CPCS Peer Review & Performance Improvement 2

Question 1

Which federal law provides immunity protections to peer review participants in healthcare organizations?

Accepted Answer

The Health Care Quality Improvement Act (HCQIA)

Answer

HCQIA provides qualified immunity to peer review participants who act in good faith when reviewing physician performance.

Question 2

A credentialing specialist discovers that a physician's peer review files contain patient-identifiable information. What is the most appropriate action?

Accepted Answer

Remove patient identifiers to protect confidentiality per HIPAA

Answer

Patient-identifiable information in peer review files must be de-identified to comply with HIPAA privacy requirements.

Question 3

In a focused professional practice evaluation (FPPE), what triggers the review process?

Accepted Answer

A new privilege request or a specific concern about a practitioner

Answer

FPPE is initiated for new privileges or when a specific concern arises about a practitioner's competence or conduct.

Question 4

What is the primary purpose of the National Practitioner Data Bank (NPDB) in the peer review process?

Accepted Answer

To flag practitioners with adverse actions for credentialing bodies

Answer

The NPDB collects and reports adverse actions and malpractice payments, helping organizations identify practitioners with a history of performance issues.

Question 5

Which performance improvement model uses Define, Measure, Analyze, Improve, and Control phases?

Accepted Answer

Six Sigma DMAIC

Answer

Six Sigma's DMAIC framework is a data-driven methodology for eliminating defects and improving processes.

(CPCS) Certified Professional Credentialing Specialist Practice Test

(CPCS) Certified Professional Credentialing Specialist Practice Test

CPCS Peer Review & Performance Improvement 2