Practice Test Geeks(CPCS) Certified Professional Credentialing Specialist Practice Test
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Regulatory Compliance & Verification Procedures Flashcards

7 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Regulatory Compliance & Verification Procedures flashcards as text

  1. Under NCQA credentialing standards, what is the minimum acceptable primary source verification method for a physician's medical degree?

    Answer: Contacting the medical school registrar directly

    NCQA requires direct contact with the primary source (the issuing medical school) to verify education credentials.

  2. Which federal law prohibits credentialing organizations from excluding providers from participation solely because they hold a specific type of license?

    Answer: Any Willing Provider laws

    Any Willing Provider laws require health plans to accept any licensed provider who meets their credentialing standards.

  3. A hospital discovers a practitioner's DEA registration expired 30 days ago. What is the immediate required action per standard credentialing policy?

    Answer: Suspend the practitioner's prescribing privileges pending DEA renewal

    An expired DEA registration means the practitioner lacks legal authority to prescribe controlled substances, requiring immediate privilege suspension.

  4. What is the purpose of querying the National Practitioner Data Bank (NPDB) during credentialing?

    Answer: To identify malpractice payments and adverse actions taken against practitioners

    The NPDB contains reports of malpractice payments, licensure actions, and clinical privilege restrictions that must be reviewed during credentialing.

  5. Under CMS Conditions of Participation, hospitals must re-credential medical staff members at least every:

    Answer: 2 years

    CMS Conditions of Participation require hospitals to re-appoint and re-credential medical staff at least every two years.

  6. Which verification procedure is used to confirm that a provider has not been excluded from participation in federal healthcare programs?

    Answer: OIG List of Excluded Individuals and Entities (LEIE) check

    The OIG LEIE must be checked to ensure providers are not excluded from Medicare, Medicaid, and other federal programs.

  7. A credentialing specialist receives an application with a 6-month gap in employment history. The best course of action is to:

    Answer: Request a written explanation from the applicant covering the gap period

    Credentialing standards require a complete work history, and unexplained gaps must be addressed through a written explanation from the applicant.