CPCS - Certified Provider Credentialing Specialist Regulatory Requirements and Law Questions and Answers — 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?
- Patient Safety and Quality Improvement Act (PSQIA)
- Health Insurance Portability and Accountability Act (HIPAA)
- Emergency Medical Treatment and Active Labor Act (EMTALA)
- Health Care Quality Improvement Act (HCQIA) (Correct answer)
Correct answer: Health Care Quality Improvement Act (HCQIA)
The Health Care Quality Improvement Act (HCQIA) of 1986 provides qualified immunity from liability for damages for physicians and others who participate in professional peer review, as long as the review is conducted in good faith and meets specified standards of due process.
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?
- 15 days
- 30 days (Correct answer)
- 60 days
- 90 days
Correct answer: 30 days
The NPDB requires that medical malpractice payments be reported within 30 days of the date the payment is made.
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?
- "Have you ever been treated for a mental health condition?"
- "Are you currently taking any prescription medications?"
- "Do you have any physical or mental diagnosis that would prevent you from performing your duties?"
- "Are you currently able to perform the essential functions and privileges requested, with or without reasonable accommodation?" (Correct answer)
Correct answer: "Are you currently able to perform the essential functions and privileges requested, with or without reasonable accommodation?"
The ADA prohibits broad, pre-offer inquiries about an applicant's health status or disabilities. However, it is permissible to ask if the applicant can perform the essential functions of the job, with or without reasonable accommodation, as this focuses on ability rather than a specific disability.
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?
- The Health Care Quality Improvement Act (HCQIA)
- The Patient Safety and Quality Improvement Act (PSQIA) (Correct answer)
- The Health Information Technology for Economic and Clinical Health (HITECH) Act
- The Emergency Medical Treatment and Active Labor Act (EMTALA)
Correct answer: The Patient Safety and Quality Improvement Act (PSQIA)
The Patient Safety and Quality Improvement Act (PSQIA) of 2005 establishes a voluntary reporting system and provides federal privilege and confidentiality protections for information designated as Patient Safety Work Product (PSWP), which is collected and created during the reporting and analysis of patient safety events within a Patient Safety Evaluation System.
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?
- 12 hours
- 48 hours
- 24 hours (Correct answer)
- 72 hours
Correct answer: 24 hours
CMS Conditions of Participation §482.22(c)(5)(i) requires that a patient's H&P be completed no more than 30 days before or 24 hours after admission or registration, and it must be completed prior to any surgery or procedure requiring anesthesia.
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?
- 36 months, to align with the state.
- 24 months, as stated in the bylaws. (Correct answer)
- 30 months, as an average of the requirements.
- The hospital may choose any cycle up to 36 months.
Correct answer: 24 months, as stated in the bylaws.
When faced with differing requirements from accreditors, state laws, and internal policies, a healthcare organization must always adhere to the most restrictive standard. In this case, the 24-month cycle required by the medical staff bylaws is the most restrictive and therefore must be followed.
CPCS - Certified Provider Credentialing Specialist Regulatory Requirements and Law Questions and Answers
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?