CPCS Clinical Privileging and Competency Evaluation (FPPE/OPPE) 5 — Questions and Answers
Question 1: A physician applies for privileges in a department where no peers in that specialty currently practice. How should the hospital evaluate clinical competency?
- Deny the application until a peer is hired
- Use external peer reviewers with appropriate specialty expertise (Correct answer)
- Allow the department chair in a related specialty to evaluate
- Grant privileges based solely on board certification
Correct answer: Use external peer reviewers with appropriate specialty expertise
When internal peer reviewers are unavailable, hospitals should obtain evaluation from external reviewers with the appropriate specialty expertise.
Question 2: Which of the following BEST defines 'proctoring' in the context of FPPE?
- A paper review of a practitioner's case records by the credentials committee
- Direct or retrospective observation of a practitioner's clinical performance by a qualified peer (Correct answer)
- An annual survey of patient outcomes data
- A self-assessment tool completed by the practitioner
Correct answer: Direct or retrospective observation of a practitioner's clinical performance by a qualified peer
Proctoring involves a qualified peer directly or retrospectively observing and evaluating a practitioner's actual clinical performance.
Question 3: A hospitalist group contracts with a hospital. The hospital is responsible for credentialing the hospitalists. Which statement is TRUE?
- The contracting group's internal credentialing satisfies hospital requirements
- The hospital must independently credential each hospitalist regardless of group affiliation (Correct answer)
- CMS allows hospitals to delegate full credentialing responsibility to contracted groups
- Credentialing is only required if the hospitalists will perform procedures
Correct answer: The hospital must independently credential each hospitalist regardless of group affiliation
Each practitioner who provides care in the hospital must be individually credentialed by the hospital, regardless of employment or contract arrangements.
Question 4: Under OPPE, which of the following represents a 'behavior' indicator that may be tracked alongside clinical performance metrics?
- Board certification status
- Adherence to the medical staff code of conduct (Correct answer)
- Number of inpatient admissions
- Malpractice insurance premium history
Correct answer: Adherence to the medical staff code of conduct
Behavioral indicators such as code of conduct adherence, collegial conduct, and adherence to hospital policies are legitimate OPPE data elements.
Question 5: A credentials specialist discovers that a practitioner did not disclose a prior malpractice settlement on their application. What is the MOST serious concern?
- The settlement must be reported to the NPDB by the hospital
- The omission may constitute falsification, warranting denial or revocation of privileges (Correct answer)
- The practitioner must pay a fine to the credentialing committee
- The case should be forwarded to the billing department for review
Correct answer: The omission may constitute falsification, warranting denial or revocation of privileges
Falsification or material omission on a credentialing application is grounds for denial, revocation, or non-renewal of privileges.
Question 6: Which of the following scenarios would MOST likely require an expedited credentialing review?
- A practitioner requesting expansion of existing privileges at reappointment
- A locum tenens physician needed within 48 hours to cover a critical staffing gap (Correct answer)
- A nurse practitioner applying for initial hospital privileges
- A physician requesting a leave of absence from the medical staff
Correct answer: A locum tenens physician needed within 48 hours to cover a critical staffing gap
Urgent patient care needs, such as imminent locum coverage gaps, trigger expedited credentialing processes with streamlined but complete verification.
Question 7: When a practitioner's privileges are voluntarily relinquished while under investigation, what MUST the hospital do?
- Keep the resignation confidential per HIPAA
- Report the resignation to the NPDB because it occurred during an active investigation (Correct answer)
- Allow the practitioner to reapply in 90 days without disclosure
- Treat the relinquishment as a clean resignation with no reporting obligation
Correct answer: Report the resignation to the NPDB because it occurred during an active investigation
NPDB reporting is required when a practitioner surrenders privileges while under investigation or to avoid an investigation.
CPCS Clinical Privileging and Competency Evaluation (FPPE/OPPE) 5
A physician applies for privileges in a department where no peers in that specialty currently practice.
How should the hospital evaluate clinical competency?