CPCS Regulatory Requirements and Law 4

Question 1

Under HIPAA, which of the following is a permissible use of a practitioner's credentialing information without explicit authorization?

Accepted Answer

Disclosing credentialing status to another hospital for treatment or quality improvement purposes

Answer

HIPAA permits disclosure of credentialing information to other covered entities for treatment, payment, and healthcare operations purposes, including quality assessment activities.

Question 2

The Medicare Conditions of Participation require that a hospital's medical staff bylaws be approved by the:

Accepted Answer

Governing body (board of directors) of the hospital

Answer

CMS Conditions of Participation (42 CFR §482.12) require that the hospital's governing body approve and be responsible for the medical staff bylaws and credentialing policies.

Question 3

An anti-kickback statute violation in the credentialing context could arise if privileges are granted in exchange for:

Accepted Answer

A practitioner referring Medicare patients to the hospital's ancillary services

Answer

Conditioning privilege grants on referral commitments could violate the Anti-Kickback Statute if federal healthcare program patients are involved, as it constitutes remuneration to induce referrals.

Question 4

Which law prohibits employment discrimination based on race, color, religion, sex, or national origin, and applies to credentialing decisions in qualifying healthcare organizations?

Accepted Answer

Title VII of the Civil Rights Act of 1964

Answer

Title VII of the Civil Rights Act of 1964 prohibits employment discrimination based on protected characteristics and applies to credentialing decisions in organizations with 15 or more employees.

Question 5

A credentialing organization that shares peer review information with another hospital during a credentialing inquiry is generally protected from liability under:

Accepted Answer

State peer review confidentiality statutes

Answer

Most states have peer review confidentiality statutes that protect the sharing of quality assurance and credentialing information between healthcare entities from discovery and civil liability.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Regulatory Requirements and Law 4