CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers

Question 1

A credentialing specialist is verifying a physician's records for a hospital's initial appointment.
Which of the following is considered an acceptable primary source for verifying a medical school diploma?

Accepted Answer

A written confirmation directly from the medical school's registrar's office.

Answer

A copy of the diploma provided by the physician.

Answer

The physician's profile on the American Medical Association (AMA) website.

Answer

A verbal confirmation from the physician's previous employer.

Question 2

According to The Joint Commission (TJC) standards, which of the following credentials requires Primary Source Verification at the time of initial appointment and at reappointment?

Accepted Answer

State medical license

Answer

Peer recommendations

Answer

Driver's license

Answer

Professional liability insurance face sheet

Question 3

A managed care organization's credentialing department is reviewing a new provider application. To comply with NCQA standards, which source would be unacceptable for the primary source verification of board certification?

Accepted Answer

A notarized copy of the board certificate provided by the applicant.

Answer

The American Board of Medical Specialties (ABMS)

Answer

The American Osteopathic Association (AOA)

Answer

Direct correspondence with the specific specialty board.

Question 4

During a credentialing audit, a specialist discovers a six-month gap in a physician's work history on their application. What is the most appropriate next step according to NCQA guidelines?

Accepted Answer

Request a signed attestation from the provider explaining the gap.

Answer

Reject the application immediately due to the unexplained gap.

Answer

Verify the gap with the provider's previous employer.

Answer

Ignore the gap as it is less than one year.

Question 5

Which of the following is the primary purpose of conducting Primary Source Verification (PSV) in the healthcare credentialing process?

Accepted Answer

To protect patient safety and ensure regulatory compliance.

Answer

To ensure the provider's contact information is up to date.

Answer

To satisfy the provider's personal record-keeping requirements.

Answer

To expedite the provider enrollment process with payers.

Question 6

A credentialing specialist needs to verify a practitioner's history of medical malpractice payments. Which of the following is the most commonly used and appropriate primary source for this verification?

Accepted Answer

The National Practitioner Data Bank (NPDB).

Answer

The provider's curriculum vitae (CV).

Answer

A search of public court records in the provider's state.

Answer

The provider's current professional liability insurance carrier.