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Primary Source Verification 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 Primary Source Verification flashcards as text

  1. What is the primary purpose of the National Practitioner Data Bank (NPDB) in credentialing?

    Answer: To identify practitioners with a history of malpractice payments or adverse actions

    The NPDB tracks malpractice payment reports and adverse licensure, clinical privilege, and professional society membership actions.

  2. A credentialing specialist discovers that a provider's license was on probation two years ago but is currently in good standing. What is the correct course of action?

    Answer: Report the finding to the credentialing committee for review and decision

    Past disciplinary actions must be disclosed to the credentialing committee, which is responsible for making the final determination.

  3. Which element is NOT typically verified through primary source verification?

    Answer: References from colleagues

    Peer references are not primary source documents; they are secondary sources used to assess professional conduct and competence.

  4. How should a credentialing specialist handle a primary source that does not respond to a verification request within the required timeframe?

    Answer: Document all attempts and escalate according to organization policy

    Credentialing standards require thorough documentation of all verification attempts and following established organizational protocols for non-responses.

  5. Which of the following statements about the OIG exclusion list is CORRECT?

    Answer: Organizations may face Civil Monetary Penalties for employing excluded individuals

    Employing or contracting with OIG-excluded individuals can result in Civil Monetary Penalties for the healthcare organization.

  6. When verifying a provider's training through a graduate medical education program that has since closed, what is the best primary source?

    Answer: The American Medical Association Physician Masterfile

    The AMA Physician Masterfile maintains historical training records even for programs that have closed, making it a reliable primary source.

  7. Under URAC credentialing standards, what is the maximum allowable gap in a provider's work history that requires explanation?

    Answer: 6 months

    URAC standards require that gaps in a provider's work history of six months or more be explained and documented.