CPCS Medical Staff Governance 3

Question 1

Which federal law requires hospitals to report adverse credentialing actions of 30 days or more to the National Practitioner Data Bank (NPDB)?

Accepted Answer

The Health Care Quality Improvement Act (HCQIA)

Answer

HCQIA of 1986 mandates hospitals to report professional review actions restricting or revoking clinical privileges for 30 days or more to the NPDB.

Question 2

A practitioner resigns from the medical staff while under investigation. How must the hospital respond regarding NPDB reporting?

Accepted Answer

A report must be filed if the investigation would have resulted in a reportable adverse action

Answer

Under HCQIA, hospitals must file an NPDB report when a practitioner resigns or surrenders privileges while under investigation to prevent circumventing the reporting system.

Question 3

Under CMS Conditions of Participation, which of the following is required when a hospital grants a telemedicine practitioner privileges via a distant-site hospital agreement?

Accepted Answer

The local hospital may rely on the distant site's credentialing if a written agreement exists

Answer

CMS allows a local hospital to rely on a distant-site hospital's credentialing decisions for telemedicine providers when a formal written agreement meeting specific criteria is in place.

Question 4

The 'ongoing professional practice evaluation' (OPPE) process is BEST described as which of the following?

Accepted Answer

A continuous evaluation of a practitioner's performance used to inform privilege decisions

Answer

OPPE is a continuous, data-driven performance monitoring process used to make privilege-related decisions between formal reappointment cycles.

Question 5

A hospital's medical staff bylaws must be reviewed and approved by which two entities to be considered valid and enforceable?

Accepted Answer

The medical staff and the governing board

Answer

Medical staff bylaws require approval by both the organized medical staff (through vote) and the governing board to be legally enforceable.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Medical Staff Governance 3