Certified Provider Credentialing Specialist (CPCS) Practice Exam 2025 – Your All-in-One Guide to Exam Success!

The Health Care Quality Improvement Act (HCQIA) is designed to provide a framework for peer review in the healthcare sector and offers legal protections to certain healthcare professionals involved in this process. The HCQIA specifically applies to physicians and dentists, as these professionals are included in the statute’s definition of healthcare providers.

This is critical because peer reviews are conducted to ensure that medical professionals maintain high standards of care and can protect against medical malpractice. The legal protections under HCQIA encourage healthcare professionals to participate in peer review activities with the assurance that they will not be subject to retaliation or lawsuits for sharing information in good faith about their peers' performance, which helps to enhance the overall quality of health care services.

The other listed professions, such as pharmacists, surgeons, chiropractors, psychologists, and social workers, do have their own structures for peer reviews or quality assessments, but they are not afforded the same specific protections under the HCQIA as physicians and dentists. As a result, it is the physicians and dentists who are primarily recognized under the HCQIA framework for peer review protections.