Quiz Time! Test Your Credentialing & Enrollment Knowledge Blog Feature

By: Maureen Clarke on December 22nd, 2020

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Quiz Time! Test Your Credentialing & Enrollment Knowledge

Provider Credentialing | Provider Management | Payer enrollment management

Calling all provider data management professionals! Take our quiz to test your industry knowledge, perhaps learn something new, and have fun in the process.

See answers and score key at bottom.

1. A credentialing verification organization’s (CVO’s) primary function is to:
  1. monitor monthly sanctions files for its clients.
  2. primary source verify providers’ professional licenses.
  3. perform credentialing activities outlined in an agreement.
  4. review provider applications for completeness.

2. An official publication of The Joint Commission is:

  1. Synergy
  2. Perspectives
  3. The Sentinel
  4. The Sentry
3. Onboarding in provider management can best be described as:
  1. enrolling newly employed providers with payers.
  2. recruiting and hiring any new provider.
  3. orienting and integrating any new provider.
  4. contracting with any new physician.

4. What temporary change related to telemedicine reimbursement did the Centers for Medicare & Medicaid Services (CMS) make during the pandemic, helping to boost the use of telemedicine, and thus access to care?

  1. Patients can be in their home or in any other setting to receive telehealth services.
  2. Patients do not need to have an existing relationship with the practitioner who is providing telehealth assistance.
  3. Both of the above are true.
  4. None of the above is true.

5. One reason payers consider delegating some or all credentialing functions is to:

  1. get timelier payment of claims.
  2. gain contracting leverage.
  3. increase the number of specialists on panels.
  4. reduce the resources needed to perform credentialing.

6. According to the standards of the National Committee for Quality Assurance (NCQA), a payer cannot also be a provider.

     True
     False
7. A strategy for maintaining compliance in managing non-physician providers’ data is:
  1. Eliminate paper and use a web-based recruiting and credentialing module.
  2. Align providers’ job descriptions with state laws governing their scopes of practice.
  3. Stay informed of fast-changing licensure laws for non-physicians.
  4. All of the above are true.

8. Medical services professionals are increasingly experiencing the addition of which new responsibility, according to the National Association Medical Staff Services (NAMSS):

  1. Privileging oversight
  2. Provider enrollment
  3. Ongoing provider performance monitoring
  4. None of the above

9. For the duration of the COVID-19 public health emergency, CMS stated that it was waiving the requirement that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician.

     True
     False

10. Medical staffs report feeling a heavier burden in credentialing locum tenens (i.e., temporary) providers. One reason is:

  1. The average number of assignments that  individual locums accept has risen, making the work of primary source verification (PSV) harder.
  2. More hospitals are refusing to accept locum clinicians, placing a heavier burden on those that do.
  3. Quality control over locums providers has decreased nationwide.
  4. Medical services professionals cite credentialing locums as a primary cause of burnout.

11. A major differentiator between the accreditation requirements for healthcare provider organizations and healthcare payer entities regarding credentialing is:

  1. decision making.
  2. application format.
  3. internal policies and procedures.
  4. verification of licensure process.

12. All of the following statements about negligent credentialing are true, except:

  1. There is no accurate number of cases filed in the U.S.
  2. The Department of Health & Human Services tracks the number of lawsuits. 
  3. Darling v. Charleston Community Hospital was a landmark legal case in negligent credentialing. 
  4. Most hospitals settle the cases.

13. According to CMS, The Joint Commission, and NCQA, the following terms are interchangeable: temporary privileging, emergency privileging, and disaster privileging:

     True
     False

14. Which is not a credentialing red flag when conducting professional reference checks?

  1. References who take a long time to respond
  2. References from all retired practitioners or from non-recent positions
  3. Provision of references who give very brief, vague, or indirect responses
  4. Information from the applicant doesn't match with data from references or data gathered by the credentialing professional

15. When considering the purchase of an end-to-end credentialing and enrollment software platform today, a critical area of focus when comparing options is:

  1. the ability to enable applicants to self-serve.
  2. software as a service capability.
  3. scalability for long-term plans.
  4. All of the above are true.

