Ongoing Monitoring and Audits Flashcards
7 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Ongoing Monitoring and Audits flashcards as text
Which federal database must credentialing organizations query as part of ongoing monitoring to identify providers with adverse actions against their Medicare/Medicaid participation?
Answer: OIG List of Excluded Individuals and Entities
The OIG List of Excluded Individuals and Entities (LEIE) must be checked to ensure providers have not been excluded from federal healthcare programs.
A hospital's medical staff office discovers mid-cycle that a physician's Drug Enforcement Administration (DEA) registration expired three weeks ago. What is the immediate required action?
Answer: Notify the department chief and restrict the physician from prescribing controlled substances
An expired DEA registration must trigger immediate restriction of controlled substance prescribing privileges until the registration is renewed.
What term describes the process of reviewing a provider's performance data, complaints, and licensure status between full recredentialing cycles?
Answer: Ongoing Professional Practice Evaluation (OPPE)
OPPE is the continuous review of practitioner performance data used to inform decisions about maintaining, modifying, or revoking privileges.
When conducting ongoing monitoring, how frequently does The Joint Commission recommend that organizations review OPPE data for licensed independent practitioners?
Answer: At least every 12 months but organizations may set shorter intervals
TJC requires OPPE data be reviewed at defined intervals that must not exceed 12 months, though organizations may review more frequently.
A credentialing specialist receives an automated alert that a practitioner's malpractice insurance policy will lapse in 10 days. Which action reflects best practice?
Answer: Contact the practitioner and require proof of renewed coverage before the lapse date
Proactive outreach to require proof of renewed coverage before a lapse protects the organization and maintains continuous compliance.
Which of the following best describes a 'watch list' in the context of credentialing ongoing monitoring?
Answer: A confidential internal list of providers requiring heightened scrutiny due to performance concerns
A watch list is an internal tool used to flag practitioners who need closer monitoring due to quality concerns, complaints, or adverse events.
What is the primary purpose of conducting a sanctions screening against the SAM (System for Award Management) database during ongoing monitoring?
Answer: To identify providers debarred from federal contracts and programs
SAM.gov lists individuals and entities debarred or suspended from participation in federal contracts, grants, and programs.