CPCS Clinical Privileging 5

Question 1

A provider's privileges are restricted pending a peer review investigation. The provider demands an immediate fair hearing. At what point is a provider entitled to a fair hearing?

Accepted Answer

When a summary suspension exceeds 14 days

Answer

Under HCQIA, a provider is entitled to a hearing when a summary suspension exceeds 30 days, or more commonly under medical staff bylaws when it exceeds 14 days or when a formal adverse action is recommended.

Question 2

What is the primary purpose of querying the NPDB at the time of initial application for privileges?

Accepted Answer

To identify prior adverse actions, malpractice payments, and licensure actions not disclosed by the provider

Answer

An NPDB query at initial application reveals any previously reported adverse privileging actions, malpractice payments, or licensure sanctions that a provider may not have disclosed.

Question 3

A physician holds privileges at two hospitals within the same health system. One hospital initiates a summary suspension. What must the second hospital do?

Accepted Answer

Be notified and independently evaluate whether action is warranted

Answer

While automatic cross-facility suspension is not universally required, the second hospital must be notified and should independently assess whether patient safety warrants action at its facility.

Question 4

Which metric is typically NOT appropriate for inclusion in an OPPE data profile for a surgeon?

Accepted Answer

The surgeon's annual continuing medical education hours

Answer

CME hours are a credentialing input and a licensure requirement, not a performance outcome metric appropriate for OPPE, which focuses on clinical performance indicators.

Question 5

A hospital grants privileges to an advanced practice registered nurse (APRN) who will practice independently in an outpatient clinic. Which standard governs the privileging process for this provider?

Accepted Answer

The same credentialing and privileging standards that apply to physicians

Answer

Joint Commission and CMS standards require that APRNs granted clinical privileges undergo a credentialing and privileging process equivalent to that applied to physicians.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Clinical Privileging 5