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Questions and Answers
What is a potential consequence of failing to submit medical documentation in a timely manner during a JCAHO survey?
What is a potential consequence of failing to submit medical documentation in a timely manner during a JCAHO survey?
Which organization is primarily responsible for setting standards and procedures for hospital accreditation?
Which organization is primarily responsible for setting standards and procedures for hospital accreditation?
What certification must an employee obtain if approached by hospital administration for continued employment in certain positions?
What certification must an employee obtain if approached by hospital administration for continued employment in certain positions?
What is a direct factor that could lead to revocation of a physician's privileges at a hospital?
What is a direct factor that could lead to revocation of a physician's privileges at a hospital?
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How might a hospital's decision about an employee's role be influenced?
How might a hospital's decision about an employee's role be influenced?
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What happens if a surgeon fails to meet the required level of malpractice insurance?
What happens if a surgeon fails to meet the required level of malpractice insurance?
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Which of the following is NOT a factor considered in evaluating the risk to patients?
Which of the following is NOT a factor considered in evaluating the risk to patients?
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What does the abbreviation CPMSM stand for?
What does the abbreviation CPMSM stand for?
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What is the primary purpose of medical credentialing in hospitals?
What is the primary purpose of medical credentialing in hospitals?
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Which factor does NOT influence the size of the medical credentialing team in a hospital?
Which factor does NOT influence the size of the medical credentialing team in a hospital?
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What is the typical duration for the medical credentialing process?
What is the typical duration for the medical credentialing process?
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Which of the following is NOT included in the application for medical credentialing?
Which of the following is NOT included in the application for medical credentialing?
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What happens to privileges granted through medical credentialing after one year?
What happens to privileges granted through medical credentialing after one year?
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Which of the following may be a requirement from hospitals regarding malpractice insurance during the credentialing process?
Which of the following may be a requirement from hospitals regarding malpractice insurance during the credentialing process?
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How is the decision to grant privileges to a physician made?
How is the decision to grant privileges to a physician made?
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What does it mean if credentials are granted by one medical city but not others?
What does it mean if credentials are granted by one medical city but not others?
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Medical credentialing is a process that verifies a healthcare professional's qualifications, training, and experience.
Medical credentialing is a process that verifies a healthcare professional's qualifications, training, and experience.
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The medical credentialing team size is not influenced by the size of the hospital.
The medical credentialing team size is not influenced by the size of the hospital.
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Malpractice insurance is not relevant in the application process for medical credentialing.
Malpractice insurance is not relevant in the application process for medical credentialing.
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All medical credentialing decisions are made uniformly across all hospitals.
All medical credentialing decisions are made uniformly across all hospitals.
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The medical credentialing process can take between 90 to 150 days.
The medical credentialing process can take between 90 to 150 days.
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There is a fee required to apply for medical credentialing.
There is a fee required to apply for medical credentialing.
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Privileges granted through medical credentialing are valid indefinitely unless revoked.
Privileges granted through medical credentialing are valid indefinitely unless revoked.
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A healthcare professional must possess ownership of surgical equipment to perform surgeries in a hospital.
A healthcare professional must possess ownership of surgical equipment to perform surgeries in a hospital.
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The hospital has no influence on the level of malpractice insurance required for healthcare professionals.
The hospital has no influence on the level of malpractice insurance required for healthcare professionals.
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If a physician's licensure is revoked, the licensure board will inform the hospital about it.
If a physician's licensure is revoked, the licensure board will inform the hospital about it.
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JCAHO is responsible for developing standards that are applicable only to a specific type of hospital.
JCAHO is responsible for developing standards that are applicable only to a specific type of hospital.
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Continuous staff relationships and proper documentation submission are essential to avoid issues during JCAHO surveys.
Continuous staff relationships and proper documentation submission are essential to avoid issues during JCAHO surveys.
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Healthcare professionals in hospitals are not required to meet specific certification standards for continued employment.
Healthcare professionals in hospitals are not required to meet specific certification standards for continued employment.
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Surgeons are required to submit medical documentation promptly; otherwise, they may face consequences during JCAHO surveys.
Surgeons are required to submit medical documentation promptly; otherwise, they may face consequences during JCAHO surveys.
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All hospitals have identical requirements for malpractice insurance due to uniform regulations.
All hospitals have identical requirements for malpractice insurance due to uniform regulations.
