CPCS Initial Application Processing 2 — Questions and Answers
Question 1: When a provider submits an initial credentialing application, what is the PRIMARY purpose of performing a primary source verification (PSV)?
- To confirm credentials directly with the issuing organization (Correct answer)
- To review the provider's malpractice history only
- To obtain a copy of the provider's curriculum vitae
- To verify the provider's employment references
Correct answer: To confirm credentials directly with the issuing organization
PSV involves contacting the original issuing source to confirm the accuracy and authenticity of credentials reported by the applicant.
Question 2: Which element is typically NOT required on a standard initial credentialing application for a hospital medical staff?
- Current state medical license number
- Social Security Number or Tax ID
- Provider's personal investment portfolio (Correct answer)
- Current DEA registration number
Correct answer: Provider's personal investment portfolio
Personal financial or investment information is not a standard credentialing requirement; licensure, DEA, and identification numbers are standard elements.
Question 3: A provider's application reveals a 6-month gap in work history. What is the credentialing specialist's MOST appropriate next step?
- Automatically deny the application
- Request a written explanation from the provider covering the gap period (Correct answer)
- Ignore the gap if all other credentials are verified
- Forward the file to legal without contacting the provider
Correct answer: Request a written explanation from the provider covering the gap period
Unexplained gaps in work history require the provider to submit a written explanation to allow the credentialing committee to evaluate the circumstances.
Question 4: Under the Health Care Quality Improvement Act (HCQIA), hospitals are required to query which database when making credentialing decisions?
- The Drug Enforcement Administration (DEA) database
- The National Practitioner Data Bank (NPDB) (Correct answer)
- The Office of Inspector General (OIG) exclusion list
- The American Medical Association (AMA) physician finder
Correct answer: The National Practitioner Data Bank (NPDB)
HCQIA mandates that hospitals query the NPDB when a practitioner applies for medical staff membership or clinical privileges.
Question 5: What does 'attestation' mean in the context of a credentialing application?
- A third-party audit of the provider's credentials
- The provider's sworn statement affirming the accuracy of submitted information (Correct answer)
- A peer review committee's written evaluation of the provider
- Verification of malpractice insurance coverage limits
Correct answer: The provider's sworn statement affirming the accuracy of submitted information
Attestation is the provider's signed declaration certifying that all information provided on the application is true and complete.
Question 6: Which of the following would cause a credentialing application to be considered INCOMPLETE?
- A license that expires within 90 days
- Missing signatures on required attestation sections (Correct answer)
- A board certification that was obtained more than 10 years ago
- A malpractice policy with a $1 million per occurrence limit
Correct answer: Missing signatures on required attestation sections
Missing required signatures on attestation sections means the application lacks mandatory elements and cannot be processed until complete.
Question 7: How long does an organization typically have to respond once a provider submits a complete initial credentialing application, per most medical staff bylaws?
- 30 days
- 60 days
- 90 days (Correct answer)
- 180 days
Correct answer: 90 days
Most medical staff bylaws specify a 90-day timeframe for the organization to complete the credentialing process after receipt of a complete application.
CPCS Initial Application Processing 2
When a provider submits an initial credentialing application, what is the PRIMARY purpose of performing a primary source verification (PSV)?