Certified Healthcare Credentialing Specialist (CHCS) Exam — Questions and Answers

Question 1: Which of the following is an example of a 'nonphysician practitioner' (NPP) that a hospital may credential and privilege?

Hospital administrator
Hospital chaplain
Medical coder
Certified Registered Nurse Anesthetist (CRNA) (Correct answer)

Correct answer: Certified Registered Nurse Anesthetist (CRNA)

CRNAs are nonphysician practitioners who must be credentialed and privileged by the hospital before providing patient care services.

Question 2: Which NPI type does an incorporated group practice need?

Type 1
Group practices don't need an NPI
Type 3
Type 2 (Correct answer)

Correct answer: Type 2

Type 2 NPIs go to organizations such as groups, hospitals and corporations.

Question 3: A tele-ICU physician provides remote critical care services. Under CMS rules, the originating hospital may rely on which credentialing approach?

Only a phone interview with the physician
Credentialing by proxy, relying on the distant-site hospital's credentialing and privileging decisions per a written agreement (Correct answer)
The physician's self-attestation alone
No credentialing is needed for telemedicine

Correct answer: Credentialing by proxy, relying on the distant-site hospital's credentialing and privileging decisions per a written agreement

CMS Conditions of Participation allow credentialing by proxy for telemedicine under a written agreement with the distant site.

Question 4: Within what timeframe must the hospital decide whether disaster privileges should continue for a volunteer practitioner?

At the next board meeting
Within 24 hours
Within 30 days
Within 72 hours, based on oversight information gathered (Correct answer)

Correct answer: Within 72 hours, based on oversight information gathered

Joint Commission requires a decision within 72 hours on continuing disaster privileges based on observed performance.

Question 5: What is the term for a formal written policy that outlines the procedures a hospital follows when making adverse credentialing decisions?

Credentialing manual
Fair hearing plan (Correct answer)
Medical staff rules and regulations
Peer review policy

Correct answer: Fair hearing plan

A fair hearing plan details the due process rights and procedures afforded to practitioners when an adverse credentialing action is being considered.

Question 6: When a health plan delegates credentialing to a provider group, what does NCQA require of the plan?

Approval by CMS before delegation
A written agreement and ongoing oversight, including annual evaluation of the delegate (Correct answer)
No further involvement once the contract is signed
Recredentialing every practitioner itself

Correct answer: A written agreement and ongoing oversight, including annual evaluation of the delegate

NCQA requires a delegation agreement and the organization's annual oversight of the delegate's performance.

Question 7: A physician requests privileges to perform robotic surgery. Which document best supports competence for this new procedure?

CAQH attestation
Malpractice insurance face sheet
Case logs showing procedures performed and outcomes (Correct answer)
DEA registration

Correct answer: Case logs showing procedures performed and outcomes

Case logs with volumes and outcomes give evidence of current clinical competence for the requested privilege.

Question 8: Which entity sets the standards for provider privileging in military healthcare?

Red Cross
Veterans Affairs
Department of Labor
Service-specific medical command (Correct answer)

Correct answer: Service-specific medical command

In military healthcare, the standards for provider privileging are set by the service-specific medical command, such as the Army Medical Command (MEDCOM), Navy Medicine, or Air Force Medical Service. These commands establish the policies and procedures that ensure providers meet the unique requirements and maintain the high standards of care necessary for military personnel and their beneficiaries. They tailor privileging to the specific operational and clinical needs of their respective branches.

Question 9: What happens if a provider fails to meet privileging standards?

They receive a warning only
Privileges may be denied or revoked (Correct answer)
They are reassigned to admin roles
They continue with a mentor

Correct answer: Privileges may be denied or revoked

If a provider fails to meet privileging standards, their clinical privileges may be denied, limited, or revoked. This action is taken to protect patient safety and ensure that only qualified and competent individuals are authorized to perform specific medical procedures. Such failures could stem from issues with performance, conduct, or a lack of current qualifications, necessitating a review of their authorization to practice.

Question 10: What is the purpose of the medical executive committee (MEC) in hospital governance?

Serve as the liaison between the medical staff and the governing board on credentialing and clinical matters (Correct answer)
Oversee nursing staff credentials
Conduct malpractice litigation
Manage hospital budgets

Correct answer: Serve as the liaison between the medical staff and the governing board on credentialing and clinical matters

The MEC acts on behalf of the organized medical staff, forwarding credentialing recommendations to the governing board and addressing clinical policy issues.

Question 11: Which regulation governs the Army Combat Fitness Test?

DA PAM 600-3
AR 670-1
AR 350-1 (Correct answer)
FM 7-22

Correct answer: AR 350-1

Army Regulation (AR) 350-1, titled "Army Training and Leader Development," is the primary regulation that governs the Army Combat Fitness Test (ACFT). This regulation outlines the policies, procedures, and standards for the ACFT, including its administration, scoring, and the requirements for soldier physical readiness. It ensures consistency and compliance across the Army in fitness testing.