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Passing the exam for CPMSM certification enhances professional opportunities within healthcare organizations.
Passing the exam for CPMSM certification enhances professional opportunities within healthcare organizations.
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Which factor is primarily influenced by the standards set by JCAHO and National Committee for Quality Assurance?
Which factor is primarily influenced by the standards set by JCAHO and National Committee for Quality Assurance?
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What is the potential reason for a physician's privileges being revoked?
What is the potential reason for a physician's privileges being revoked?
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What is a critical factor that hospitals consider regarding their employee's certifications?
What is a critical factor that hospitals consider regarding their employee's certifications?
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What is one of the primary roles of the Certified Professional in Medical Staff Management (CPMSM)?
What is one of the primary roles of the Certified Professional in Medical Staff Management (CPMSM)?
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Which situation may prompt the licensure board to inform the hospital about a physician?
Which situation may prompt the licensure board to inform the hospital about a physician?
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Which aspect is critical for maintaining privileges within a hospital setting?
Which aspect is critical for maintaining privileges within a hospital setting?
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How do slightly varying hospital practices relate to JCAHO regulations?
How do slightly varying hospital practices relate to JCAHO regulations?
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Which action could lead to the introduction of a risk factor during the JCAHO survey?
Which action could lead to the introduction of a risk factor during the JCAHO survey?
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What is a common reason hospitals may request an increase in malpractice insurance from a provider?
What is a common reason hospitals may request an increase in malpractice insurance from a provider?
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How often must privileges granted through the medical credentialing process be renewed?
How often must privileges granted through the medical credentialing process be renewed?
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What role does the administrator play in the medical credentialing process?
What role does the administrator play in the medical credentialing process?
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Which of the following factors can vary significantly between different hospitals regarding the credentialing process?
Which of the following factors can vary significantly between different hospitals regarding the credentialing process?
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What component is typically included in a medical credentialing application?
What component is typically included in a medical credentialing application?
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In which type of institution is a medical credentialing department primarily found?
In which type of institution is a medical credentialing department primarily found?
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What is a potential duration for the entire medical credentialing process?
What is a potential duration for the entire medical credentialing process?
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Which statement accurately reflects the nature of the medical credentialing process across different hospitals?
Which statement accurately reflects the nature of the medical credentialing process across different hospitals?
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Study Notes
Medical Credentialing Process
- Medical credentialing verifies healthcare professionals' qualifications, training, and experience.
- Every hospital has a medical credentialing department.
- Team size varies based on hospital size (bigger team = bigger hospital).
- Credentialing is required for all surgeons to perform surgery in a hospital.
- They do not own the equipment and supplies.
- It is also necessary to obtain hospital privileges in specific areas like surgery and OB/GYN.
- Applications include educational background, references, licensure numbers (DEA #), malpractice insurance, and disciplinary actions.
- Submitted applications are reviewed by medical credentialing staff and hospital administrators.
- Application process typically takes 90-150 days.
- Hospitals grant privileges on a case-by-case basis, considering risk assessment. Hospital policy and standards guide decisions.
- Privileges are often granted for one year.
- Forms related to granted privileges include guidelines, regulations, and orientation.
- Hospitals can require higher malpractice insurance coverage to match privilege scope, or due to policy changes.
- Hospitals set malpractice insurance levels, not the providers.
Staff Requirements
- Medical credentialing staff requires a healthcare background.
- Staff perform verification and decision-making regarding privileges.
- Staff may be approached by hospital administration about continuing employment and certification requirements.
Career Advancement
- Certified Professional in Medical Staff Management (CPMSM) is a certification for career advancement.
- CPMSM certification is visible on a business card for the holder.
- This certification can lead to director roles.
Regulatory Standards
- JCAHO and the National Committee for Quality Assurance (NCQA) set standards impacting credentialing applications.
- Hospitals are regulated by JCAHO, somewhat minimizing differences between hospitals.
Privilege Revocation
- Privileges can be revoked.
- Revocation reasons include licensure revocation, arrest, failure to maintain malpractice insurance, or late submission of medical documentation.
- The review considers risks to patients (e.g., provider-staff relations, instrument theft, post-surgery patient monitoring, missing documentation).
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Description
This quiz covers the essential aspects of the medical credentialing process, including verification of qualifications, the application process, and the importance of hospital privileges for healthcare professionals. Learn how credentialing impacts surgeons and their ability to perform surgeries in hospitals.
