CPCS - Certified Provider Credentialing Specialist Peer Review and Performance Improvement Questions and Answers Flashcards
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What triggers a Focused Professional Practice Evaluation (FPPE) for a currently privileged practitioner?
Answer: A specific concern about the practitioner's competence or a pattern of adverse outcomes
FPPE for existing practitioners is triggered by a specific concern, complaint, or identified pattern of adverse outcomes requiring closer scrutiny.
Which committee typically has primary responsibility for reviewing peer review findings and recommending privilege actions?
Answer: The Credentials Committee or Medical Executive Committee
The Credentials Committee or Medical Executive Committee reviews peer review outcomes and recommends privilege actions to the governing body.
Under NPDB reporting requirements, a hospital must report to the National Practitioner Data Bank when clinical privileges are reduced, suspended, or revoked for a period exceeding how many days?
Answer: 30 days
Hospitals must report to the NPDB any adverse clinical privilege action taken for a period longer than 30 days due to professional review activity.
What is the purpose of a performance improvement (PI) plan in the credentialing context?
Answer: To provide a structured corrective pathway for a practitioner with identified performance deficiencies before privilege action is taken
A PI plan offers practitioners a structured, time-limited opportunity to correct identified deficiencies, often as an alternative to immediate adverse privilege action.
Which principle ensures that peer review proceedings are protected from discovery in most U.S. states?
Answer: Peer review privilege (peer review protection statutes)
Most states have peer review privilege statutes that protect peer review deliberations and records from being used as evidence in civil litigation.
In performance improvement, what does a 'benchmark' refer to?
Answer: A performance standard based on best practices or comparison data used to evaluate practitioner or organizational performance
A benchmark is a reference standard drawn from best-practice data or peer organizations, used to measure and compare performance outcomes.