CPCS - Certified Provider Credentialing Specialist Accreditation Standards and Compliance Questions and Answers

Question 1

A rural hospital (originating site) enters into a written agreement to use a neurology group from a distant-site, TJC-accredited hospital.
To comply with CMS Conditions of Participation for credentialing by proxy, which of the following is required?

Accepted Answer

The distant-site hospital must be a Medicare-participating hospital and provide a list of the neurologist's current privileges.

Answer

The originating site must re-verify the neurologist's medical license and DEA certificate from the primary source.

Answer

The originating site's medical staff must review and recommend the neurologist for privileges based on performance data from the distant-site hospital.

Answer

The neurologist must be a member of the originating site's medical staff before telemedicine services can be provided.

Question 2

A hospital activates its emergency operations plan due to a mass casualty event. A volunteer physician arrives to help. According to The Joint Commission (TJC) standards for disaster privileges, which two items are the minimum necessary for the hospital to verify before granting the physician privileges?

Accepted Answer

A valid government-issued photo ID and a current, valid license.

Answer

Board certification and DEA registration.

Answer

Medical school diploma and two peer references.

Answer

NPDB query results and malpractice insurance face sheet.

Question 3

A Managed Care Organization (MCO) delegates the verification of provider credentials to a CVO. According to NCQA standards, which of the following responsibilities must the MCO ultimately retain?

Accepted Answer

The final authority to make all credentialing decisions.

Answer

The primary source verification of state licensure.

Answer

The collection of initial applications from providers.

Answer

The semi-annual audit of the CVO's credentialing files.

Question 4

A physician is notified that the Medical Executive Committee has recommended the termination of their clinical privileges due to quality of care concerns. Under the Health Care Quality Improvement Act (HCQIA), the physician is entitled to which of the following?

Accepted Answer

A fair hearing and appellate review process.

Answer

A monetary settlement from the hospital.

Answer

An immediate report to the National Practitioner Data Bank (NPDB).

Answer

A mandatory transfer to a non-clinical position.

Question 5

A hospital needs to grant temporary privileges to a locum tenens physician to fill an urgent and unexpected vacancy. According to The Joint Commission (TJC), which of the following must be completed BEFORE the physician begins work?

Accepted Answer

Verification of a current, valid license and a query of the NPDB.

Answer

Verification of all training and education from primary sources.

Answer

Receipt of all peer references as listed on the application.

Answer

Approval by the hospital's governing body at its next scheduled meeting.

Question 6

Which of the following activities is a required component of a health plan's ongoing monitoring process to comply with NCQA standards?

Accepted Answer

Tracking provider licensure sanctions between recredentialing cycles.

Answer

Reviewing annual patient satisfaction surveys for each provider.

Answer

Conducting a full background check on each provider every six months.

Answer

Verifying board certification status on a quarterly basis.

A rural hospital (originating site) enters into a written agreement to use a neurology group from a distant-site, TJC-accredited hospital.To comply with CMS Conditions of Participation for credentialing by proxy, which of the following is required?

A rural hospital (originating site) enters into a written agreement to use a neurology group from a distant-site, TJC-accredited hospital.
To comply with CMS Conditions of Participation for credentialing by proxy, which of the following is required?