CHCS Primary Source Verification & Quality Management Flashcards

What is the primary purpose of quality management (QM) data in the credentialing and reappointment process?

Answer: To provide objective performance information that informs privileging and reappointment decisions

QM data such as outcome metrics, peer review findings, and patient complaints provides evidence of a practitioner's current clinical competency for reappointment.

Which of the following quality indicators is most directly relevant to a surgical privilege reappointment decision?

Answer: Complication and mortality rates for procedures the surgeon performs

Complication and mortality rates for specific procedures directly reflect a surgeon's clinical outcomes and competency in the privileges being renewed.

A peer review committee determines that a physician's care in a specific case was 'not consistent with expected standards.' What is the appropriate next step?

Answer: Provide the findings to the credentials committee for consideration in the reappointment or FPPE process

Peer review findings flow into the credentialing and FPPE process so the credentials committee can evaluate whether performance concerns affect privilege continuation.

What does 'confidentiality of peer review' protect in most US states?

Answer: Documents and proceedings of the peer review process from discovery in civil litigation

Most states have peer review privilege statutes that protect peer review committee records and deliberations from being subpoenaed in malpractice lawsuits.

Which federal statute requires hospitals to report certain adverse privileging actions and malpractice payments to the NPDB?

Answer: HCQIA (Health Care Quality Improvement Act)

HCQIA mandates that hospitals report professional review actions that adversely affect a practitioner's clinical privileges for more than 30 days to the NPDB.

A credentialing specialist receives a query result from the NPDB showing a malpractice payment report on an applicant. What is the correct handling?

Answer: Review the report in context as part of the complete credentialing file and present it to the credentials committee for evaluation

A single NPDB malpractice payment report does not automatically disqualify a practitioner; it must be reviewed in the context of the full application file by the credentials committee.