Reappointment and Recredentialing Flashcards
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Read the first 7 Reappointment and Recredentialing flashcards as text
A hospital's medical staff bylaws state that reappointment applications must be submitted 120 days before privileges expire. A physician submits her application 60 days before expiration. What is the most appropriate action?
Answer: Notify the physician of the late submission and follow the bylaw's late-submission policy
The credentialing office should notify the physician and apply the late-submission policy outlined in the medical staff bylaws.
Which of the following best describes 'lapse in privileges' during the recredentialing process?
Answer: A gap in clinical privileges that occurs when reappointment is not completed before the expiration date
A lapse in privileges occurs when the reappointment process is not finalized before the provider's current privilege period ends.
During recredentialing, a physician's NPDB query reveals a malpractice payment made since the last appointment. What is the FIRST step the credentials committee should take?
Answer: Request a detailed explanation from the physician
The committee should first request a detailed explanation from the physician before making any determination about reappointment.
A telehealth provider seeking reappointment at a distant site hospital relies on credentialing by proxy. The credentialing is based on the originating site's credentials. What document must the originating site provide?
Answer: An attestation that the provider is currently credentialed and privileged at the originating site in good standing
CMS and accreditation standards require the originating site to provide an attestation of current good standing for telemedicine credentialing by proxy.
An organization's recredentialing cycle is every two years. A provider who was appointed 18 months ago voluntarily resigns. If they reapply 10 months later, how should the organization treat this application?
Answer: As an initial appointment requiring full primary source verification
A voluntary resignation followed by reapplication is treated as a new initial appointment requiring complete primary source verification regardless of prior credentialing.
Which performance data source is most organization-specific and critical for evaluating a provider's competency during recredentialing?
Answer: Ongoing Professional Practice Evaluation (OPPE) data
OPPE data is generated internally by the organization and reflects the provider's actual performance within that specific facility.
A credentials specialist discovers that a provider failed to disclose a hospital privilege revocation on his reappointment application. This omission is considered:
Answer: Grounds for denial or rescission of reappointment due to misrepresentation
Failure to disclose a privilege revocation is material misrepresentation and can be grounds for denial or rescission of reappointment.