Question 12: A hospital restricts a physician's clinical privileges for 45 days due to professional competence concerns. Within how many days must the action be reported to the NPDB?

10 days
15 days (Correct answer)
30 days
60 days

Correct answer: 15 days

Adverse privileging actions lasting more than 30 days must be reported to the NPDB within 15 days of the action.

Question 13: Under HIPAA's minimum necessary standard, a credentialing report sent to a department chair should include:

Only the information needed for the chair's specific purpose (Correct answer)
All data in each provider's file
Social Security numbers for identification
Full malpractice claim narratives for all staff

Correct answer: Only the information needed for the chair's specific purpose

Minimum necessary limits disclosed information to what is needed for the intended purpose.

Question 14: Which federal law prohibits physicians from referring Medicare patients for designated health services to entities in which they have a financial relationship, unless an exception applies?

Stark Law (Correct answer)
HIPAA
EMTALA
Anti-Kickback Statute

Correct answer: Stark Law

The Stark Law is a strict-liability self-referral prohibition for designated health services.

Question 15: A physician's Medicare enrollment is approved, and the application was filed on June 30. What is the earliest date they can usually bill retroactively?

June 30, the filing date
The approval date
May 31, 30 days before filing (Correct answer)
January 1 of that year

Correct answer: May 31, 30 days before filing

Physicians and NPPs may bill retroactively up to 30 days before the effective filing date if they met all requirements then.

Question 16: How often must a hospital query the NPDB for each practitioner holding clinical privileges, at minimum?

Only when a complaint is filed
Every 3 years only
At initial appointment and every 2 years at reappointment (Correct answer)
Annually

Correct answer: At initial appointment and every 2 years at reappointment

Hospitals must query the NPDB when granting privileges and at least every two years thereafter.

Question 17: Under the HIPAA Privacy Rule, a patient's right to request an accounting of disclosures generally covers how many years prior to the request?

Ten years
Six years (Correct answer)
One year
Thirty days

Correct answer: Six years

HIPAA allows individuals to request an accounting of certain disclosures made in the prior six years.

Question 18: Which system is used to track ACFT scores and compliance?

Finance system
AKO Mail
TRICARE portal
DTMS (Digital Training Management System) (Correct answer)

Correct answer: DTMS (Digital Training Management System)

The Digital Training Management System (DTMS) is the official Army system used for planning, managing, and recording individual and collective training, including physical fitness tests like the ACFT. It provides a centralized platform for tracking scores, compliance, and overall unit readiness. This system is crucial for comprehensive training oversight.

Question 19: A physician has no plans to bill Medicare but must order lab tests for Medicare patients. Which form lets them enroll only to order and refer?

CMS-855I
CMS-855R
CMS-855O (Correct answer)
CMS-460

Correct answer: CMS-855O

The CMS-855O enrolls practitioners solely to order, certify or refer Medicare items and services.

Question 20: When granting or renewing privileges, what must the organization confirm about the practitioner's health status?

That the practitioner has no chronic illness
That the practitioner has no prescription medications
That the practitioner had a full physical within 30 days
That the practitioner can perform the privileges requested (Correct answer)

Correct answer: That the practitioner can perform the privileges requested

Accreditation standards require confirmation that the practitioner can perform the requested privileges, not disclosure of every condition.

Question 21: What is the primary communication goal when notifying a provider that their DEA registration is about to expire?

To penalize the provider
To report the provider to the DEA
To give timely advance notice so the provider renews before lapse and avoids interruption of prescribing privileges (Correct answer)
To remove the provider from the schedule immediately

Correct answer: To give timely advance notice so the provider renews before lapse and avoids interruption of prescribing privileges

Expirables tracking aims to prevent lapses through timely reminders.

Question 22: Under the Joint Commission, temporary privileges granted to meet an important patient care need may not exceed how many days?

90 days
60 days
120 days (Correct answer)
30 days

Correct answer: 120 days

TJC limits temporary privileges to a maximum of 120 days.

Question 23: Which landmark 1965 case established that a hospital can be held directly liable for failing to monitor the quality of care provided by its medical staff?

Darling v. Charleston Community Memorial Hospital (Correct answer)
Elam v. College Park Hospital
Patrick v. Burget
Johnson v. Misericordia Community Hospital

Correct answer: Darling v. Charleston Community Memorial Hospital

Darling established the doctrine of corporate negligence, making hospitals responsible for overseeing physician care.

Question 24: Which metric best reflects the accuracy of a credentialing department's data?

Number of applications received
Error rate found in internal file audits (Correct answer)
Number of staff in the department
Number of committee meetings held

Correct answer: Error rate found in internal file audits

Audit error rates measure how often file data is incomplete or incorrect.

