Negligent Credentialing and Legal Risk Management 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 Negligent Credentialing and Legal Risk Management flashcards as text
A hospital grants expanded surgical privileges to a physician without requiring demonstration of competency in the new procedures. A patient is harmed. Which credentialing failure is MOST directly at issue?
Answer: Granting privileges beyond demonstrated current competence
Granting privileges without evidence of competency in the specific procedures is the classic negligent privileging failure.
Which of the following actions by a medical staff member during peer review is MOST likely to eliminate HCQIA immunity protection?
Answer: Acting with the knowledge that the recommendation was false and motivated by personal animus
HCQIA immunity is lost if the action was taken in bad faith or with knowledge that the underlying information was false.
A practitioner's malpractice insurer makes a payment on the practitioner's behalf. Who is responsible for reporting this to the NPDB?
Answer: The malpractice insurance entity making the payment
Under HCQIA, the malpractice insurance entity (insurer or self-insurer) making the payment must report it to the NPDB within 30 days.
A physician is placed on a summary suspension pending investigation. What is the hospital's obligation regarding NPDB reporting at this stage?
Answer: Reporting is required only if the suspension exceeds 30 days or becomes a final adverse action
Summary suspensions pending investigation are reportable only if they result in a final adverse action exceeding 30 days.
Which legal concept requires a physician whose privileges are under review to be given adequate notice and an opportunity to be heard before an adverse action becomes final?
Answer: Due process in peer review (fair hearing rights)
HCQIA and most medical staff bylaws require fair hearing rights—notice and an opportunity to be heard—before a final adverse credentialing action.
A hospital system uses a centralized credentialing verification organization (CVO) to collect and verify credentials. If the CVO provides inaccurate information, who bears ultimate liability for a resulting credentialing error?
Answer: The hospital, which retains non-delegable responsibility for credentialing decisions
Hospitals cannot delegate away their corporate duty of care; they remain ultimately liable for credentialing decisions even when using a CVO.
A practitioner's application reveals gaps in employment history. What is the credentialing specialist's BEST course of action?
Answer: Request written explanation for each gap and verify through additional references if needed
Unexplained gaps require written clarification and, if necessary, additional reference verification to ensure completency and patient safety.