Study 2/25/2025 Flashcards
Which accreditation states that OIG Medicare / Medicaid Exclusions must be primary source verified when granting temporary privileges?
a. ACHC
b. NCQA
c. DNV
DNV
Which motion DOES NOT require a “seconding motion”?
a. Register a complaint
b. Kill main motion
c. Close meeting
Register a complaint
________ states that the organization can verify Medicare / Medicaid sanctions with the issuing organization or the NPDB?
a. URAC
b. NCQA
c. DNV
URAC
________ states that organizations are responsible for the ongoing monitoring of Medicare / Medicaid sanctions between recredentialing cycles and that information must be reviewed within 30 days of release by the reporting entity?
a. URAC
b. NCQA
c. DNV
NCQA
Organizations must have processes in place to ensure that credentials file are accessed only by authorized staff. Requirements for storage, maintenance and disposal of credentialing documents must also be defined.
a. NCQA
b. Medicare
c. URAC
URAC
Must have evidence of professional liability insurance including current certificates showing amount insurance; malpractice litigation history from insurance carrier.
a. TJC
b. DNV
c. ACHC
ACHC
For this accreditation PSV of education is required. Documentation regarding training and education must be sufficient to support requested privileges.
a. URAC
b. ACHC
c. NCQA
ACHC
Query of the NPDB is required by these 3 accreditations on initial and reappointment.
a. DNV, ACHC, URAC
b. NCQA, URAC, TJC
c. ACHC, DNV, AAAHC
ACHC, DNV, AAAHC
What standard states that bylaws provide a mechanism for immediate and auto suspension of privileges due to termination or revocation of Medicare / Medicaid status. Must be PSV at initial, reappointment, and temporary privileges
a. AAAHC
b. TJC
c. DNV
DNV
According to NCQA organizations are responsible for ongoing monitoring of Medicare/Medicaid sanctions between credentialing cycles. Information must be reviewed within ___ days for release by the reporting entity. If reports are not published o a regular basis, organizations must query the sources at least every 6 months. If reports are not published the organization must query the sources within 12-18 months from the last credentialing cycle.
a. 120
b. 60
c. 30
30
Whenever a practitioner’s privileges are limited, revoked, or in any way constrained, the hospital must, in accordance with State and / or Federal laws or regulations, report those constraints to the appropriate State and Federal authorities, registries, and / or data bases, such as the National Practitioner Data Bank.
a. NCQA
b. TJC
c. Medicare
Medicare
Which accrediting body requires the practitioner’s history of education and professional training must be included on the application. PSV can be performed with the primary source (medical / professional school) or the state licensing board. Verification of education is not required if the practitioner is board certified.
*Verification time limit: Six months
a. URAC
b. NCQA
c. Medicare
URAC
Who states that the application requests information regarding disciplinary actions taken or investigations pending by Medicare / Medicaid?
a. DNV
b. AAAHC
c. ACHC
ACHC
Bylaws provide a mechanism for immediate and automatic suspension of privileges due to the termination or revocation of Medicare / Medicaid status.
a. DNV
b. ACHC
c. AAAHC
DNV
According to TJC, verification of medical school completion can be obtained from the follow primary or Designated Equivalent Source (des):
a. The school, AMA Physician Masterfile, ECFMG
b. AOA Physician Database for predoctoral education accredited by the AOA Bureau of Professional Education, or AAPA Profile for Physician Assistant Education
c. All of the above
All of the above
This following standard does not require the query of the NPDB, but can use to verify malpractice history, licensure sanctions, Medicare / Medicaid sanctions, hospital and other healthcare entity actions and professional society actions if the organization is eligible to query the NPDB.
a. TJC
b. NCQA
c. URAC
URAC
Education and Training verification for ___ has a limit of six months.
a. DNV
b. NCQA
c. URAC
URAC
There are two accrediting bodies whose standards state that sanctions are reviewed and do not specifically state sanctions must be verified; which two are they?
a. URAC and AAAHC
b. ACHC and TJC
c. AAAHC and ACHC
AAAHC and ACHC