Question 25: In a hospital, who has final authority to grant clinical privileges?

Medical Staff Office
Governing body (Correct answer)
Department chair
Credentials committee

Correct answer: Governing body

The medical executive committee recommends, but the governing body (board) grants privileges.

Question 26: Under NCQA standards, how soon after sanction information is released must an organization review it during ongoing monitoring?

At the next recredentialing cycle
Within 30 calendar days (Correct answer)
Within 90 calendar days
Within 7 calendar days

Correct answer: Within 30 calendar days

NCQA requires review of new Medicare/Medicaid sanctions and license actions within 30 days of their release.

Question 27: Which HIPAA concept requires that credentialing staff access only the protected health information needed to perform their task?

Business associate exemption
Right of access
Breach notification rule
Minimum necessary standard (Correct answer)

Correct answer: Minimum necessary standard

The minimum necessary standard limits uses and disclosures of PHI to what is needed for the purpose.

Question 28: What is one consequence of non-compliance in ACFT standards?

Test scores being voided (Correct answer)
Access to more equipment
Bonus leave days
Higher promotion score

Correct answer: Test scores being voided

Non-compliance with ACFT standards undermines the validity and fairness of the test. If procedures are not followed correctly, the integrity of the scores is compromised, leading to the test results being voided. This ensures that only properly administered and recorded tests are counted.

Question 29: Which situation would generally disqualify a practitioner from expedited credentialing under Joint Commission standards?

The practitioner is board certified
The practitioner has a current DEA registration
The application is complete and verified
The practitioner has a history of involuntary termination of medical staff membership (Correct answer)

Correct answer: The practitioner has a history of involuntary termination of medical staff membership

Involuntary termination, reduced privileges, or unusual malpractice history make an applicant ineligible for the expedited process.

Question 30: What is primary source verification?

Verifying credentials from the original institution (Correct answer)
Looking up credentials on social media
Asking the applicant to confirm details
Contacting a colleague for confirmation

Correct answer: Verifying credentials from the original institution

Primary source verification (PSV) is the process of confirming a healthcare provider's credentials directly with the original issuing source. This includes contacting universities for transcripts, licensing boards for professional licenses, and hospitals for affiliation details. PSV is a critical step in credentialing to ensure the authenticity and validity of a provider's qualifications, safeguarding patient care.

Question 31: What is the purpose of regulatory compliance in ACFT administration?

To personalize fitness goals
To make the test easier
To eliminate paperwork
To ensure consistent and fair testing (Correct answer)

Correct answer: To ensure consistent and fair testing

Regulatory compliance in Army Combat Fitness Test (ACFT) administration is crucial to ensure that the test is conducted consistently and fairly across all units and soldiers. Adhering to established regulations, such as AR 350-1, standardizes procedures, equipment, and scoring, minimizing bias and ensuring equitable evaluation of physical readiness. This consistency is vital for maintaining the integrity and validity of the ACFT results.

Question 32: Why is a 'primary source verification' notation important in a credentials file?

It shows the medical staff president approved the file
It documents that information was confirmed directly with the issuing source (Correct answer)
It proves the file was scanned into the electronic system
It confirms the applicant personally signed every page

Correct answer: It documents that information was confirmed directly with the issuing source

Primary source verification documents confirmation directly from the entity that issued the credential, as required by accreditors.

Question 33: Which federal law grants peer review bodies limited immunity from damages when they meet specific due-process standards?

Health Insurance Portability and Accountability Act
Patient Safety and Quality Improvement Act of 2005
Emergency Medical Treatment and Labor Act
Health Care Quality Improvement Act of 1986 (Correct answer)

Correct answer: Health Care Quality Improvement Act of 1986

HCQIA provides immunity for professional review actions that meet its four standards and also created the NPDB.

Question 34: What is Ongoing Professional Practice Evaluation (OPPE) designed to do?

Evaluate new applicants before privileges are granted
Verify malpractice insurance annually
Continuously monitor current practitioners' performance between reappointments (Correct answer)
Replace the reappointment process

Correct answer: Continuously monitor current practitioners' performance between reappointments

OPPE is a continuous evaluation of privileged practitioners' performance to identify trends that affect quality.

Question 35: Under HIPAA, which is the best practice when emailing a credentialing file that contains a provider's Social Security number?

Fax it to a general office line
Send it in the body of a standard email
Use encrypted email or a secure portal and send only the minimum necessary (Correct answer)
Post it on a shared network drive open to all staff

Correct answer: Use encrypted email or a secure portal and send only the minimum necessary

Sensitive identifiers should be transmitted securely and limited to the minimum necessary.

Question 36: Privileging refers to what process in military healthcare settings?

