Ongoing Monitoring and Audits 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 Ongoing Monitoring and Audits flashcards as text
During an internal credentialing audit, reviewers find that 15% of provider files lack current immunization records as required by policy. What type of finding is this?
Answer: A compliance gap requiring a corrective action plan
A systemic gap identified in an audit requires a corrective action plan to remediate the deficiency and prevent recurrence.
A credentialing manager is designing an audit tool to evaluate file completeness. Which element is most critical to include for ongoing monitoring compliance?
Answer: Expiration dates of all time-limited credentials
Tracking expiration dates of licenses, certifications, and insurance policies is essential to proactive ongoing monitoring.
Which accreditation standard specifically requires hospitals to have a process for ongoing monitoring of licensed independent practitioners' competency?
Answer: The Joint Commission MS.08.01.01
TJC standard MS.08.01.01 addresses OPPE and requires a defined process for ongoing review of practitioner performance.
A peer review committee flags a surgeon for an unusually high complication rate. Under OPPE requirements, what should happen next?
Answer: Initiation of FPPE to evaluate the specific concerns in a structured manner
OPPE data triggering concern leads to FPPE, a time-limited focused evaluation designed to assess the specific performance issue.
How does ongoing monitoring of provider sanctions differ from the initial credentialing verification process?
Answer: Ongoing monitoring occurs continuously between credentialing cycles; initial credentialing is a one-time review
Ongoing monitoring is a continuous process that occurs between formal recredentialing cycles, while initial credentialing is a discrete one-time review of a new applicant.
An organization subscribes to an automated exclusion screening service that checks the OIG LEIE daily. A match is returned for a nurse practitioner. What is the FIRST step?
Answer: Verify the match is the correct individual before taking action
False positives occur due to common names, so the identity must be confirmed before any adverse action is taken.
What is the recommended best practice for documenting the results of ongoing monitoring activities in a provider's credentials file?
Answer: Maintain a running log with dates, sources checked, and outcomes for all monitoring activities
A comprehensive, date-stamped audit trail of all monitoring activities demonstrates due diligence and supports accreditation surveys.