Reappointment and Recredentialing 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 Reappointment and Recredentialing flashcards as text
An organization uses a 'clean file' exception to expedite reappointment for providers with no adverse findings. Which criterion would DISQUALIFY a provider from the clean file process?
Answer: A single unresolved patient complaint under investigation
An open or unresolved complaint or investigation disqualifies a provider from the expedited clean file process requiring full committee review.
Which of the following BEST describes the relationship between OPPE and recredentialing?
Answer: OPPE data informs the credentials committee's reappointment decision
OPPE provides ongoing performance data that the credentials committee uses as evidence when making reappointment decisions.
A provider's reappointment file is complete except for one outstanding reference letter. The privilege period expires in five days. What is the most appropriate action?
Answer: Contact the reference directly to expedite the letter and follow the organization's incomplete application policy
The credentialing staff should actively pursue the missing reference and apply the organization's policy for incomplete applications to prevent a privilege lapse.
A credentials committee member has a financial relationship with a provider whose reappointment is being reviewed. What must this committee member do?
Answer: Recuse themselves from the discussion and vote on that provider's reappointment
A committee member with a conflict of interest must recuse themselves from all deliberation and voting on that provider's reappointment.
An organization learns mid-cycle that a provider's Drug Enforcement Administration (DEA) registration was revoked. Which action is required IMMEDIATELY?
Answer: Initiate a summary suspension of DEA-controlled substance prescribing privileges pending investigation
DEA revocation requires immediate restriction of controlled substance prescribing authority pending a full investigation to protect patient safety.
What does the term 'gap in practice' mean in the context of recredentialing, and why is it significant?
Answer: A period when the provider did not actively practice in their specialty, raising competency concerns
A gap in practice is a period of clinical inactivity that may indicate competency concerns and typically requires additional evaluation such as proctoring or FPPE.
When verifying a provider's current malpractice coverage during recredentialing, which element is MOST important to confirm?
Answer: That coverage limits meet the organization's minimum requirements and the policy is active
Verifying that the malpractice policy is currently active and meets the organization's minimum coverage limits is the essential element of malpractice verification.