Authorizing specific clinical duties (Correct answer)
Providing uniforms
Assigning duty stations
Scheduling fitness test events

Correct answer: Authorizing specific clinical duties

In military healthcare settings, privileging is the process of formally authorizing a healthcare provider to perform specific clinical procedures and services based on their verified credentials, experience, and demonstrated competence. This ensures that providers only perform duties for which they are qualified and proficient, thereby safeguarding patient safety and maintaining quality of care within the military health system.

Question 37: Which method is acceptable for overseeing the professional performance of practitioners holding disaster privileges?

Peer review only after one year
No oversight is required during a disaster
A written exam administered on arrival
Direct observation, mentoring, or clinical record review as defined by the medical staff (Correct answer)

Correct answer: Direct observation, mentoring, or clinical record review as defined by the medical staff

The medical staff must describe an oversight mechanism such as direct observation, mentoring, or clinical record review.

Question 38: In a disaster, when the emergency operations plan is activated, who may grant disaster privileges to volunteer licensed independent practitioners?

The state medical board
The CEO, medical staff president or their designee (Correct answer)
The charge nurse
Any attending physician

Correct answer: The CEO, medical staff president or their designee

Joint Commission lets individuals identified in the medical staff bylaws, such as the CEO or medical staff president, grant disaster privileges.

Question 39: A credentialing specialist notices that a physician's privilege request exceeds what their training documents support. What is the correct action?

Approve it if the physician has many years of experience
Forward directly to the CEO
Request additional documentation of training and competency before recommending approval (Correct answer)
Automatically deny the application

Correct answer: Request additional documentation of training and competency before recommending approval

Privileges must be based on documented training, experience, and demonstrated competency, so additional documentation is required before recommendation.

Question 40: Which documentation would a credentialing specialist use to verify a physician's controlled substance prescribing authority at the federal level?

DEA registration (Correct answer)
NPDB report
Board certification
State medical license

Correct answer: DEA registration

The DEA registration authorizes practitioners to prescribe controlled substances federally.

Question 41: Which CMS enrollment form does a clinic or group practice use to enroll as a supplier organization?

CMS-855S
CMS-855B (Correct answer)
CMS-855A
CMS-855O

Correct answer: CMS-855B

Clinics, group practices and certain other suppliers enroll with the CMS-855B.

Question 42: What is the purpose of Ongoing Professional Practice Evaluation (OPPE)?

Continuous monitoring of performance between reappointments (Correct answer)
One-time verification of education
Replacement for NPDB queries
Approval of temporary privileges

Correct answer: Continuous monitoring of performance between reappointments

OPPE continuously evaluates a practitioner's performance data to support decisions about keeping privileges.

Question 43: Which of the following best describes 'focused professional practice evaluation' (FPPE)?

A time-limited review triggered by a new privilege or concern about a provider's performance (Correct answer)
A credentialing renewal process
An internal audit of billing practices
Annual peer review of all providers

Correct answer: A time-limited review triggered by a new privilege or concern about a provider's performance

FPPE is a defined period of performance monitoring used when a provider receives new privileges or when a question arises about clinical competency.

Question 44: How often must a practitioner re-attest their CAQH ProView profile to keep it active?

Every 30 days
Every 120 days (Correct answer)
Every 180 days
Annually

Correct answer: Every 120 days

CAQH ProView requires re-attestation every 120 days.

Question 45: A credentials file note reads 'PRN.' In clinical and staffing documentation, what does this abbreviation mean?

Prior to review
Patient record number
Primary registered nurse
As needed (Correct answer)

Correct answer: As needed

PRN comes from the Latin 'pro re nata,' meaning as needed.

Question 46: Which pediatric certification is most commonly required for emergency physicians treating critically ill children?

ACLS
PALS (Pediatric Advanced Life Support) (Correct answer)
BLS only
NRP

Correct answer: PALS (Pediatric Advanced Life Support)

PALS covers advanced resuscitation for infants and children.

Question 47: Which institutional provider type must generally pay a Medicare enrollment application fee?

Individual physician
Hospital or other institutional provider (Correct answer)
Nurse practitioner
Physician group of physicians only

Correct answer: Hospital or other institutional provider

Institutional providers pay the application fee, while individual practitioners and physician/NPP groups are exempt.

Question 48: Which disease requires droplet precautions rather than airborne or contact precautions?

MRSA wound infection
Measles
Varicella
Pertussis (Correct answer)

Correct answer: Pertussis

Pertussis spreads through large respiratory droplets, so droplet precautions apply.

Question 49: Which of the following is a rate-based OPPE indicator?

A thank-you letter from a patient
Years since medical school graduation
Surgical site infection rate (Correct answer)
Attendance at a staff party

Correct answer: Surgical site infection rate

Infection rates are measurable outcome indicators commonly used in OPPE.

Question 50: A 'service line' or 'department' in a hospital medical staff structure is primarily organized around which concept?

