Cpcs SOLUTION FALL-2023/24 EDITION GUARANTEED GRADE A+

Wherever surgical procedures are scheduled According to CMS guidelines, a roster listing each practitioners specific surgical privileges should be available in which locations? HCQIA Which of the following is an essen ...

Wherever surgical procedures are scheduled According to CMS guidelines, a roster listing each practitioners specific surgical privileges should be available in which locations? HCQIA Which of the following is an essential source when developing a policy regarding the functions of a peer review committee? Release of information According to URAC, the Credentialing application must include which of the following? Medical staff members and non-members holding clinical privileges According to TJC, a fair hearing and appeals process as described in the medical staff by,was is available to which of the followings? DEA License for all states where care is provided According to NCQA, which of the following verifications must be documented for Credentialing. Medical executive committee According to TJC, which of the following is required to review and make recommendations regarding Credentialing applications? Actions on a license According to NCQA, in which situation should a practitioner be notified about a discrepancy and be required to submit additional information? Annually According to NCQA, How often must an organization conduct an audit of the Credentialing process delegated to another organization? At least every 3 years, unless state law provides otherwise Within what time frame must practitioners in an AAAHC accredited organization be re Credentialed? Gastroenterologist Which of the following practitioners would require privileges to perform an Endoscopy? ABMS According to TJC, which of the following resources can be used to verify Board Certification? License According to TJC, which of the following documents is required to be verified at the time if expiration? License & Highest level of education According to URAC, which of the following credentials must be verified using PSV? Federation of chiropractic licensing boards A chiropractor has applied for membership in a preferred provider organization. The chiropractor has a previous sanction against his license. Which source should the Credentialing professional query to obtain additional information regarding the sanction? Senior clinical staff person According to URAC, who should oversee the clerical aspects of the Credentialing program within the organizations? One How many peer references does HFAP require at initial appointments? Medical staff According to CMS, members are appointed to the medical staff after receiving recommendations from which of the following? Negligence Which of the following would be considered a standard of care violation? 5 years claims history According to NCQA, which of the following must be verified in order to grant provisional credentialing? Internet verification from a website not controlled by the primary source that attests to the accuracy & timeliness of the information Which of the following is recognized by NCQA as an incomplete verifications? State licensing board According to NCQA, which of the following sources can be used for verifications of state licensure? Standard release for the organization What type of release should the medical services professional obtain for the release of negative information to another facility? Clinical privileges Each hospital must request for information for the NPDB when a physician applies for which of the following? Evidence of physical ability to perform the requested privileges According to TJC, which of the following must be evaluated when determining a practitioners current competence? 10 According to URAC, within how many days must the practitioner be notified of Credentialing decisions? Anesthesiologists According to NCQA, which of the following providers must be credentialed when working in an independent relationship within the inpatient setting? NTIS Which of the following organizations could a Credentialing professional query to obtain a current copy of a practitioner DEA? Credentialing policies According to NCQA, which of these must an organization have in place in order to enter in a delighted Credentialing agreement? Committee chairperson When preparing for a committee meeting, the medical services professional MOST LIKELY would meet with whom to coordinate the agenda and meeting packet? All privileged practitioners According to TJC, ongoing practice evaluation (OPPE) should be conducted for which of the following individuals? NPDB According to the NCQA, which of the following sources may be used to verify ongoing monitoring of license sanctions? Governing body According to TJC, which of the entities may amend the medical staff bylaws? License sanctions According to NCQA, which of the following requires ongoing monitoring between cycles? Specialty board Which of the following BEST determines which procedures should be performed by which specialty? Medical staff bylaws According to TJC, which of the following dictates the qualification and criteria for appointment to the medical staff? State licensing agency According to the NCQA, which of the following credentials must be utilized to verify licensure? Lifetime board certification According to NCQA, which of the following credentials must be verified at the tie of re credentialing? AMA physician masterfile According to TJC, which of the following is an approved source for verification of a medical degree from a U.S. Educational institution? Hospitals Which of the following are required to query the NPDB? Education & training According to the AAAHC, primary or secondary source verification is required for which of the following? Every 3 years to the month NCQA re credentials how often? Medical director According to NCQA, who can approve a "clean file" immediately? NCQA What accrediting body has a credentials committee and a medical director? 5 years of employment or work experience According to NCQA, and insurance application must contain what? Every 3 years AAAHC re credentials how often? NTIS What is the only authorized distributor of the DEA and controlled substance database on the web called? State licensing agency Verification of licensure must come directly fro where? 180 days Verification time limit for licensure is? 2 years According to TJC standards, initial appointments to the medical staff are not to exceed what time period? NCQA- 180 days/ CVO- 120 days What is the verification time limit for licensure per NCQA CVO standards? The most recent 5 year period According to NCQA standards, on initial application, review of information on sanctions, restrictions on a licensure and limitations on scope of practice must cover what period of time? Governing board In a hospital environment, what body has the ultimate authority for granting privileges? Initial appointment, reappointment and revision or renewal of privileges (every 2 years) According to HCQIA, at what times must e hospital query the NPDB for a physician, dentist or other health care practitioner? MEC What medical staff committee(s) is/are required by TJC hospital standards for the medical staff? CONTINUED..