CPCS Regulatory Requirements and Law 2

Question 1

Under the Health Care Quality Improvement Act (HCQIA), which condition must be met for a professional review action to receive immunity from damages?

Accepted Answer

The action must be taken in the reasonable belief that it furthers quality healthcare

Answer

HCQIA immunity applies when the review action is taken in the reasonable belief that it furthers quality healthcare, adequate notice and hearing procedures are followed, and there is a reasonable effort to obtain the facts.

Question 2

Which federal law established the National Practitioner Data Bank (NPDB) and mandated reporting of certain adverse actions?

Accepted Answer

Health Care Quality Improvement Act of 1986

Answer

The Health Care Quality Improvement Act of 1986 (HCQIA) established the NPDB and created mandatory reporting requirements for malpractice payments and adverse privilege actions.

Question 3

A state medical board revokes a physician's license. Under HCQIA, within how many days must the board report this action to the NPDB?

Accepted Answer

30 days

Answer

State licensing boards must report adverse licensure actions to the NPDB within 30 days of the action being taken.

Question 4

Which accreditation standard requires hospitals to query the NPDB at the time of initial appointment and at reappointment?

Accepted Answer

CMS Conditions of Participation

Answer

CMS Conditions of Participation (42 CFR §482.12) require hospitals to query the NPDB when granting initial privileges and at reappointment.

Question 5

The Americans with Disabilities Act (ADA) requires credentialing organizations to make reasonable accommodations for practitioners with disabilities UNLESS doing so would cause:

Accepted Answer

Undue hardship on the organization

Answer

The ADA requires reasonable accommodation unless it would create an undue hardship, meaning significant difficulty or expense relative to the organization's resources.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Regulatory Requirements and Law 2