Physician seniority
Alphabetical physician names
Clinical specialty or type of service provided (Correct answer)
Insurance payer type

Correct answer: Clinical specialty or type of service provided

Hospital medical staff departments are organized by clinical specialty (e.g., surgery, internal medicine) to facilitate peer review and competency oversight.

Question 51: During its NCQA accreditation renewal, what must a health plan demonstrate regarding any credentialing CVOs it uses?

That proper delegation agreements are in place and required oversight audits have been conducted (Correct answer)
That CVO services represent the lowest cost credentialing option available
That all CVOs are physically located within the same state as the health plan
That all CVOs are subsidiaries owned by the health plan

Correct answer: That proper delegation agreements are in place and required oversight audits have been conducted

For NCQA accreditation, health plans must demonstrate they have valid delegation agreements with CVOs and have conducted required oversight audits to verify CVO compliance with standards.

Question 52: Which of the following is NOT one of the four HCQIA standards a professional review action must meet for immunity?

Reasonable effort to obtain the facts
Adequate notice and hearing procedures
Approval by the state licensing board before action (Correct answer)
Reasonable belief the action furthers quality health care

Correct answer: Approval by the state licensing board before action

HCQIA immunity does not require prior licensing board approval; it requires quality purpose, fact-finding, due process, and a warranted belief.

Question 53: Which statement about peer review privilege is most accurate?

It protects all hospital documents from any disclosure
It applies only to nursing records
It is uniformly defined by a single federal statute in every case
It is established by state law and varies from state to state (Correct answer)

Correct answer: It is established by state law and varies from state to state

Peer review confidentiality protections are largely created by state statutes, so scope differs by state.

Question 54: Which CMS regulation contains the hospital Condition of Participation for the medical staff?

42 CFR 482.12
42 CFR 485.616
45 CFR 164.502
42 CFR 482.22 (Correct answer)

Correct answer: 42 CFR 482.22

42 CFR 482.22 sets the medical staff Condition of Participation, including credentialing requirements.

Question 55: What document governs the medical staff's self-governance structure, including credentialing requirements, within a hospital?

CMS Conditions of Participation
The Joint Commission manual
Medical staff bylaws (Correct answer)
State licensing statute

Correct answer: Medical staff bylaws

Medical staff bylaws establish the rules and procedures for self-governance, including credentialing and privileging requirements.

Question 56: Which verification is used to confirm a practitioner's authority to prescribe controlled substances federally?

DEA registration verification (Correct answer)
NPI registry lookup
State medical license only
CAQH attestation

Correct answer: DEA registration verification

Federal authority to prescribe controlled substances is confirmed through DEA registration.

Question 57: What does 'confidentiality of peer review' protect in most US states?

The practitioner's employment contract
Documents and proceedings of the peer review process from discovery in civil litigation (Correct answer)
All NPDB reports from public disclosure
A hospital's financial records

Correct answer: Documents and proceedings of the peer review process from discovery in civil litigation

Most states have peer review privilege statutes that protect peer review committee records and deliberations from being subpoenaed in malpractice lawsuits.

Question 58: A practitioner may access their own NPDB report by:

Submitting a self-query to the NPDB (Correct answer)
Requesting it from the hospital credentialing office
Filing a FOIA request
Calling the state medical board

Correct answer: Submitting a self-query to the NPDB

Practitioners can self-query the NPDB at any time to view reports about themselves.

Question 59: Which situation requires a provider to update Medicare enrollment within 30 days?

Change of practice location (Correct answer)
New board certification
New CME credits
Change of home address

Correct answer: Change of practice location

Physicians and NPPs must report changes of practice location, ownership and adverse legal actions within 30 days.

Question 60: After the 2023 Consolidated Appropriations Act (MAT Act), what is required for a practitioner to prescribe buprenorphine for opioid use disorder?

Board certification in psychiatry
A current DEA registration that includes Schedule III authority (Correct answer)
Enrollment in an opioid treatment program
A separate DATA-2000 X-waiver

Correct answer: A current DEA registration that includes Schedule III authority

The MAT Act eliminated the X-waiver, so any practitioner with a Schedule III DEA registration may prescribe buprenorphine for OUD, subject to state law.

Question 61: How often must a provider re-attest their CAQH ProView profile to keep it active?

Every 36 months
Every 30 days
Every 120 days (Correct answer)
Every 12 months

Correct answer: Every 120 days

CAQH ProView requires re-attestation every 120 days to keep data current for participating organizations.

Question 62: What does a 'core privileges' approach to delineation mean?

Privileges that don't need board approval
Privileges granted only to department chairs
A bundle of activities that any competent specialist in the field can perform (Correct answer)
Privileges limited to emergencies

Correct answer: A bundle of activities that any competent specialist in the field can perform

Core privileges group the routine procedures expected of any appropriately trained practitioner in a specialty.

Question 63: Which tool best supports consistent communication of credentialing status to department chairs?

