CPCS - Certified Provider Credentialing Specialist Regulatory Requirements and Law Questions and Answers

Question 1

A hospital peer review committee, acting in good faith and after a thorough, fair process, recommends the termination of a physician's privileges due to quality of care concerns.
The physician subsequently files a lawsuit against the individual members of the committee.
Which federal law provides qualified immunity to these committee members?

Accepted Answer

Health Care Quality Improvement Act (HCQIA)

Answer

Patient Safety and Quality Improvement Act (PSQIA)

Answer

Health Insurance Portability and Accountability Act (HIPAA)

Answer

Emergency Medical Treatment and Active Labor Act (EMTALA)

Question 2

A medical malpractice insurance company makes a payment on behalf of a physician in settlement of a written claim. According to National Practitioner Data Bank (NPDB) regulations, within how many days of the payment must this action be reported?

Accepted Answer

30 days

Answer

15 days

Answer

60 days

Answer

90 days

Question 3

In compliance with the Americans with Disabilities Act (ADA), which of the following questions is permissible to ask a practitioner on an initial credentialing application?

Accepted Answer

"Are you currently able to perform the essential functions and privileges requested, with or without reasonable accommodation?"

Answer

"Have you ever been treated for a mental health condition?"

Answer

"Are you currently taking any prescription medications?"

Answer

"Do you have any physical or mental diagnosis that would prevent you from performing your duties?"

Question 4

During a root cause analysis that is part of a hospital's formal Patient Safety Evaluation System, a provider discloses information about a near-miss event. This information is documented as part of the analysis. What law provides federal privilege and confidentiality protections for this specific documentation, shielding it from discovery in a lawsuit?

Accepted Answer

The Patient Safety and Quality Improvement Act (PSQIA)

Answer

The Health Care Quality Improvement Act (HCQIA)

Answer

The Health Information Technology for Economic and Clinical Health (HITECH) Act

Answer

The Emergency Medical Treatment and Active Labor Act (EMTALA)

Question 5

According to the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation for hospitals, a medical history and physical examination (H&P) must be completed and documented for each patient no more than 30 days before or within how many hours after admission?

Accepted Answer

24 hours

Answer

12 hours

Answer

48 hours

Answer

72 hours

Question 6

A hospital's internal medical staff bylaws state that all practitioners must be recredentialed every 24 months. The state law allows for a recredentialing cycle of up to 36 months, and NCQA standards also permit a cycle up to 36 months. To maintain full compliance, the organization must adhere to which recredentialing timeframe?

Accepted Answer

24 months, as stated in the bylaws.

Answer

36 months, to align with the state.

Answer

30 months, as an average of the requirements.

Answer

The hospital may choose any cycle up to 36 months.