applicant to provide the names of other facilities where she is practicing, then write to those facilities to obtain documentation of procedures performed and outcome data, if available.
According to HFAP standards, in addition to direct contact with program, which of the following is/are approved designated source(s) for verification of residency training?
AMA Physicians Profile for MDs and AOA Official Osteopathic Physician Profile for DOs
AAAHC standards require appointments to be for no longer than
Three years
Substantive and procedural are two distinct elements of
due process.
Which of the following is a requirement of the Joint Commission for the medical staff?
Define circumstances requiring focused review of a practitioner’s performance
Which federal agency has been delegated the responsibility for conducting the Medicare Program?
Centers for Medicare and Medicaid services
What term best describes the examination and evaluation of the appropriateness of use of an organization’s resources to determine medical necessity and cost effectiveness of services provided?
Utilization review or utilization management
Which is the term applied to initial appointment to the medical staff to permit observation for monitoring and evaluation of physician performance?
Provisional appointment
Which term applies to a practitioner filling in or working in place of another practitioner?
Locum tenens
Which term is used to describe the use of criteria unrelated to quality of care or professional competency in determining an individual’s qualifications for initial or continuing hospital medical staff appointment or privileges or continued participation in a provider panel of a managed care plan?
Economic credentialing
New amendments to the Medicare Conditions of Participation are officially published in the
Federal Register
Which type of hospital board consists of non-paid individuals who contribute their time and expertise in the interest of service to the facility or to the community?
Philanthropic
Mind-body interventions, biologically-based treatments, manipulative and body based methods, and energy therapies are all examples of
alternative or complimentary medicine
Which term describes skilled and intermediate nursing facilities, hospice programs, community mental health centers, and home health care systems are designed to provide needed services in manner that is more cost effective than in a hospital?
Alternative delivery systems
Which term describes an organization which reviews services provided under the Medicare program to determine whether a hospital has misrepresented admission or discharge information or has taken an action that results in the unnecessary admission of an individual entitled to benefits under Medicare Part A?
Peer Review Organization
Which term describes programs providing palliative care and emotional and physical support to terminally ill patients and their families, generally during the last six months of the patient’s life in the patient’s home?
Hospice
Which body acts for the medical staff as a whole, and makes recommendations to the governing body with regard to medical staff issues?
Medical executive committee
You go to the file cabinet and pick out 20 files for audit. This type of sample is called
a simple random sample
What is the name of the data collection developed by the Centers for Medicare & Medicaid Services to improve outcomes of patient care and to ensure that they receive the best health care available?
Core Measures
When a proctor visits a hospital nursing station to review inpatient health records, this is called
concurrent review
In any computerized data collection system
computerized information processing requires quality control checks to be performed
Which graphical presentation type always depicts percentages?
pie chart
A person against whom an action is brought in a lawsuit is the
defendant
What a reasonably prudent person would have done under similar circumstances is termed the
standard of care
The party who commences a lawsuit is the
plaintiff
In order to verify HIPPA security provisions are met, an organization should have a
Information Access Control Plan
According to the Medicare Conditions of Participation for Hospitals, criteria for selection to the medical staff must include individual competence, training, experience, judgement and
character
Which statement is characteristic of a group practice?
It consists of a single specialty or multi-specialty and provides comprehensive care.
Which is an example of what would be include in a medical staff rule and regulation?
Description of how members are appointed to the emergency room call schedule
Compliance by a hospital with which of the following would be considered voluntary?
HFAP standards
According to the DNV, a History and Physical completed within 30 days prior to admission or registration shall include an entry in the medical record which documents an examination for any change in the patient’s current medical condition and placed in the patient’s medical record within what time frame?
Within 24 hours after admission or registration, and prior to surgery, or procedures requiring anesthesia services
A departmentalized medical staff is organized according to service. What is the title of the medical staff leader who is responsible for directing the functions of each service?
chairperson
Automatic Suspension of clinical privileges may be considered at a DNV accredited hospital for the following instances:
Revocation/restriction of professional license; non-compliance with completing medical records
In selecting a new information system, the primary consideration should be the
available technology
According to the DNV, if the medical staff has an executive committee, who must attend the meetings?
Medical Staff Members, CEO and CNO (or designee) on an ex-officio basis
Information is
less complex than data
In addition to the Chief Executive Officer, what medical staff authority is required for granting temporary privileges.
Member of the Executive Committee, President of the Medical Staff, or Medical Director
A system that shows who has accessed what information in a computer system, such as a patient registration database, is called a (an)
audit trail
Which term most accurately defines programs designed to control liability for human errors and equipment failures?
risk management programs
According to Joint Commission standard, relevant findings from quality management activities must be considered as part of the
reappointment of clinical privileges of medical staff members