Informal sticky notes
A standardized status report or dashboard distributed on a regular schedule (Correct answer)
Ad hoc phone calls when someone remembers
Personal text messages

Correct answer: A standardized status report or dashboard distributed on a regular schedule

Standardized, scheduled reports keep leaders informed and reduce errors.

Question 64: Under HCQIA, how often must a hospital query the NPDB for practitioners already on its medical staff?

Every three years
Only when an adverse event occurs
Annually
At least every two years (Correct answer)

Correct answer: At least every two years

Hospitals must query the NPDB at initial appointment and at least every two years thereafter.

Question 65: Which Joint Commission process requires continuous review of practitioner performance data rather than only at reappointment?

Proctoring
OPPE (Correct answer)
Peer reference collection
FPPE

Correct answer: OPPE

OPPE is the ongoing evaluation of each practitioner's performance used to support privilege decisions.

Question 66: During ongoing monitoring, a credentialing specialist finds that a physician's DEA registration expired yesterday. What is the most appropriate action?

Revoke all clinical privileges permanently
Ignore it until the next reappointment cycle
Use the physician's previous DEA number
Notify medical staff leadership and restrict controlled-substance prescribing per bylaws until renewal is verified (Correct answer)

Correct answer: Notify medical staff leadership and restrict controlled-substance prescribing per bylaws until renewal is verified

A practitioner without a current DEA registration may not prescribe controlled substances, so the lapse must be escalated and related privileges restricted until the renewal is verified.

Question 67: Under NCQA standards, how often must health plans recredential practitioners?

Every 12 months
Every 60 months
Every 36 months (Correct answer)
Every 24 months

Correct answer: Every 36 months

NCQA requires recredentialing at least every 36 months.

Question 68: Under Joint Commission standards, disaster privileges may be granted when:

The Emergency Operations Plan is activated and the hospital cannot meet immediate patient needs (Correct answer)
Any staffing shortage occurs
The credentials committee is on vacation
A practitioner requests faster onboarding

Correct answer: The Emergency Operations Plan is activated and the hospital cannot meet immediate patient needs

Disaster privileges are allowed only when the EOP is activated and the organization cannot meet patient needs.

Question 69: Temporary privileges to meet an important patient care need for a pending applicant may last no longer than:

120 days (Correct answer)
60 days
30 days
1 year

Correct answer: 120 days

TJC limits temporary privileges for applicants pending approval to 120 days.

Question 70: A physician group wants a newly hired physician to bill Medicare under the group's TIN. Which CMS form reassigns the physician's Medicare benefits to the group?

CMS-588
CMS-855R (Correct answer)
CMS-855I
CMS-855B

Correct answer: CMS-855R

The CMS-855R reassigns an individual practitioner's right to receive Medicare payments to a group or organization.

Question 71: Can a hospital grant procedure privileges based solely on board certification?

Yes, board certification proves competence
Only for surgical specialties
Yes, if the board is ABMS-recognized
No, current competence must also be evaluated (Correct answer)

Correct answer: No, current competence must also be evaluated

Board certification is one factor, but privileges also require evidence of current clinical competence.

Question 72: Which situation would most likely expose a hospital to an antitrust claim during credentialing?

Requiring primary source verification of licensure
Denying privileges to reduce competition for existing staff physicians (Correct answer)
Denying privileges because the applicant lacks board certification required by bylaws
Querying the NPDB at reappointment

Correct answer: Denying privileges to reduce competition for existing staff physicians

Using credentialing to exclude competitors rather than for quality reasons can violate the Sherman Antitrust Act.

Question 73: Which certification would a credentialing specialist most likely require for privileges to resuscitate newborns in the delivery room?

ACLS
ATLS
NRP (Neonatal Resuscitation Program) (Correct answer)
TNCC

Correct answer: NRP (Neonatal Resuscitation Program)

The Neonatal Resuscitation Program is the standard certification for newborn resuscitation.

Question 74: Which database must be checked to confirm that a provider is not excluded from federal healthcare programs?

AMA Masterfile
NPPES
OIG LEIE (Correct answer)
FSMB

Correct answer: OIG LEIE

The OIG List of Excluded Individuals/Entities identifies people barred from federal healthcare programs.

Question 75: How often does the OIG recommend that organizations screen employees and contractors against the LEIE?

Every six months
Only at hire
Annually
Monthly (Correct answer)

Correct answer: Monthly

OIG guidance recommends monthly LEIE checks because the list is updated monthly.

Question 76: The Joint Commission expects the quality of care for patients receiving moderate or deep sedation to be:

Monitored only in the operating room
Comparable throughout the organization regardless of location (Correct answer)
Overseen solely by nursing
Determined separately by each department

Correct answer: Comparable throughout the organization regardless of location

Sedation privileging criteria and care standards must be consistent hospital-wide so patients receive the same level of care.

Question 77: Who is responsible for submitting ACFT data for a unit?

