CPCS - Certified Provider Credentialing Specialist Reappointment and Recredentialing Questions and Answers Flashcards
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Read the first 6 CPCS - Certified Provider Credentialing Specialist Reappointment and Recredentialing Questions and Answers flashcards as text
A practitioner's three-year NCQA recredentialing cycle is due, but the practitioner has been on extended medical leave for the past 6 months and is not currently seeing patients. Must the organization complete the recredentialing cycle on schedule?
Answer: The organization can defer recredentialing until the practitioner returns, but must complete it before the practitioner resumes seeing patients
An organization may defer recredentialing during an extended leave, but must complete the full recredentialing process and receive approval before the practitioner is allowed to resume seeing patients.
Which element of reappointment review is designed to evaluate whether a practitioner's clinical performance justifies continuation, modification, or revocation of specific privileges?
Answer: Focused Professional Practice Evaluation (FPPE) results and OPPE data
FPPE results and OPPE data provide actual performance-based evidence that directly evaluates whether the practitioner's privileges should be continued, modified, or revoked, the core purpose of performance-based reappointment review.
A practitioner at reappointment discloses a malpractice case that settled 18 months ago, which was also reported to the NPDB. The NPDB report shows the case involved a surgical complication. How should the credentials committee approach this disclosure?
Answer: Review the case details, OPPE data related to surgical outcomes, and peer input to make a holistic reappointment decision
The credentials committee should conduct a holistic review that includes the case details, the practitioner's surgical OPPE data, peer input, and any corrective actions taken. Malpractice history alone does not determine reappointment.
What is the purpose of a 'reappointment application' as distinct from the initial credentialing application?
Answer: Reappointment applications are shorter because they only require updating changes since the last appointment
Reappointment applications are streamlined to collect only updates and changes since the previous appointment, supplemented by updated credential verifications. The full initial application is not repeated.
Under most medical staff bylaws, what is the consequence if a practitioner fails to respond to a reappointment application within the required timeframe?
Answer: The practitioner's clinical privileges may be automatically suspended or lapsed
Most medical staff bylaws provide that failure to complete and return the reappointment application within the required timeframe results in automatic suspension or lapsing of clinical privileges.
When a practitioner's recredentialing reveals a new adverse licensure action (such as a probationary license) that was NOT disclosed on the application, what is the appropriate response?
Answer: Refer to the credentials committee, noting both the adverse action and the failure to disclose, for comprehensive review
Both the substantive finding (adverse licensure action) and the failure to disclose must be presented to the credentials committee for comprehensive review of both issues.