CPCS MCQ 2 — Questions and Answers
Question 1: Under NCQA standards, how long may a credentialing file remain active before re-credentialing is required?
- 12 months
- 24 months
- 36 months (Correct answer)
- 48 months
Correct answer: 36 months
NCQA requires re-credentialing of practitioners at least every 36 months.
Question 2: Which federal act established the National Practitioner Data Bank (NPDB)?
- HIPAA
- Health Care Quality Improvement Act of 1986 (Correct answer)
- Affordable Care Act
- Balanced Budget Act of 1997
Correct answer: Health Care Quality Improvement Act of 1986
The Health Care Quality Improvement Act of 1986 created the NPDB to track adverse actions against practitioners.
Question 3: A provider's DEA registration is expiring in 45 days. What action should a credentialing specialist take first?
- Immediately suspend the provider's privileges
- Notify the provider and initiate a renewal reminder (Correct answer)
- Remove the provider from the panel
- File a report with the state medical board
Correct answer: Notify the provider and initiate a renewal reminder
Proactively notifying the provider and initiating a renewal reminder ensures continuous compliance before expiration.
Question 4: Which of the following best describes 'primary source verification' in credentialing?
- Reviewing a copy of a diploma submitted by the applicant
- Confirming credentials directly with the issuing organization (Correct answer)
- Accepting a sworn affidavit from the provider
- Using a third-party database without contacting the source
Correct answer: Confirming credentials directly with the issuing organization
Primary source verification requires confirming credentials directly with the original issuing organization.
Question 5: Which organization publishes the Credentials Verification Organization (CVO) certification program?
- URAC
- The Joint Commission
- NAMSS
- NCQA (Correct answer)
Correct answer: NCQA
NCQA certifies CVOs through its CVO Certification program to standardize credentialing verification.
Question 6: A practitioner reports a malpractice settlement that was not disclosed on the initial application. Which step is most appropriate?
- Automatically deny privileges
- Conduct a focused review of the omission and apply established policy (Correct answer)
- Refer the matter directly to law enforcement
- Ignore it if the settlement was less than $50,000
Correct answer: Conduct a focused review of the omission and apply established policy
A focused review of the undisclosed settlement and application of established policy ensures fair and consistent handling.
Question 7: Under the Americans with Disabilities Act (ADA), a healthcare organization's credentialing process must:
- Exclude providers with any mental health history
- Not discriminate against qualified providers based on disability (Correct answer)
- Require additional psychological evaluations for all applicants
- Deny privileges to providers using prescription medications
Correct answer: Not discriminate against qualified providers based on disability
The ADA prohibits discrimination against qualified individuals with disabilities, including during credentialing.
CPCS MCQ 2
Under NCQA standards, how long may a credentialing file remain active before re-credentialing is required?