Training room trainee
Company clerk
Squad leader
Unit data officer or NCOIC (Correct answer)

Correct answer: Unit data officer or NCOIC

The Unit Data Officer or NCOIC is typically responsible for managing and submitting official unit data, including ACFT scores. This role ensures that data is accurately collected, verified, and entered into the appropriate systems like DTMS. Their oversight maintains data integrity and compliance with reporting standards.

Question 78: How often must most Medicare providers and suppliers revalidate their enrollment?

Every 2 years
Every 5 years (Correct answer)
Every 10 years
Every 3 years

Correct answer: Every 5 years

Most providers revalidate every 5 years, while DMEPOS suppliers revalidate every 3 years.

Question 79: Under OSHA's Respiratory Protection Standard, how often must employees who wear tight-fitting N95 respirators be fit-tested?

Only at hire
At least annually (Correct answer)
Every five years
Every two years

Correct answer: At least annually

OSHA 29 CFR 1910.134 requires fit testing before first use and at least once a year after that.

Question 80: Medicare provider enrollment records in PECOS generally must be revalidated how often for most providers?

Every year
Every 10 years
Every 3 years
Every 5 years (Correct answer)

Correct answer: Every 5 years

CMS requires most providers and suppliers to revalidate enrollment every 5 years (DMEPOS suppliers every 3).

Question 81: Which best describes the scope of Pharmacology & Medication Management in professional practice?

A narrow topic relevant only to entry-level professionals
A comprehensive area covering both theoretical foundations and practical applications (Correct answer)
A theoretical framework with no practical applications
An outdated concept no longer relevant to modern practice

Correct answer: A comprehensive area covering both theoretical foundations and practical applications

Pharmacology & Medication Management encompasses both theoretical foundations and practical applications that are essential to professional practice in this field.

Question 82: Which of the following quality indicators is most directly relevant to a surgical privilege reappointment decision?

Average length of stay for all hospital patients
Patient satisfaction scores for front desk staff
Complication and mortality rates for procedures the surgeon performs (Correct answer)
Billing accuracy rates

Correct answer: Complication and mortality rates for procedures the surgeon performs

Complication and mortality rates for specific procedures directly reflect a surgeon's clinical outcomes and competency in the privileges being renewed.

Question 83: Under Joint Commission standards, what is the maximum time a practitioner may hold temporary privileges while their application is pending?

60 days
120 days (Correct answer)
90 days
30 days

Correct answer: 120 days

Joint Commission limits temporary privileges for pending applications to 120 days.

Question 84: What is the primary purpose of provider enrollment in military health systems?

To manage equipment allocation
To verify provider qualifications (Correct answer)
To approve fitness training materials
To reduce patient wait times

Correct answer: To verify provider qualifications

The primary purpose of provider enrollment in military health systems is to rigorously verify that healthcare providers meet all necessary qualifications, licenses, and certifications. This process ensures that only competent and qualified professionals are authorized to deliver care to service members and their families. It is a fundamental step in maintaining high standards of patient safety and quality healthcare within the military.

Question 85: A medical staff office employee discovers a false statement on a physician's application. Under typical medical staff bylaws, this is most commonly treated as:

A reportable HIPAA breach
Grounds for denial or termination of the application (Correct answer)
An automatic grant of temporary privileges
A minor clerical issue to be corrected silently

Correct answer: Grounds for denial or termination of the application

Bylaws generally treat material misrepresentation or omission as grounds for denial or automatic relinquishment.

Question 86: A practitioner's privilege request covers procedures outside the hospital's available equipment and services. What should happen?

Approve it because the practitioner is qualified
Grant the privilege conditionally
Deny or not process the request because the hospital cannot support the service (Correct answer)
Grant temporary privileges instead

Correct answer: Deny or not process the request because the hospital cannot support the service

Privileges are granted only for services the organization can support with its facilities and resources.

Question 87: Which federal statute imposes liability on persons who knowingly submit false claims to the government and allows whistleblowers to file qui tam suits?

Sherman Act
Fair Credit Reporting Act
False Claims Act (Correct answer)
Stark Law

Correct answer: False Claims Act

The False Claims Act permits qui tam relators to sue on behalf of the government and share in recoveries.

Question 88: Which approach is most effective for educating newly credentialed providers about reappointment requirements?

Wait until the file expires to tell them
Provide a written orientation packet and calendar reminders well ahead of reappointment deadlines (Correct answer)
Rely on the provider's office manager to figure it out
Mention it only if they ask

Correct answer: Provide a written orientation packet and calendar reminders well ahead of reappointment deadlines

Proactive written education and reminders prevent lapses in privileges or enrollment.

Question 89: A hospital receives telemedicine services from a Joint Commission-accredited distant-site hospital. Which method lets it rely on the distant site's privileging decisions?

