CPCS - Certified Provider Credentialing Specialist Medical Staff Governance Questions and Answers Flashcards
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The medical staff bylaws at a hospital have a provision that conflicts with a newly enacted state law regarding credentialing timelines. Which takes precedence?
Answer: The state law, because state law supersedes organizational policies
State law takes precedence over organizational policies, including medical staff bylaws. Bylaws must be updated to comply with applicable state and federal laws.
What is the primary function of the Medical Executive Committee (MEC) in the credentialing process?
Answer: To make final credentialing decisions that are then recommended to the governing board
The MEC receives credentialing committee recommendations, reviews them, and makes final medical staff recommendations to the governing board for final approval. The governing board retains ultimate authority.
A practitioner who has been denied privileges invokes their right to a fair hearing. Under HCQIA, what protection does this invoke for the hospital?
Answer: HCQIA immunity from damages applies if the hospital followed the required fair hearing process and the action was taken for legitimate reasons
HCQIA provides immunity from damages to hospitals that conduct peer review and adverse actions according to the Act's standards, including providing adequate notice and fair hearing procedures, if the action was taken for patient safety reasons.
Medical staff bylaws typically address which of the following regarding categories of medical staff membership?
Answer: The types of membership (active, associate, courtesy, consulting, etc.) and associated rights and privileges
Medical staff bylaws define the categories of medical staff membership (active, associate, courtesy, consulting, honorary, etc.) and specify the rights, responsibilities, and privileges associated with each category.
Which document typically outlines the specific clinical privileges available at a hospital and the criteria required to obtain them?
Answer: The delineation of privileges form
The delineation of privileges form (or privilege delineation form) lists the specific clinical procedures and privileges available at the hospital along with the criteria required to obtain each one.
Under most medical staff bylaws, what is the practitioner's responsibility regarding changes in licensure status that occur between credentialing cycles?
Answer: Practitioners have an affirmative duty to immediately report any changes in licensure, DEA, insurance, or adverse actions to the medical staff office
Most medical staff bylaws require practitioners to immediately notify the medical staff office of any changes to licensure, DEA certification, malpractice insurance, hospital privileges elsewhere, or adverse actions, as a condition of medical staff membership.