Accreditation Standards and Compliance 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 Accreditation Standards and Compliance flashcards as text
A provider's license was revoked in one state but they hold an active license in another state. What is the accreditation-required response when this is discovered during primary source verification?
Answer: Report the finding to the credentials committee for review and decision
A license revocation in any state is a red flag that must be reviewed by the credentials committee before a credentialing decision is made.
Which federal database must be queried during the credentialing process to check for Medicare and Medicaid exclusions?
Answer: OIG List of Excluded Individuals and Entities (LEIE)
The OIG LEIE must be queried to identify providers excluded from participation in federal healthcare programs like Medicare and Medicaid.
Which accreditation body uses the term 'deemed status' to allow its accredited hospitals to meet Medicare Conditions of Participation?
Answer: The Joint Commission
The Joint Commission holds CMS-granted deemed status, meaning TJC-accredited hospitals are considered to have met Medicare Conditions of Participation.
An organization fails to complete recredentialing before a provider's two-year credentialing period expires. What is the accreditation-compliant action?
Answer: Suspend or restrict the provider's privileges until recredentialing is complete
Accreditation standards require that providers whose credentials have lapsed not be permitted to practice until recredentialing is successfully completed.
What is the primary purpose of the Focused Professional Practice Evaluation (FPPE) required by TJC?
Answer: To assess a practitioner's competence when granting new or initial privileges
FPPE is a time-limited, focused review triggered by initial privilege granting or a specific concern about a practitioner's performance.
When a credentialing application is incomplete, accreditation standards require the organization to:
Answer: Notify the applicant in writing of the missing information within a specified time frame
Standards require timely written notification to the applicant identifying specific missing elements so the application can be completed.
Which accreditation standard specifically addresses the requirement for a health plan to credential individual practitioners rather than credentialing only at the facility level?
Answer: NCQA HP Standards
NCQA Health Plan (HP) standards require health plans to individually credential practitioners in their network, not just rely on facility-level credentialing.