Credentialing Information Management Flashcards
7 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 7 Credentialing Information Management flashcards as text
A credentialing specialist receives a provider's application with a gap in employment history from 2019 to 2021. What is the most appropriate next step?
Answer: Request a written explanation from the provider for the gap
CPCS standards require that all employment gaps be explained in writing by the provider before the application can be processed.
Which document type is considered primary source verification for a provider's medical education?
Answer: Direct written confirmation from the medical school's registrar
Primary source verification requires confirmation directly from the originating institution, such as the medical school registrar.
A hospital's credentialing database shows a physician's DEA registration expiring in 30 days. What action should the credentialing specialist take?
Answer: Send an automated renewal reminder to the provider immediately
Proactive expiration tracking and timely notifications are essential credentialing information management functions to prevent lapses.
Under HIPAA, who is authorized to access a provider's credentialing file containing peer reference letters?
Answer: Only those with a legitimate need-to-know role in the credentialing process
Access to credentialing files must be restricted to individuals with a documented, role-based need to know.
A credentialing specialist discovers that a provider's board certification lapsed two years ago and was never renewed. What is the correct action if board certification is a condition of privileges?
Answer: Immediately refer the matter to the medical staff office or appropriate committee
When a required credential lapses, the credentialing specialist must escalate immediately to the appropriate authority per medical staff bylaws.
Which of the following best describes the purpose of a credentialing information management system's audit trail feature?
Answer: To track who accessed or modified credentialing records and when
Audit trails document all access and modifications to credentialing records, supporting accountability and regulatory compliance.
A provider applies for privileges at a new facility while their current privileges at another facility are under investigation. Which database should be queried to detect this situation?
Answer: The National Practitioner Data Bank (NPDB)
The NPDB contains reports of adverse actions, investigations, and malpractice payments that must be queried during credentialing.