GENERAL QUESTIONS - ALL TOPICS Flashcards
According to the TJC Medical Staff Membership appointments and granting or denying initial and renewed privileges must be based off on evidence of?
-Education and training
-Licensure
-Competence
-Physical ability to care for patients
Individual practitioner’s ability to perform each task, activity and privilege must be individually assessed is required by what accreditation body?
ACHC/HFAP
What regulatory body requires an application without any limitations in ability to perform the functions of the position with or without accommodations?
CMS Managed Care Manual
What accreditation body requires an application to include reasons for the applicant’s inability to perform essential functions of the position?
NCQA (National Committee for Quality Acceditation)
Which accrediting organization requires healthcare professionals to disclose any health conditions or substance abuse problems that could affect their ability to provide good patient care?
AAAHC (Accreditation Association for Ambulatory Health Care)
What does The Joint Commission (TJC) require hospitals to check to confirm a healthcare provider’s identity when they apply for privileges?
The TJC requires hospitals to verify the identity of the applicant by reviewing one of the following:
-A current picture organizational ID card: This could be an ID card issued by the hospital or another healthcare organization where the practitioner works.
-A valid picture ID issued by a state or federal agency: Examples include a driver’s license, passport, or state-issued identification card
Re: Recredentialing/Reappointment
-Medical Staff must periodically conduct appraisals of its members
-Absent of State Law that establishes timeframes for reappraisal, a hospital’s Medical Staff must conduct an appraisal of each practitioner at least every 24 months
Medicare CoPs (Conditions of Participation)
What accreditation body’s standards specify that practitioner appointments should last for a duration defined by state law, with a maximum limit of three years?
DNV (Det Norske Veritas):
-DNV emphasizes adherence to state regulations, mandating that reappointments align with state law, not exceeding a three-year timeframe
-Medical staff bylaws, a crucial document outlining organizational structure, duties, and privileges, must also comply with this three-year rule for reappointments
-DNV standards further highlight the necessity of primary source verification for licensure and current competence during reappointments
-Additionally, reappointments involve a review of professional liability actions, performance data against benchmarks, and database checks (NPDB, OIG, Medicare/Medicaid Exclusions)
What regulatory body mandates that medical staff bylaws specify the frequency of medical staff appraisals, with a minimum frequency of every 24 months?
ACHC Reappraisal Frequency
The Accreditation Commission for Health Care (ACHC) mandates that medical staff bylaws specify the frequency of medical staff appraisals, with a minimum frequency of every 24 months.
-ACHC standards require medical staff bylaws to clearly outline the frequency of appraisals, ensuring a regular evaluation process
-While the specific timing can be customized, ACHC sets a minimum standard of every 24 months for conducting appraisals, guaranteeing a consistent review of practitioner qualifications
-This reappointment/reappraisal process, as described in the sources, primarily focuses on evaluating the practitioner’s professional conduct and competence within the institution
What is the approach of CMS Managed Care re: reappraisal/recredentialing frequency?
-CMS Managed Care’s reappointment timeframe is “at least every 3 years”
-Medicare Conditions of Participation (CoPs), which are part of the Code of Federal Regulations and aim to protect patient safety and quality of care, mandate periodic appraisals of medical staff members
-CMS recommends conducting appraisals at least every 24 months in the absence of a specific state law dictating the timeframe for periodic reappraisal
-Surgical privileges, according to CMS guidelines, should be reviewed and updated at least biennially
NCQA’s standards on recredentialing cycle timeframe?
The NCQA (National Committee for Quality Assurance) mandates that the recredentialing cycle for practitioners be completed within 36 months.
-Calculated to the month from the previous credentialing or recredentialing date. This means that if a practitioner was initially credentialed on January 15, 2020, their recredentialing must be finalized by the end of January 2023.
-NCQA emphasizes a month-to-month calculation, disregarding the specific day of credentialing or recredentialing.
-Organizations are responsible for initiating and completing the recredentialing process within this timeframe to ensure practitioners maintain their network participation
URAC’s standards on the recredentialing cycle timeline?
-URAC (Utilization Review Accreditation Commission) mandates recredentialing “at least every three years,” also counting the cycle to the month. (calculated to the month, not the day)
-This means if a practitioner is credentialed on January 5th, 2019, they must be recredentialed by the end of January 2022.
ACHC reappraisal/reappointment timeline?
-The Accreditation Commission for Health Care (ACHC) requires medical staff bylaws to establish the frequency for conducting appraisals of medical staff members.
-The minimum frequency for these appraisals is every 24 months. However, the bylaws can specify a more frequent appraisal schedule if necessary
AAAHC requires reappointment be completed how often?
-The Accreditation Association for Ambulatory Health Care (AAAHC) mandates that reappointment for healthcare practitioners be completed every three years, or more frequently if required by state law or the organization’s internal policies.
The Joint Commission (TJC) requires reappointment for healthcare practitioners be completed how frequently? Is it calculated monthly or daily?
-The Joint Commission (TJC) requires reappointment for healthcare practitioners to be completed within 3 years, measured precisely to the day, from the previous appointment date.
-This means the reappointment date must be the same calendar date as the initial appointment date, three years later.
-For example, if a practitioner’s initial appointment was on July 1, 2021, their reappointment must be finalized by July 1, 2024.
Which accrediting and regulatory bodies do not specifically address attestation statements within their credentialing and privileging requirements?
CMS CoPs: While the Medicare Conditions of Participation (CoPs) don’t explicitly use the term “attestation,” they include requirements suggesting providers should attest to the truthfulness and accuracy of information. For example, hospital CoPs require medical staff bylaws with a process for verifying practitioner qualifications, often implying attestation.
TJC: The Joint Commission (TJC) does not have specific requirements for attestation statements. However, organizations may choose to include attestation in their policies and procedures.
ACHC: Although not explicitly addressed in ACHC standards, surveyors review files to verify practitioners attest to responsibilities at appointment and reappointment.
DNV GL Healthcare: DNV focuses on ISO 9001 quality management, which does not explicitly mandate attestation. They prioritize accurate information, aligning with attestation’s purpose, but allow organizational flexibility.
Who must assure the medical staff has bylaws and that they comply with federal and state laws and the requirements of the CoP?
Governing Board
Which body’s requirements specifically state that “The organization must meet applicable State or local laws.”?
ACHC
According to CMS Managed Care, the verification time limit of the attestation can be no more than – days at the time of appointment?
6 months/180 days
According to CMS Managed Care, application attestations signed and dated by applicant are proving truthful and correct information re:
1) correctness a)nd completeness of the application
2) accuracy of at least 5 yrs. of relevant work history
3) any limitations in their ability to perform
4) loss of license history
5) felony convictions history
6) history of loss or limitations of privileges or disciplinary activity.
