The Application Process (#1) Flashcards

1
Q

Pre-Application Form

A

Screens applicants for membership eligibility

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2
Q

Review of Application

A
  • Application= education, training, experience, contact information, dates for PSV, no time gaps
  • An application is considered complete when all required information is provided; must be signed & dated
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3
Q

Gaps

A

Gaps= Medical school- time of application

- All gaps should be explained by the applicant

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4
Q

Practitioner Questions

A

Any “Yes” requires explanation

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5
Q

TJC on Practitioner Questions

A

Require statement of no health issues
Investigate:
- Challenges/ relinquishment of licensure
- Termination of medical staff membership
- Limitation, reduction or loss of clinical privileges
- Excessive number of PL actions resulting in final judgment against applicant

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6
Q

HFAP on Practitioner Questions

A

Application requests following information:

  • Disciplinary actions/ investigations by hospitals, boards, Medicare/ Medicaid
  • Actions against DEA or CDS
  • Actions listed on NPDB
  • Information regarding criminal history
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7
Q

DNV on Practitioner Questions

A

No specific requirements

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8
Q

NCQA on Practitioner Questions

A

Current & signed attestation required

  • Reasons for any inability to perform essential functions of the position
  • Illegal drug use
  • Loss of license/ felony convictions
  • Loss/ limitation of privileges or disciplinary activity
  • Current PL coverage
  • Correctness & completeness of application
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9
Q

URAC on Practitioner Questions

A

Application includes:

  • History of sanctions
  • Loss/ limitation of privileges or disciplinary activity
  • Disclosure of any physical, mental or substance abuse problems that could impede practitioner’s ability to provide care
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10
Q

AAAHC on Practitioner Questions

A

Organization requires information on:

  • Complaints or adverse actions by professional society, licensing board
  • Licensure disciplinary actions
  • Refusal of PL
  • Criminal convictions
  • Medicare/ Medicaid sanctions
  • Current physical/ mental health
  • Chemical dependency problems
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11
Q

Red Flags

A

No reference to quality of care of FV need to be investigated
Red flags should be investigated fully
- Missing dates/ gaps in training/ professional practice
- Discrepancies between information provided & information verified
- Interruption of training
- Hospital privileges listed as “Active” but verified as “Consulting” or “Courtesy”
- Active privileges that become “Courtesy” or “Inactive” without explanation
- Challenges to license/ DEA
- Excessive PL history
- PL canceled for any reason
- Ambiguous peer references
- References/ PSVs that only refer to dates not disciplinary actions

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