Credentialing
Per NCQA, this must be verified in each state where the practitioner provides care to its members
What is a DEA or CDS? Drug Enforcement Agency Certificate (federal) or Controlled Dangerous Substances Certificate (state) Not all states have a CDS
The timeframe for review of OPPE data collection cannot exceed what time period
What is "cannot exceed every 12 months"?
CME is considered part of demonstrated competencies for this accrediting body as well as evidence of CME every 2 years, which may be requested.
What is ACHC?
This theory replaced the Charitable Immunity Doctrine
What is Respondeat Superior “Let the Master Answer”?
Negligent credentialing case where hospital failed to obtain malpractice claims data for Podiatrist and medical records department was aware of claims.
What is Elam v. College Park Hospital?
Here you may find ALL actions against a physician's medical license
What is Federation of State Medical Boards (FSMB)?
Specialty performing a salpingectomy
What is a Gynecologist or Obstetrician-Gynecologist?
This accrediting body does not require peer references at reappointment
What is DNV?
The National Practitioner Data Bank (NPDB) was established by this act
What is the Health Care Quality Improvement Act of 1986 (HCQIA)?
Disruptive behavior case where personality may be considered if affects the ability to practice or hospital operations.
What is Rao v. Auburn General Hospital?
According to NCQA standards, on initial application, review of information on sanctions, restrictions on licensure, and limitations on scope of practice must cover what time period?
What is the most recent five-year period?
During a disaster, privileges may be granted to licensed practitioners when this has been activated
What is the Emergency Operations Plan (EOP)?
This accrediting body may grant one-time provisional privileges for no more than 60 days
What is NCQA?
Substantial and Procedural are elements of what process
What is Due Process?
What is Patrick v. Burget?
URAC requires attestations to be signed/dated no more than what time prior to Cred Comm review
What is 180 Days?
Information from this evaluation is used in the decision to maintain, revise or revoke existing privileges prior to or at time of renewal.
What is Ongoing Professional Practice Evaluation (OPPE)?
Upon initial application, this accrediting body requires a criminal history for 7 to 10 years
What is ACHC?
This law prohibits physicians from referring patients where they may hold a financial relationship
What is Stark Law?
*BONUS FOR $1,000
Case related to Ophthalmologist failing to disclose all prior hospital affiliations on application resulting in Hospital summarily suspending privileges.
What is Oskooi v. Fountain Valley Regional Hospital and Health Center?
Per NCQA, credential decisions much be communicated within this period of time
What is 60 calendar days?
This is provided when medical staff privileges are revoked
What is Due Process?
NCQA must only verify the highest level of credentials attained through this source
What is board certification? Fellowship verification does NOT meet this requirement
Provides regional services on behalf of Medicare, including processing of claims, enrolling providers and other activities
What is a MAC (Medical Administrative Contractor)?
Case involving reference letters that were false and patently misleading, leading to liabilty on the part of facility that provided the letters.
Who is Kadlec v. Lakeview Anesthesia Associates and Lakeview Medical Center?