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

Routine reappointment every two years

Answer

A new primary source verification request

Answer

Submission of a new credentialing application

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 Board of Trustees

Answer

The Quality Assurance Department

Answer

The Human Resources Department

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

14 days

Answer

60 days

Answer

90 days

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

To automatically suspend a practitioner's privileges pending investigation

Answer

To replace the peer review process for low-risk practitioners

Answer

To satisfy primary source verification requirements for new applicants

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

HIPAA Privacy Rule

Answer

The Health Care Quality Improvement Act (HCQIA)

Answer

Due process protections under the 14th Amendment

Question 6

In performance improvement, what does a 'benchmark' refer to?

Accepted Answer

A performance standard based on best practices or comparison data used to evaluate practitioner or organizational performance

Answer

The minimum passing score on a credentialing exam

Answer

A type of primary source verification document

Answer

A formal report submitted to the NPDB