CPCS CPCS - Certified Provider Credentialing Specialist Reappointment and Recredentialing Questions and Answers 2

Question 1

What is the standard maximum interval for medical staff reappointment under TJC standards?

Accepted Answer

Two years

Answer

One year

Answer

Three years

Answer

Five years

Question 2

Which of the following is typically included in a hospital reappointment review that is NOT required for initial appointment?

Accepted Answer

Review of OPPE data and peer review findings from the current appointment period

Answer

Primary source verification of medical education

Answer

Primary source verification of current medical license

Answer

Peer recommendations from practitioners who know the applicant

Question 3

A practitioner's reappointment is up for renewal, but their malpractice insurance expired 2 weeks ago. The practitioner states they are switching carriers and the new policy will be effective in 10 days. What is the appropriate action?

Accepted Answer

Extend the current appointment for 10 days pending verification of new insurance, or consider temporary suspension if the policy allows

Answer

Grant immediate reappointment with a note about the insurance gap

Answer

Deny reappointment until a full new credentialing cycle is completed

Answer

Contact the NPDB to report the lapse

Question 4

Under NCQA health plan credentialing standards, which of the following is required at recredentialing (every 3 years) that is NOT explicitly required for ongoing monitoring between cycles?

Accepted Answer

Practitioner application or profile update with current attestation

Answer

OIG LEIE exclusion check

Answer

Monthly license database checks

Answer

NPDB query upon receipt of adverse information

Question 5

What is the recommended minimum advance notice to send reappointment packets to practitioners to ensure the process is completed before the current appointment expires?

Accepted Answer

90 to 120 days

Answer

2 weeks

Answer

30 days

Answer

6 months

Question 6

At reappointment, an OPPE review reveals that a practitioner's case complication rate is significantly above the peer comparison benchmark. What is the appropriate credentialing action?

Accepted Answer

Initiate FPPE for the practitioner to further evaluate the performance concern before making a reappointment decision

Answer

Deny reappointment automatically based on the statistical finding

Answer

Reappoint with standard privileges without additional review

Answer

Refer the matter to the hospital's compliance department rather than credentials committee