Data Management & Reporting Flashcards

Within what time frame must an entity report an adverse clinical privileges action to the NPDB?

Answer: Within 30 days

NPDB reports of reportable adverse actions are due within 30 days of the action.

Ongoing Professional Practice Evaluation (OPPE) data under Joint Commission standards is primarily used to:

Answer: Continuously evaluate practitioner performance to support privileging decisions

OPPE collects ongoing performance data that informs whether privileges should continue, be limited, or be revoked.

In a delegated credentialing arrangement, the delegate's reports to the health plan typically include:

Answer: Credentialing activity data such as new, recredentialed, and terminated practitioners

Delegates submit periodic activity reports so the delegating plan can oversee credentialing performance.

Which is the most reliable way to monitor provider license sanctions between recredentialing cycles?

Answer: Perform ongoing sanction monitoring using state board and federal exclusion data sources

Ongoing monitoring of licensing boards and exclusion lists catches sanctions between cycles.

Which federal system should be queried to identify individuals and entities excluded from receiving federal contracts and awards?

Answer: SAM.gov

SAM.gov contains federal exclusion records across agencies, beyond OIG's LEIE.

What is the purpose of role-based access controls in a credentialing software system?

Answer: To limit each user's access to the data and functions their job requires

Role-based access protects confidential credentialing data by restricting access to job-related needs.

A credentialing manager wants to show the trend in application turnaround time over 12 months. Which report format is most effective?

Answer: A line chart of monthly averages

Line charts clearly display trends in a metric across time periods.