Mixed Deck — All CHCS Topics Flashcards

Which organization primarily accredits health plans and grants credentialing certification to credentials verification organizations (CVOs)?

Answer: NCQA

NCQA accredits health plans and offers CVO certification for credentialing verification services.

Which body is the primary source for verifying graduation of an international medical graduate from a foreign medical school?

Answer: ECFMG

ECFMG certification is accepted as primary source verification of foreign medical education.

Which suffix means 'inflammation' in medical terminology?

Answer: -itis

'-itis' denotes inflammation, as in arthritis or appendicitis.

Which is an acceptable primary source for verifying board certification of an MD?

Answer: ABMS Certification Matters or the specialty board

ABMS and the certifying member board are recognized primary sources for board certification.

What is the recommended approach to staying current in Treatment Protocols & Interventions?

Answer: Regular professional development, industry publications, and peer collaboration

Staying current in Treatment Protocols & Interventions requires ongoing professional development, reading industry publications, and collaborating with peers to share knowledge and best practices.

Which source is acceptable for primary source verification of graduation from a foreign medical school?

Answer: ECFMG certification

ECFMG certification is an accepted primary source for verifying foreign medical education.

Which situation would most likely expose a hospital to an antitrust claim during credentialing?

Answer: Denying privileges to reduce competition for existing staff physicians

Using credentialing to exclude competitors rather than for quality reasons can violate the Sherman Antitrust Act.

Which Joint Commission National Patient Safety Goal addresses maintaining and communicating accurate patient medication information?

Answer: Medication reconciliation (NPSG.03.06.01)

NPSG.03.06.01 requires organizations to maintain and communicate accurate medication information, known as medication reconciliation.

How long does a physician's Medicare opt-out last before it renews automatically unless canceled?

Answer: 2 years

Opt-out periods run for 2 years and renew automatically unless the physician cancels at least 30 days before the period ends.

Under NCQA, how frequently must CAQH ProView users re-attest that their profile information is current?

Answer: Every 120 days

CAQH requires providers to re-attest their ProView data every 120 days.

Which database feature best supports demonstrating to auditors who changed a provider's license expiration date and when?

Answer: An audit trail or change log

An audit trail records user, date, time, and before/after values for each data change.

What is the primary role of a proctor during FPPE?

Answer: To observe, evaluate, and report on the practitioner's competence

A proctor evaluates and documents competence for the department, usually without taking responsibility for patient care.

A practitioner requests privileges for 'arthroscopy.' What does this procedure involve?

Answer: Visual examination inside a joint

'Arthr/o' (joint) + '-scopy' (visual examination) describes looking inside a joint with a scope.

Which term describes a procedure performed on both sides of the body?

Answer: Bilateral

'Bi-' means two, so bilateral refers to both sides.

Temporary privileges to meet an important patient care need for a pending applicant may last no longer than:

Answer: 120 days

TJC limits temporary privileges for applicants pending approval to 120 days.

Which patient safety tool proactively identifies possible process failures before they cause harm, unlike a root cause analysis?

Answer: Failure Mode and Effects Analysis (FMEA)

FMEA is a proactive risk assessment that looks for failure points before an adverse event happens.

A credentialing specialist who owns stock in a vendor being considered for the CVO contract should first:

Answer: Disclose the conflict of interest and recuse from the decision

Ethical standards require disclosing conflicts of interest and recusing from related decisions.

A new practitioner meets all FPPE criteria. What usually happens next?

Answer: FPPE results go to the credentials or department committee, which recommends ending FPPE and moving to OPPE

Once FPPE is completed successfully, the medical staff reviews the results and moves the practitioner to routine OPPE.

What is the primary purpose of an oversight audit in a delegated credentialing arrangement?

Answer: To ensure the CVO is performing delegated functions in compliance with the delegation agreement and applicable standards

Oversight audits verify that the CVO is fulfilling its delegated responsibilities according to the agreement terms and accreditation standards.

What is the primary role of the credentials committee in the medical staff governance structure?

Answer: Review and recommend credentialing and privileging actions to the medical executive committee

The credentials committee reviews applications, verifies qualifications, and makes recommendations to the medical executive committee before final board action.