NaimExplain

According to NCQA standards, which of the following is an approved source for verification of board certification? State licensing agency IF state agency conducts primary verification of board.

According to JC hospital standards, professional criteria for the granting of clinical privileges must include at least? Relevant training or experience, ability to perform privileges requested, current licensure and competance.

Which organization has been recognized by the JC and NCQA to provide PSV of medical school and residency graduation for US graduates? American Medical Association Master File

According to NCQA standards, a copy of which of the following is acceptable cerification of the document? Medical school diploma. NCQA need only verify the highest level of edu credentials which would be residency/internship/fellowship.

According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians? Federation of State Medical Boards

According to JC, Temporary Privileges can be granted by who? The CEO. JC standards allows the CEO or his authorized designee to grant temp privileges on the recommendation of the president of medical staff or authorized designee.

Which credentials must be tracked on an ongoing basis and why? State licensure - because licensure will expire and must be kept current.

According to URAC's health network standards, each applicant must submit an application that includes state licensure information. Must licensure information from all states be included or only those in which the applicant will be providing services to the network's members? The application must include state licensure information, including current licenses and history of licensure in all jurisdictions.

Per NCQA, is there any situation in which it would be acceptable to use confirmation from the state licensing agency in lieu of verification of education, residency training, and board certification? Yes. In order to accept this confirmation from the state licensing agency, the state agency must perform primary source verification of these elements and, at least annually, the organization must obtain written confirmation from the state licensing agency that it performs this primary-source verification.

Name at least three of the four appropriate sources for peer recommendation according to TJC standards. 1. An organization performance improvement committee, the majority of whose members are the applicant's peers. 2. A reference letter, written documentation, or documented telephone conversation about the applicant from a peer who is knowledgeable about the applicant's professional performance and competence. 3. A department or major clinical service chairperson who is a peer. 4. The medical staff executive committee

According to TJC standards, peer recommendation must include written information regarding six elements. Five of these elements are: Current medical/clinical knowledge Technical and clinical skills Clinical Judgment Interpersonal Skills Communication Skills What is the sixth element that must be included in a peer recommendation? Answer: Professionalism

According to NCQA Standards, is verification from the ECFMG acceptable for education and training completed through the AMA's Fifth Pathway Program? No. This must be confirmed through primary source verification from the AMA.

When verifying licensure sanctions for physicians, NCQA allows verification to be done with NPDB, HIPDB, the appropriate state agencies and what other organizations? FSMB - The Federation of State Medical Boards

True or False: According to NCQA standards an organization must verify sanctions or limitations on licensure in each state where the practitioner holds or has ever held licensure. False. The organization must verify sanctions or limitations on licensure in each state where the practitioner provides care for its members.

Can the hospital accept a NPDB self query performed by a physician to satisfy the Joint Commissions requirement for NPDB query? No, the hospital or its designated agent must perform the query.

According to the Joint Commission, the hospital must query the National Practitioner Data Bank at what 3 times? 1. When the clinical privileges are initially granted 2. At the time of renewal of privileges 3. When a new privilege is requested

The Joint Commission requires licensure to be verified with the primary source at what four times? 1. Initial granting 2. Renewal of privileges 3. Revision of privileges 4. At the time of license expiration

According to NCQA, is the ABMS Certified Doctor Verification Program, accessible through the ABMS Web site, an acceptable source for verifying board certification for an MD? NO, this site is intended for consumer reference only and is not considered PSV

What is the correct order HFAP uses to process applications? 1. Receive application and then verify completeness and that all requested materials are included. 2. Process application: Conduct Primary Source Verification and verify current competency for privileges requested. 3. Chief of Service/Department Chair reviews and makes recommendation (if departmentalized) 4. Credentials Committee review and recommendation, if credentials committee exists. 5. Executive Committee reviews and makes recommendation to the Board of Trustees 6. Board Approves 7. Notify applicant of final decision

What is the correct order NCQA uses to process applications? 1. Receive application 2. Verifly completeness and that all requested materials are included 3. Process application: Conduct Primary Source Verification 4. Medical Director reviews and approves or makes recommendation to Credentials Committee, if required by procedure 5. Credentials Committee reviews for information only or to approve 6. Notify applicant of final decision