Peer Review & Performance Improvement Flashcards
7 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Peer Review & Performance Improvement flashcards as text
Which federal law provides immunity protections to peer review participants in healthcare organizations?
Answer: The Health Care Quality Improvement Act (HCQIA)
HCQIA provides qualified immunity to peer review participants who act in good faith when reviewing physician performance.
A credentialing specialist discovers that a physician's peer review files contain patient-identifiable information. What is the most appropriate action?
Answer: Remove patient identifiers to protect confidentiality per HIPAA
Patient-identifiable information in peer review files must be de-identified to comply with HIPAA privacy requirements.
In a focused professional practice evaluation (FPPE), what triggers the review process?
Answer: A new privilege request or a specific concern about a practitioner
FPPE is initiated for new privileges or when a specific concern arises about a practitioner's competence or conduct.
What is the primary purpose of the National Practitioner Data Bank (NPDB) in the peer review process?
Answer: To flag practitioners with adverse actions for credentialing bodies
The NPDB collects and reports adverse actions and malpractice payments, helping organizations identify practitioners with a history of performance issues.
Which performance improvement model uses Define, Measure, Analyze, Improve, and Control phases?
Answer: Six Sigma DMAIC
Six Sigma's DMAIC framework is a data-driven methodology for eliminating defects and improving processes.
When a peer review committee recommends suspension of privileges, what due process right must the practitioner be afforded?
Answer: The right to a hearing before the medical staff
HCQIA and medical staff bylaws require that practitioners facing adverse privilege actions receive a fair hearing opportunity.
A hospital's quality dashboard shows a surgeon's complication rate is two standard deviations above the mean. What is the most appropriate next step?
Answer: Initiate a focused professional practice evaluation (FPPE)
An outlier statistical finding warrants a structured FPPE to determine whether the deviation reflects a true performance concern.