CPCS Negligent Credentialing and Legal Risk Management 4

Question 1

A hospital grants expanded surgical privileges to a physician without requiring demonstration of competency in the new procedures. A patient is harmed. Which credentialing failure is MOST directly at issue?

Accepted Answer

Granting privileges beyond demonstrated current competence

Answer

Granting privileges without evidence of competency in the specific procedures is the classic negligent privileging failure.

Question 2

Which of the following actions by a medical staff member during peer review is MOST likely to eliminate HCQIA immunity protection?

Accepted Answer

Acting with the knowledge that the recommendation was false and motivated by personal animus

Answer

HCQIA immunity is lost if the action was taken in bad faith or with knowledge that the underlying information was false.

Question 3

A practitioner's malpractice insurer makes a payment on the practitioner's behalf. Who is responsible for reporting this to the NPDB?

Accepted Answer

The malpractice insurance entity making the payment

Answer

Under HCQIA, the malpractice insurance entity (insurer or self-insurer) making the payment must report it to the NPDB within 30 days.

Question 4

A physician is placed on a summary suspension pending investigation. What is the hospital's obligation regarding NPDB reporting at this stage?

Accepted Answer

Reporting is required only if the suspension exceeds 30 days or becomes a final adverse action

Answer

Summary suspensions pending investigation are reportable only if they result in a final adverse action exceeding 30 days.

Question 5

Which legal concept requires a physician whose privileges are under review to be given adequate notice and an opportunity to be heard before an adverse action becomes final?

Accepted Answer

Due process in peer review (fair hearing rights)

Answer

HCQIA and most medical staff bylaws require fair hearing rights—notice and an opportunity to be heard—before a final adverse credentialing action.

(CPCS) Certified Professional Credentialing Specialist Practice Test

(CPCS) Certified Professional Credentialing Specialist Practice Test

CPCS Negligent Credentialing and Legal Risk Management 4