Regulatory Compliance & Accreditation Flashcards

Under NCQA standards, how often must a health plan recredential its contracted practitioners?

Answer: Every 36 months

NCQA requires recredentialing at least every 36 months.

Which federal law grants peer review bodies limited immunity from damages when they meet specific due-process standards?

Answer: Health Care Quality Improvement Act of 1986

HCQIA provides immunity for professional review actions that meet its four standards and also created the NPDB.

Under HCQIA, how often must a hospital query the NPDB for practitioners already on its medical staff?

Answer: At least every two years

Hospitals must query the NPDB at initial appointment and at least every two years thereafter.

Within how many days must an entity report a medical malpractice payment to the NPDB?

Answer: 30 days

Malpractice payments must be reported to the NPDB within 30 days of the payment.

A hospital restricts a physician's clinical privileges for 45 days after a professional review action. What is the NPDB reporting obligation?

Answer: A report is required because the restriction exceeds 30 days

Adverse privilege actions lasting more than 30 days based on competence or conduct must be reported to the NPDB.

Which Joint Commission process evaluates a practitioner who has been newly granted privileges at the organization?

Answer: Focused Professional Practice Evaluation (FPPE)

TJC requires a time-limited FPPE for all practitioners with newly requested privileges.

An accreditation organization approved by CMS to survey hospitals on its behalf grants what status to accredited facilities?

Answer: Deemed status

CMS-approved accreditation lets facilities be 'deemed' to meet the Medicare Conditions of Participation.