CHCS Communication & Patient Education 3

Question 1

When communicating an adverse privileging decision to a physician, which element is required by most bylaws and the HCQIA?

Accepted Answer

Written notice of the action, reasons, and the right to request a hearing

Answer

HCQIA due process standards call for written notice including the proposed action, reasons, and hearing rights.

Question 2

A payer representative asks for a provider's hospital privileges status. What should the specialist do before releasing information?

Accepted Answer

Verify the requester's identity and confirm a signed provider release/authorization is on file

Answer

Verification of identity and authorization protects the provider and the organization.

Question 3

Which approach is most effective for educating newly credentialed providers about reappointment requirements?

Accepted Answer

Provide a written orientation packet and calendar reminders well ahead of reappointment deadlines

Answer

Proactive written education and reminders prevent lapses in privileges or enrollment.

Question 4

When reminding health plan network practitioners about recredentialing, what maximum interval do NCQA standards allow between cycles?

Accepted Answer

Every 36 months

Answer

NCQA requires practitioners to be recredentialed at least every 36 months.

Question 5

A patient complaint about a provider arrives in the medical staff office. How should it be handled from a communication standpoint?

Accepted Answer

Document it, route it per policy to quality/peer review, and include it in ongoing monitoring

Answer

Patient complaints are quality data that must be documented and routed confidentially for OPPE/peer review.

CHCS - Certified Healthcare Credentialing Specialist Practice Test