CPCS Cheat Sheet 2026

The 30 highest-yield CPCS facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Which accreditation body uses the term 'deemed status' to allow its accredited hospitals to meet Medicare Conditions of Participation? → The Joint Commission
2. What is 'tail coverage' in the context of malpractice insurance? → An endorsement that extends claims-made coverage after a policy ends
3. What does 'primary source verification' mean in credentialing? → Confirming credentials directly with the original issuing organization
4. Which of the following is an example of secondary source verification in the credentialing process? → Using a credentials verification organization (CVO) to confirm licensure
5. In a health plan's credentialing delegation arrangement, which party retains ultimate responsibility for compliance with NCQA credentialing standards? → The delegating health plan
6. Under FPPE, how long is a focused evaluation period typically conducted for a newly privileged provider? → For a minimum of six months or a defined case volume
7. Which credentialing process allows a provider to begin seeing patients before the full credentialing review is complete? → Provisional credentialing
8. Which of the following organizations administers the ABMS Continuing Certification (formerly Maintenance of Certification) program? → ABMS and its member specialty boards
9. Requires the greatest level of education and training among the three offered by HP/CVO. → Verification of Medical Education in Compliance with NCQA Guidelines
10. Under URAC credentialing standards, what is the maximum acceptable time frame for completing a credentialing decision once an application is deemed complete? → 90 days
11. When adverse privilege action is taken against a practitioner, what due process right must hospitals guarantee under HCQIA to receive immunity protections? → The practitioner must be given notice of the action and an opportunity for a hearing
12. Which document formally delegates credentialing authority from a hospital's governing board to the medical staff? → Bylaws
13. An organization fails to complete recredentialing before a provider's two-year credentialing period expires. What is the accreditation-compliant action? → Suspend or restrict the provider's privileges until recredentialing is complete
14. A credentialing specialist discovers that a provider's work history contains a gap of 18 months with no explanation. What is the most appropriate action? → Request a written explanation from the provider for the gap period
15. Which element is NOT typically verified during the initial credentialing process? → Personal credit score
16. A hospital's medical staff bylaws conflict with a newly adopted accreditation standard. Which action should the credentialing specialist recommend first? → Amend the bylaws through the medical staff governance process
17. A hospital grants temporary privileges to a provider pending completion of primary source verification. Which standard governs this practice? → CMS Conditions of Participation
18. Which accrediting body specifically governs credentialing standards for managed care organizations and health plans? → National Committee for Quality Assurance (NCQA)
19. Which accreditation body requires a 'deemed status' survey that satisfies Medicare Conditions of Participation? → TJC and DNV GL Healthcare
20. A credentialing manager is designing an audit tool to evaluate file completeness. Which element is most critical to include for ongoing monitoring compliance? → Expiration dates of all time-limited credentials
21. Which of the following best describes 'attestation' in the credentialing process? → A provider's sworn statement confirming the accuracy of their application
22. Under NCQA standards, which practitioners must be credentialed by a health plan? → All licensed independent practitioners who provide services to plan members
23. What does OPPE stand for in the context of credentialing and performance review? → Ongoing Professional Practice Evaluation
24. A physician requests temporary privileges due to an emergency need. Which condition typically must be met for approval? → Evidence of current licensure and a pending complete application
25. Which of the following is typically included in a hospital reappointment review that is NOT required for initial appointment? → Review of OPPE data and peer review findings from the current appointment period
26. Which scenario would most likely trigger an 'ongoing professional practice evaluation' (OPPE)? → A routine review of practitioner performance data over time
27. Which scenario MOST likely triggers a mandatory NPDB query outside of the standard reappointment cycle? → A provider requests additional privileges
28. Under The Joint Commission standards, which committee typically has final authority over clinical privileging decisions? → The Governing Board
29. Which credentialing concept describes granting temporary privileges to a practitioner during a disaster or emergency situation? → Emergency privileges
30. A practitioner reports a malpractice settlement that was not disclosed on the initial application. Which step is most appropriate? → Conduct a focused review of the omission and apply established policy