Delegated health plan credentialing
Locum tenens enrollment
Temporary privileges
Credentialing by proxy (Correct answer)

Correct answer: Credentialing by proxy

CMS and Joint Commission allow originating sites to privilege telemedicine practitioners by proxy using the distant site's decisions.

Question 90: What is 'expedited credentialing' most appropriately used for?

Correcting application errors
Renewing expired medical licenses
All new physician applications to save time
Situations where a specific patient needs care from a particular physician immediately (Correct answer)

Correct answer: Situations where a specific patient needs care from a particular physician immediately

Expedited credentialing allows a hospital to quickly verify minimum credentials for a specific patient care need when delay would harm the patient.

Question 91: What does the term 'delineation of privileges' refer to in credentialing?

Listing a provider's disciplinary history
Documenting a provider's education history
Specifying the exact clinical procedures and patient care activities a practitioner is authorized to perform (Correct answer)
Outlining the provider's billing codes

Correct answer: Specifying the exact clinical procedures and patient care activities a practitioner is authorized to perform

Privilege delineation defines the specific scope of clinical activities a practitioner may perform based on their demonstrated competence and training.

Question 92: The National Practitioner Data Bank (NPDB) must be queried during initial credentialing and at minimum how often thereafter?

Only when a concern arises
Every 2 years (Correct answer)
Every 6 months
Every year

Correct answer: Every 2 years

NPDB regulations require hospitals to query the databank at initial appointment and at least every two years at reappointment.

Question 93: What is the term for verifying a provider’s education and experience directly with issuing sources?

Peer validation
Primary source verification (Correct answer)
Reference check
Internal review

Correct answer: Primary source verification

The term for verifying a provider's education and experience directly with the original issuing sources is "primary source verification." This rigorous process involves contacting institutions like universities, licensing boards, and previous employers to confirm the authenticity and validity of credentials. It is a cornerstone of credentialing, ensuring that all information is accurate and reliable, thereby safeguarding patient care.

Question 94: Ongoing Professional Practice Evaluation (OPPE) must be conducted at minimum how often according to The Joint Commission standards?

Every 24 months
Monthly
Quarterly
Every 12 months (Correct answer)

Correct answer: Every 12 months

TJC requires OPPE data to be collected and reviewed at least every 12 months to support reappointment decisions.

Question 95: What system may be used for credential tracking and updates?

Credential management system (Correct answer)
Spreadsheet templates
Calendar apps
Employee chat logs

Correct answer: Credential management system

A credential management system is a specialized software solution designed to efficiently track, store, and update all aspects of a healthcare provider's credentials. These systems automate reminders for expirations, facilitate primary source verification, and maintain a comprehensive, secure database of provider information. They are essential for ensuring compliance, reducing administrative burden, and supporting timely re-credentialing processes.

Question 96: An OPPE indicator such as 'unplanned return to the operating room within 48 hours' is an example of what?

A licensure requirement
A quality trigger that may prompt case review (Correct answer)
A financial metric
A demographic statistic

Correct answer: A quality trigger that may prompt case review

Triggers such as unplanned returns flag cases for focused peer review.

Question 97: Which law requires an organization to obtain the applicant's written authorization before obtaining a consumer report for a background check from a third-party agency?

Americans with Disabilities Act
False Claims Act
Fair Credit Reporting Act (FCRA) (Correct answer)
Health Care Quality Improvement Act

Correct answer: Fair Credit Reporting Act (FCRA)

The FCRA requires disclosure and written consent before procuring consumer reports through a reporting agency.

Question 98: A practitioner requests privileges for 'arthroscopy.' What does this procedure involve?

Removal of a joint
Visual examination inside a joint (Correct answer)
X-ray imaging of an artery
Fusion of a joint

Correct answer: Visual examination inside a joint

'Arthr/o' (joint) + '-scopy' (visual examination) describes looking inside a joint with a scope.

Question 99: Who should ideally perform peer review of an orthopedic surgeon's clinical cases?

A practitioner with similar training and specialty (Correct answer)
A hospital administrator
A nurse manager from the ICU
An external auditor with no clinical training

Correct answer: A practitioner with similar training and specialty

Valid peer review requires a reviewer with comparable training and clinical expertise.

Question 100: Which form does a provider submit to receive Medicare payments by electronic funds transfer?

CMS-20134
CMS-460
CMS-855R
CMS-588 (Correct answer)

Correct answer: CMS-588

The CMS-588 is the Medicare EFT authorization agreement.

Certified Healthcare Credentialing Specialist (CHCS) Exam

The CHCS certification validates a professional's expertise in healthcare credentialing processes, including primary source verification, privileging, and compliance with regulatory standards.

100

Questions

120 min

Time Limit

70%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. We have not yet matched this exam's facts to an official source, so confirm fees, dates and rules with the exam body. Not reviewed by a subject-matter expert. Editorial policy