CPCS Negligent Credentialing and Legal Risk Management 3 — Questions and Answers
Question 1: Which landmark case established the hospital's independent duty to ensure the competency of its medical staff, forming the foundation of corporate negligence in credentialing?
- Darling v. Charleston Community Memorial Hospital (Correct answer)
- Gonzales v. Nork
- Johnson v. Misericordia Community Hospital
- Patrick v. Burget
Correct answer: Darling v. Charleston Community Memorial Hospital
Darling v. Charleston (1965) established that hospitals have a direct corporate duty to oversee and supervise the quality of medical care, including credentialing.
Question 2: A hospital's credentialing policy requires reverification of credentials every two years. A physician's license was revoked 18 months after initial appointment, but the hospital did not discover this until a patient was harmed at month 20. What risk management failure does this illustrate?
- Inadequate primary source verification at appointment
- Failure to conduct ongoing monitoring between reappointment cycles (Correct answer)
- Improper delegation of credentialing to the medical staff
- Violation of NPDB self-query requirements
Correct answer: Failure to conduct ongoing monitoring between reappointment cycles
Continuous monitoring (e.g., license sanction alerts) between reappointment cycles is essential to catch mid-cycle adverse actions.
Question 3: Which organization's accreditation standards require hospitals to have a process for granting temporary privileges in urgent situations while maintaining appropriate oversight?
- CMS only
- The Joint Commission (TJC) (Correct answer)
- URAC
- NCQA
Correct answer: The Joint Commission (TJC)
TJC Medical Staff standards explicitly address temporary privilege requirements including oversight and time limitations.
Question 4: A credentialing specialist learns a physician applicant has an active malpractice suit. Under standard credentialing practice, what is the CORRECT response?
- Automatically deny the application
- Request details and evaluate within the overall credentialing review process (Correct answer)
- Grant privileges and defer review until the suit resolves
- Report the physician to the NPDB immediately
Correct answer: Request details and evaluate within the overall credentialing review process
A pending lawsuit alone is not disqualifying; it must be evaluated in context with the full credentialing file.
Question 5: Proctoring a newly privileged physician for a defined number of cases is primarily intended to address which credentialing risk?
- Reducing antitrust exposure
- Verifying current clinical competence before granting full independent privileges (Correct answer)
- Meeting NPDB reporting obligations
- Satisfying Stark Law safe harbors
Correct answer: Verifying current clinical competence before granting full independent privileges
Proctoring validates that a practitioner can actually perform procedures safely in the hospital's specific environment before full independent practice.
Question 6: A hospital's peer review records are subpoenaed in a malpractice lawsuit. Which federal law provides the primary protection for peer review documents from discovery?
- HCQIA peer review privilege provisions
- HIPAA Privacy Rule
- Federal Rules of Evidence Rule 407
- Patient Safety and Quality Improvement Act (PSQIA) (Correct answer)
Correct answer: Patient Safety and Quality Improvement Act (PSQIA)
PSQIA provides federal privilege and confidentiality protections for information reported to Patient Safety Organizations (PSOs), shielding quality improvement data from discovery.
Question 7: Which of the following BEST describes 'focused professional practice evaluation' (FPPE) in the credentialing context?
- Annual performance review required by CMS Conditions of Participation
- Time-limited monitoring triggered by a question about a practitioner's competence or upon granting new privileges (Correct answer)
- Ongoing evaluation of all practitioners conducted at each reappointment
- A peer review process used only when privileges are being revoked
Correct answer: Time-limited monitoring triggered by a question about a practitioner's competence or upon granting new privileges
FPPE is a focused, time-limited evaluation used when a concern arises about competence or when new privileges are initially granted.
CPCS Negligent Credentialing and Legal Risk Management 3
Which landmark case established the hospital's independent duty to ensure the competency of its medical staff, forming the foundation of corporate negligence in credentialing?