CPCS CPCS - Certified Provider Credentialing Specialist Peer Review and Performance Improvement Questions and Answers 2

Question 1

What triggers a Focused Professional Practice Evaluation (FPPE) for a currently privileged practitioner?

Accepted Answer

A specific concern about the practitioner's competence or a pattern of adverse outcomes

Answer

FPPE for existing practitioners is triggered by a specific concern, complaint, or identified pattern of adverse outcomes requiring closer scrutiny.

Question 2

Which committee typically has primary responsibility for reviewing peer review findings and recommending privilege actions?

Accepted Answer

The Credentials Committee or Medical Executive Committee

Answer

The Credentials Committee or Medical Executive Committee reviews peer review outcomes and recommends privilege actions to the governing body.

Question 3

Under NPDB reporting requirements, a hospital must report to the National Practitioner Data Bank when clinical privileges are reduced, suspended, or revoked for a period exceeding how many days?

Accepted Answer

30 days

Answer

Hospitals must report to the NPDB any adverse clinical privilege action taken for a period longer than 30 days due to professional review activity.

Question 4

What is the purpose of a performance improvement (PI) plan in the credentialing context?

Accepted Answer

To provide a structured corrective pathway for a practitioner with identified performance deficiencies before privilege action is taken

Answer

A PI plan offers practitioners a structured, time-limited opportunity to correct identified deficiencies, often as an alternative to immediate adverse privilege action.

Question 5

Which principle ensures that peer review proceedings are protected from discovery in most U.S. states?

Accepted Answer

Peer review privilege (peer review protection statutes)

Answer

Most states have peer review privilege statutes that protect peer review deliberations and records from being used as evidence in civil litigation.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS CPCS - Certified Provider Credentialing Specialist Peer Review and Performance Improvement Questions and Answers 2