Regulatory Compliance & Accreditation Flashcards

Which federal database must be checked to confirm a provider is not excluded from participating in Medicare and Medicaid?

Answer: OIG List of Excluded Individuals/Entities (LEIE)

The OIG LEIE lists individuals and entities excluded from federal health care programs.

How often does the OIG recommend that organizations screen employees and contractors against the LEIE?

Answer: Monthly

OIG guidance recommends monthly LEIE checks because the list is updated monthly.

Under the Joint Commission, temporary privileges granted to meet an important patient care need may not exceed how many days?

Answer: 120 days

TJC limits temporary privileges to a maximum of 120 days.

A distant-site telemedicine provider is credentialed by the originating hospital relying on the distant-site hospital's decision. What is this process called?

Answer: Credentialing by proxy

CMS rules allow originating hospitals to credential telemedicine practitioners by proxy using a written agreement.

Which situation would generally disqualify a practitioner from expedited credentialing under Joint Commission standards?

Answer: The practitioner has a history of involuntary termination of medical staff membership

Involuntary termination, reduced privileges, or unusual malpractice history make an applicant ineligible for the expedited process.

When a health plan delegates credentialing to a provider group, what does NCQA require of the plan?

Answer: A written agreement and ongoing oversight, including annual evaluation of the delegate

NCQA requires a delegation agreement and the organization's annual oversight of the delegate's performance.

Under NCQA standards, a gap in work history longer than one year must be explained how?

Answer: In writing by the practitioner

NCQA requires gaps over one year to be explained in writing, while gaps of six months to one year may be explained verbally.