CPCS CPCS - Certified Provider Credentialing Specialist Peer Review and Performance Improvement Questions and Answers 2 — Questions and Answers
Question 1: What triggers a Focused Professional Practice Evaluation (FPPE) for a currently privileged practitioner?
- A specific concern about the practitioner's competence or a pattern of adverse outcomes (Correct answer)
- Routine reappointment every two years
- A new primary source verification request
- Submission of a new credentialing application
Correct 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.
Question 2: Which committee typically has primary responsibility for reviewing peer review findings and recommending privilege actions?
- The Credentials Committee or Medical Executive Committee (Correct answer)
- The Board of Trustees
- The Quality Assurance Department
- The Human Resources Department
Correct 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.
Question 3: 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?
- 30 days (Correct answer)
- 14 days
- 60 days
- 90 days
Correct 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.
Question 4: What is the purpose of a performance improvement (PI) plan in the credentialing context?
- To provide a structured corrective pathway for a practitioner with identified performance deficiencies before privilege action is taken (Correct answer)
- To automatically suspend a practitioner's privileges pending investigation
- To replace the peer review process for low-risk practitioners
- To satisfy primary source verification requirements for new applicants
Correct 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.
Question 5: Which principle ensures that peer review proceedings are protected from discovery in most U.S. states?
- Peer review privilege (peer review protection statutes) (Correct answer)
- HIPAA Privacy Rule
- The Health Care Quality Improvement Act (HCQIA)
- Due process protections under the 14th Amendment
Correct 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.
Question 6: In performance improvement, what does a 'benchmark' refer to?
- A performance standard based on best practices or comparison data used to evaluate practitioner or organizational performance (Correct answer)
- The minimum passing score on a credentialing exam
- A type of primary source verification document
- A formal report submitted to the NPDB
Correct 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.
CPCS CPCS - Certified Provider Credentialing Specialist Peer Review and Performance Improvement Questions and Answers 2
What triggers a Focused Professional Practice Evaluation (FPPE) for a currently privileged practitioner?