Accreditation Standards and Compliance 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 Accreditation Standards and Compliance flashcards as text
Which accrediting body specifically focuses on managed care organizations and requires credentialing standards as part of its NCQA accreditation process?
Answer: National Committee for Quality Assurance (NCQA)
NCQA accreditation for health plans includes rigorous credentialing and recredentialing standards that managed care organizations must meet.
Under URAC credentialing standards, what is the maximum acceptable time frame for completing a credentialing decision once an application is deemed complete?
Answer: 90 days
URAC standards generally require that credentialing decisions be completed within 90 days of receiving a complete application.
A hospital's medical staff bylaws conflict with a newly adopted accreditation standard. Which action should the credentialing specialist recommend first?
Answer: Amend the bylaws through the medical staff governance process
Bylaws must be updated through proper governance channels to align with accreditation standards, ensuring legal and procedural compliance.
Which element is NOT typically required by accreditation standards during the initial credentialing process?
Answer: Submission of a five-year financial disclosure statement
Financial disclosure statements are not a standard credentialing requirement; education, malpractice history, and DEA registration are routinely verified.
CMS Conditions of Participation require hospitals to grant temporary privileges in which specific circumstance?
Answer: To meet important patient care needs when a complete credentialing file is pending
CMS allows temporary privileges when there is an important patient care need and the full credentialing process has not yet been completed.
Which accreditation standard concept requires that a provider's privileges be matched to their demonstrated current competency rather than solely their training?
Answer: Privilege Delineation
Privilege delineation ensures that each specific clinical privilege granted reflects the provider's demonstrated ability to perform that procedure or service.
Under The Joint Commission standards, how often must a hospital's credentialing and privileging policies be reviewed and updated?
Answer: Every two years
TJC requires that medical staff bylaws, rules, regulations, and policies—including credentialing policies—be reviewed and updated at least every two years.