CHCS CHCS Primary Source Verification & Quality Management 1 — Questions and Answers
Question 1: What is 'primary source verification' (PSV) in the credentialing process?
- Verifying credentials through a third-party database only
- Confirming a practitioner's credentials directly with the originating institution or licensing body (Correct answer)
- Checking a practitioner's resume against their application
- Reviewing peer references only
Correct answer: Confirming a practitioner's credentials directly with the originating institution or licensing body
PSV requires confirmation of a practitioner's credentials directly from the source that issued them, such as a medical school or licensing board.
Question 2: Which organization established the most widely recognized standards for primary source verification in credentialing, particularly for health plans?
- The Joint Commission
- NCQA (National Committee for Quality Assurance) (Correct answer)
- CMS
- URAC
Correct answer: NCQA (National Committee for Quality Assurance)
NCQA's credentialing standards define PSV requirements for health plans and are used as the benchmark for managed care credentialing.
Question 3: Under NCQA standards, which of the following elements requires primary source verification?
- Practitioner's personal biography
- Current valid license to practice (Correct answer)
- Mailing address
- Languages spoken
Correct answer: Current valid license to practice
Current, valid licensure is one of the core elements that must be verified at the primary source (state licensing board) under NCQA credentialing standards.
Question 4: The National Practitioner Data Bank (NPDB) must be queried during initial credentialing and at minimum how often thereafter?
- Every 6 months
- Every year
- Every 2 years (Correct answer)
- Only when a concern arises
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 5: Which type of NPDB report allows a hospital to continuously monitor practitioners between required queries?
- One-time query
- Continuous query (proactive disclosure) (Correct answer)
- Bulk data request
- Self-query
Correct answer: Continuous query (proactive disclosure)
The NPDB's continuous query (proactive disclosure) service automatically notifies enrolled organizations when a new report is filed on a monitored practitioner.
Question 6: A credentialing application is considered 'complete' for the purpose of starting the PSV process when:
- The practitioner signs the application
- All required information and supporting documentation have been submitted and are ready for verification (Correct answer)
- The credentials committee meets
- The medical staff office assigns an application number
Correct answer: All required information and supporting documentation have been submitted and are ready for verification
PSV cannot begin until the application is complete with all required elements, as missing information prevents accurate and thorough verification.
CHCS CHCS Primary Source Verification & Quality Management 1
What is 'primary source verification' (PSV) in the credentialing process?