CPCS Primary Source Verification 2 — Questions and Answers
Question 1: Which organization is considered the primary source for verifying a physician's board certification status?
- The American Medical Association
- The American Board of Medical Specialties (ABMS) (Correct answer)
- The state medical board
- The National Practitioner Data Bank
Correct answer: The American Board of Medical Specialties (ABMS)
ABMS member boards are primary sources for verifying board certification because they directly issue and maintain certification records.
Question 2: When performing primary source verification for a foreign medical graduate's education, which resource is most appropriate?
- The Educational Commission for Foreign Medical Graduates (ECFMG) (Correct answer)
- The American Medical Association
- The World Health Organization
- The Joint Commission
Correct answer: The Educational Commission for Foreign Medical Graduates (ECFMG)
ECFMG verifies the credentials of international medical graduates who want to practice in the United States.
Question 3: A credential file shows a provider's DEA registration expired 30 days ago. What is the FIRST action a credentialing specialist should take?
- Immediately suspend the provider's privileges
- Contact the DEA directly to verify current status
- Notify the medical staff office and request updated documentation (Correct answer)
- Flag the file and wait for the provider to submit renewal
Correct answer: Notify the medical staff office and request updated documentation
The first action is to notify the appropriate parties and request current documentation so the issue can be resolved promptly.
Question 4: Which of the following best describes 'attestation' in the credentialing process?
- A third-party confirmation of a credential's authenticity
- A provider's sworn statement confirming the accuracy of their application (Correct answer)
- A hospital's formal acceptance of a provider's privileges
- A primary source document mailed directly to the organization
Correct answer: A provider's sworn statement confirming the accuracy of their application
Attestation is when the applicant personally affirms the truthfulness and completeness of information provided on their application.
Question 5: Under NCQA standards, how frequently must primary source verification be repeated for re-credentialing?
- Annually
- Every two years
- Every three years (Correct answer)
- Every five years
Correct answer: Every three years
NCQA requires re-credentialing, including primary source verification, at least every three years.
Question 6: A provider's malpractice insurance certificate lists a coverage amount below the organization's minimum requirement. What should the credentialing specialist do?
- Approve the application and note the discrepancy
- Contact the malpractice carrier directly to verify coverage and amount (Correct answer)
- Deny the application without further review
- Accept a provider attestation that coverage is sufficient
Correct answer: Contact the malpractice carrier directly to verify coverage and amount
The specialist should verify directly with the malpractice carrier to confirm actual coverage terms and amounts.
Question 7: Which federal database must be queried as part of primary source verification before granting clinical privileges?
- The Healthcare Integrity and Protection Data Bank (HIPDB)
- The National Practitioner Data Bank (NPDB) (Correct answer)
- The Office of Inspector General (OIG) exclusion list
- The CMS Provider Enrollment database
Correct answer: The National Practitioner Data Bank (NPDB)
The NPDB must be queried for all practitioners applying for clinical privileges as required by federal law.
CPCS Primary Source Verification 2
Which organization is considered the primary source for verifying a physician's board certification status?