Applicant Identity, Credentialing System Controls, Criminal Background Checks (NAMSS Comparison)

Question 1

APPLICANT IDENTITY: There must be a mechanism to determine the applicant is the individual identified in the credentialing documents by viewing either a current picture hospital ID card or a valid picture ID issued by a State or Federal agency, such as a driver’s license or passport. This verification must be performed prior to the practitioner providing patient care services and may be performed in person or through the use of a telecommunications link that includes both audio and video capabilities.

a. NCQA
b. TJC (CAMH)
c. AAAHC

Answer 1

TJC (CAMH)

Question 2

CREDENTIALING SYSTEM CONTROLS: The organization’s credentialing process describes: How primary source verification information is received, dated, and stored; How modified information is tracked and dated from its initial verification; Titles or roles of staff who are authorized to review, modify, and delete information, and circumstances when modification or deletion is appropriate; The security controls in place to protect the information from unauthorized modification; The building security that adequately limits physical access to credentialing information; How the organization monitors its compliance with the policies and procedures at least annually and takes appropriate action when applicable

a. DNV (NIAHO)
b. TJC (CAMH)
c. NCQA

Answer 2

NCQA

Question 3

CRIMINAL BACKGROUND CHECKS: Applies to hospital employees: A criminal background check is obtained and documented for the applicant as required by law and regulation or hospital policy

a. TJC (CAMH)
b. ACHC (HFAP)
c. DNV (NIAHO)

Answer 3

TJC (CAMH)

Question 4

CRIMINAL BACKGROUND CHECKS: The initial application must request information regarding any criminal history for 7 - 10 years. A criminal background check is conducted with the initial application at a minimum; thereafter in accordance with Medical Staff bylaws. The facility conducts criminal background investigation based on information provided in the application or as required by federal and state regulations

a. URAC
b. ACHC (HFAP)
c. Medicare CoP

Answer 4

ACHC (HFAP)

Question 5

CRIMINAL BACKGROUND CHECKS: Not specifically addressed but must be performed if required by state regulation

a. URAC
b. NCQA
c. DNV (NIAHO)

Answer 5

DNV (NIAHO)

Question 6

CRIMINAL BACKGROUND CHECKS: required if state law requires

a. DNV (NIAHO)
b. Medicare CoP
c. URAC

Answer 6

Medicare CoP