Credentialing Processes & Accreditation Standards Flashcards
7 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Credentialing Processes & Accreditation Standards flashcards as text
Which term describes the process of verifying a provider's credentials directly with the original issuing source?
Answer: Primary source verification
Primary source verification means confirming credentials directly with the institution, licensing board, or organization that originally issued the credential.
Ongoing Professional Practice Evaluation (OPPE) differs from FPPE in that OPPE:
Answer: Is a continuous review of all practitioners with privileges
OPPE is an ongoing, systematic review of all privileged practitioners to ensure continued competency, unlike FPPE which is time-limited for new privileges.
A provider receives an adverse credentialing decision. Under HCQIA, the provider is entitled to:
Answer: A fair hearing and appellate review
HCQIA requires that providers subject to adverse professional review actions be given a fair hearing and appellate review opportunity.
What does the term 'delineation of privileges' refer to in credentialing?
Answer: Specifying the exact clinical procedures and services a provider is authorized to perform
Delineation of privileges defines the specific clinical activities and procedures a practitioner is authorized to perform within a healthcare organization.
Which organization maintains the Healthcare Sanctions database that credentialing specialists use to identify excluded providers?
Answer: Office of Inspector General (OIG)
The OIG maintains the List of Excluded Individuals and Entities (LEIE), which identifies providers excluded from participation in federal healthcare programs.
A telemedicine provider licensed in State A wants to practice in State B without obtaining a full license. Which mechanism may allow this?
Answer: Interstate Compact for Telemedicine
The Interstate Medical Licensure Compact (IMLC) streamlines the process for eligible physicians to obtain licenses in multiple member states, facilitating telemedicine practice.
What is the purpose of a 'gap in practice' policy in credentialing?
Answer: To establish criteria for assessing competency when a provider has not practiced recently
Gap-in-practice policies define how organizations assess and verify current competency for providers returning after a period of inactivity.