Regulatory Compliance & Accreditation Flashcards
7 cards from real CHCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Regulatory Compliance & Accreditation flashcards as text
Which CMS regulation contains the hospital Condition of Participation for the medical staff?
Answer: 42 CFR 482.22
42 CFR 482.22 sets the medical staff Condition of Participation, including credentialing requirements.
How often must most Medicare providers and suppliers revalidate their enrollment with CMS?
Answer: Every 5 years
Most providers revalidate Medicare enrollment every five years, while DMEPOS suppliers revalidate every three years.
Which Joint Commission process requires continuous review of practitioner performance data rather than only at reappointment?
Answer: OPPE
OPPE is the ongoing evaluation of each practitioner's performance used to support privilege decisions.
Under NCQA standards, how soon after sanction information is released must an organization review it during ongoing monitoring?
Answer: Within 30 calendar days
NCQA requires review of new Medicare/Medicaid sanctions and license actions within 30 days of their release.
After a Joint Commission survey identifies requirements for improvement, the organization typically submits what document?
Answer: Evidence of Standards Compliance (ESC)
TJC requires an Evidence of Standards Compliance report showing how cited issues were corrected.
Which accrediting organization integrates ISO 9001 quality management requirements into its hospital accreditation program?
Answer: DNV
DNV's NIAHO program combines CMS Conditions of Participation with ISO 9001 quality management.
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.
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