CPCS CPCS - Certified Provider Credentialing Specialist Ongoing Monitoring and Audits Questions and Answers 2

Question 1

How frequently must organizations participating in the Medicare and Medicaid programs check practitioners against the OIG List of Excluded Individuals/Entities (LEIE)?

Accepted Answer

At least monthly, per OIG guidance

Answer

Annually only

Answer

At initial credentialing only

Answer

Only when a complaint is received

Question 2

During a credentialing audit, a surveyor finds that OPPE reports have not been provided to practitioners at any point during the past 18 months. Under TJC standards, this would be considered which type of deficiency?

Accepted Answer

A Requirement for Improvement (RFI)

Answer

A minor documentation gap

Answer

An Immediate Threat to Life (ITL) finding

Answer

A Sentinel Event finding

Question 3

An organization is implementing continuous monitoring for its practitioner network. Which database should be checked to identify practitioners who have had DEA registration revoked or surrendered?

Accepted Answer

The DEA Diversion Control Division website

Answer

The NPDB only

Answer

The state pharmacy board website

Answer

CAQH ProView

Question 4

What is the primary purpose of conducting a 'focused audit' of credentialing files?

Accepted Answer

To identify specific compliance gaps or areas needing improvement in the credentialing process

Answer

To replace the need for ongoing primary source verification

Answer

To satisfy annual HIPAA audit requirements

Answer

To determine practitioner compensation adjustments

Question 5

A credentialing manager is developing a quality dashboard for the credentialing program. Which of the following metrics would best measure the efficiency of the initial credentialing process?

Accepted Answer

Average number of days from completed application receipt to committee approval

Answer

Number of NPDB reports received per month

Answer

Number of practitioners recredentialed per year

Answer

Percentage of practitioners with malpractice claims

Question 6

An organization's recredentialing audit reveals that 8% of practitioners have not been sent recredentialing letters within the policy-required timeframe. This finding should be addressed through which quality improvement mechanism?

Accepted Answer

A root cause analysis to identify why the timing requirement is not being met, followed by process correction

Answer

Immediate suspension of all affected practitioners

Answer

Reporting each practitioner to the NPDB for non-compliance

Answer

Requesting an extension from the accreditation body