CPCS FREE CPCS Knowledge Questions and Answers 2

Question 1

What is the role of the Federation of State Medical Boards (FSMB) in the credentialing process?

Accepted Answer

FSMB maintains databases of physician licensure information and disciplinary actions that can be used for PSV

Answer

FSMB licenses physicians directly and replaces state medical boards

Answer

FSMB accredits hospital credentialing programs

Answer

FSMB manages the NPDB on behalf of HRSA

Question 2

Which of the following is a key difference between 'occurrence-based' and 'claims-made' malpractice insurance policies for credentialing purposes?

Accepted Answer

Claims-made policies cover claims filed during the policy period regardless of when the incident occurred; occurrence-based policies cover incidents that occurred during the policy period regardless of when the claim is filed

Answer

Occurrence-based policies cost more but are otherwise identical

Answer

Claims-made policies are only available to board-certified physicians

Answer

There is no practical difference for credentialing purposes

Question 3

A hospital is implementing a new electronic health records (EHR) system and plans to link it to the credentialing database to automatically check that only credentialed practitioners are ordering and documenting care. This type of integration is an example of which quality improvement concept?

Accepted Answer

Hard stop / forcing function

Answer

Peer review

Answer

Privileging automation

Answer

Continuous monitoring

Question 4

Which of the following organizations administers the ABMS Continuing Certification (formerly Maintenance of Certification) program?

Accepted Answer

ABMS and its member specialty boards

Answer

ACGME

Answer

The Joint Commission

Answer

NAMSS

Question 5

Under the Health Insurance Portability and Accountability Act (HIPAA), a health plan sharing credentialing information with a hospital about a mutual network practitioner is most likely covered under which HIPAA provision?

Accepted Answer

Treatment, Payment, or Healthcare Operations (TPO)

Answer

Minimum Necessary Disclosure

Answer

Business Associate Agreement

Answer

De-identification Safe Harbor

Question 6

A credentialing specialist at a large health plan is told that the organization has decided to stop querying the NPDB at recredentialing to save costs. What should the specialist do?

Accepted Answer

Document the concern, explain that NPDB queries at recredentialing are required by NCQA and CMS standards, and escalate through appropriate channels if the directive stands

Answer

Follow the directive since management has authority over credentialing policy

Answer

Proceed but query the NPDB informally on a personal basis

Answer

Resign because this makes the organization's credentialing non-compliant