FREE CPCS Basic Questions and Answers Flashcards
6 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 FREE CPCS Basic Questions and Answers flashcards as text
What is the purpose of requiring practitioners to disclose malpractice claims history on their credentialing application?
Answer: To allow the credentials committee to evaluate the practitioner's clinical risk profile and identify potential patterns of performance concern
Malpractice history disclosure enables the credentials committee to evaluate whether the nature, frequency, or pattern of claims raises concerns about the practitioner's clinical competence or judgment warranting closer review.
In the context of credentialing, what does 'attestation' mean?
Answer: A practitioner's written certification that application information is accurate and complete, with authorization for verification
In credentialing, an attestation is the practitioner's signed statement certifying that the information provided on the application is accurate, complete, and truthful, and authorizing the organization to verify the information.
What is the meaning of 'expirable' in credentialing terminology?
Answer: A credential element that has a defined expiration date and must be renewed periodically
An 'expirable' is any credential element that has a defined expiration date and requires periodic renewal, such as a medical license, DEA certificate, board certification, or malpractice insurance policy.
A credentialing specialist discovers that a board certification listed on a practitioner's application does not exist in the ABMS Certification Matters database. What is the most appropriate initial response?
Answer: Contact the practitioner to obtain an explanation and additional documentation supporting the claimed certification
When a credential cannot be verified, the first step is to contact the practitioner to obtain an explanation and additional documentation. The issue may be a database error, name change, or other administrative discrepancy.
Under NCQA standards, which of the following is acceptable for verifying a practitioner's current medical license?
Answer: Checking the state medical board's online license verification portal in real-time
Real-time online verification through the state medical board's official license verification portal constitutes primary source verification of licensure under NCQA standards.
Which of the following terms describes the formal process by which a practitioner's appointment, privileges, or network participation is formally ended before the scheduled expiration?
Answer: Termination or revocation
Termination or revocation refers to the formal ending of a practitioner's medical staff appointment, clinical privileges, or network participation before the scheduled expiration, typically following an adverse credentialing action.