BONUS: 

In October 2020, CMS approved the merger of which two accreditation bodies? (Hint: One of the organizations involved is the oldest CMS-approved hospital accreditation program in the nation.):
  1. Healthcare Facilities Accreditation Program (HFAP) & the Accreditation Commission for Health Care (ACHC)
  2. Utilization Review Accreditation Commission (URAC) & Accreditation Commission for Health Care  (ACHC)
  3. Healthcare Facilities Accreditation Program (HFAP) & National Committee for Quality Assurance (NCQA)
  4. None of the above

SCORE KEY

0-4 CORRECT ANSWERS: Keep studying and reading our blog. You’ll get there!

5-8 CORRECT ANSWERS: You’re well on your way to being a pro.

9-12 CORRECT ANSWERS: You’re exceptionally well rounded in credentialing, privileging, and enrollment.

13+ CORRECT ANSWERS: You’re a pro. Ever consider being a mentor?

ANSWERS

1. A credentialing verification organization’s (CVO’s) primary function is to:

C. perform credentialing activities outlined in an agreement.

2. An official publication of The Joint Commission is:

B. Perspectives

3. Onboarding in provider management can best be described as:

C. orienting and integrating any new provider.

4. What temporary change related to telemedicine reimbursement did the Centers for Medicare & Medicaid Services (CMS) make during the pandemic, helping to boost the use of telemedicine, and thus access to care?

C. Both of the above are true.

5. One reason payers consider delegating some or all credentialing functions is to:

D. reduce the resources needed to perform credentialing.

6. According to the standards of the National Committee for Quality Assurance (NCQA), a payer cannot also be a provider.

False

7. A strategy for maintaining compliance in managing non-physician providers’ data is:

D. All of the above are true.

8. Medical services professionals are increasingly experiencing the addition of which new responsibility, according to the National Association Medical Staff Services (NAMSS):

B. Provider enrollment

9. For the duration of the COVID-19 public health emergency, CMS stated that it was waiving the requirement that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician.

True

10. Medical staffs report feeling a heavier burden in credentialing locum tenens (i.e., temporary) providers. One reason is:

A. The average number of assignments that  individual locums accept has risen, making the work of primary source verification (PSV) harder.

11. A major differentiator between the accreditation requirements for healthcare provider organizations and healthcare payer entities regarding credentialing is:

A. decision making.

12. All of the following statements about negligent credentialing are true, except:

B. The Department of Health & Human Services tracks the number of lawsuits.*  

13. According to CMS, The Joint Commission, and NCQA, the following terms are interchangeable: temporary privileging, emergency privileging, and disaster privileging:

False

14. Which is not a credentialing red flag when conducting professional reference checks?

A. References who take a long time to respond

15. When considering the purchase of an end-to-end credentialing and enrollment software platform today, a critical area of focus when comparing options is:

D. All of the above are true.

BONUS: 

In October 2020, CMS approved the merger of which two accreditation bodies? (Hint: One of the organizations involved is the oldest CMS-approved hospital accreditation program in the nation.):

A. Healthcare Facilities Accreditation Program (HFAP) & the Accreditation Commission for Health Care (ACHC)

SOURCES

American Medical Association, “Medical Staff Leaders and Professionals: Protect Your Organization From Negligent Credentialing Legal Action,” webinar presented by Carol Cairns, CPCS, CPMSM.  October 4, 2019. 

Becker’s Hospital Review, “How hospital and physician leaders can prevent negligent credentialing lawsuits,” by Morgan Haefner. October 10th, 2019.

Centers for Medicare & Medicaid Services (COVID-19 Resources)

Centers for Medicare & Medicaid Services Conditions of Participation

Healthcare Facilities Accreditation Program Standards

NAMSS, “Achieving the Credentialing Trifecta: Real Results in Alignment Between Credentialing, Provider Enrollment and Delegation;” 2016; NAMSS Presenter: Amy Niehaus, MBA, CPMSM, CPCS

National Committee for Quality Assurance Standards (login required)

symplr Blog

symplr CVO

symplr, eBook: How to Manage Expedited Privileges during Disasters & Emergencies

Joint Commission Resources 


U.S. Department of Health & Human Services (HIPAA and Public Health Emergencies)

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