Regulatory Requirements and Law 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 Regulatory Requirements and Law flashcards as text
Under the Health Care Quality Improvement Act (HCQIA), which condition must be met for a professional review action to receive immunity from damages?
Answer: The action must be taken in the reasonable belief that it furthers quality healthcare
HCQIA immunity applies when the review action is taken in the reasonable belief that it furthers quality healthcare, adequate notice and hearing procedures are followed, and there is a reasonable effort to obtain the facts.
Which federal law established the National Practitioner Data Bank (NPDB) and mandated reporting of certain adverse actions?
Answer: Health Care Quality Improvement Act of 1986
The Health Care Quality Improvement Act of 1986 (HCQIA) established the NPDB and created mandatory reporting requirements for malpractice payments and adverse privilege actions.
A state medical board revokes a physician's license. Under HCQIA, within how many days must the board report this action to the NPDB?
Answer: 30 days
State licensing boards must report adverse licensure actions to the NPDB within 30 days of the action being taken.
Which accreditation standard requires hospitals to query the NPDB at the time of initial appointment and at reappointment?
Answer: CMS Conditions of Participation
CMS Conditions of Participation (42 CFR §482.12) require hospitals to query the NPDB when granting initial privileges and at reappointment.
The Americans with Disabilities Act (ADA) requires credentialing organizations to make reasonable accommodations for practitioners with disabilities UNLESS doing so would cause:
Answer: Undue hardship on the organization
The ADA requires reasonable accommodation unless it would create an undue hardship, meaning significant difficulty or expense relative to the organization's resources.
Under EMTALA, which type of practitioner privilege decision could implicate the law if it results in a hospital being unable to staff its emergency department?
Answer: Denial of privileges to an on-call specialist needed for emergency coverage
EMTALA requires hospitals to maintain adequate on-call coverage; denying privileges to specialists essential for emergency care could impair the hospital's ability to meet EMTALA obligations.
Which legal concept protects peer review committee members from civil liability when they act in good faith during credentialing proceedings?
Answer: Qualified privilege
Qualified privilege protects peer review participants from defamation claims when they share credentialing information in good faith within appropriate channels without malice.