CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers — 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?
- A copy of the diploma provided by the physician.
- The physician's profile on the American Medical Association (AMA) website.
- A written confirmation directly from the medical school's registrar's office. (Correct answer)
- A verbal confirmation from the physician's previous employer.
Correct answer: A written confirmation directly from the medical school's registrar's office.
Primary Source Verification (PSV) requires verifying credentials directly from the issuing source. In this case, the medical school that issued the diploma is the primary source. The AMA Physician Masterfile is a designated equivalent source, but direct confirmation from the school is the most direct primary source.
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?
- Peer recommendations
- Driver's license
- Professional liability insurance face sheet
- State medical license (Correct answer)
Correct answer: State medical license
The Joint Commission mandates that licensure, which is required by law or regulation to practice a profession, must be verified directly from the issuing authority (the state licensing board) at several key times, including initial appointment and reappointment.
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?
- The American Board of Medical Specialties (ABMS)
- A notarized copy of the board certificate provided by the applicant. (Correct answer)
- The American Osteopathic Association (AOA)
- Direct correspondence with the specific specialty board.
Correct answer: A notarized copy of the board certificate provided by the applicant.
NCQA standards require verification of board certification to come directly from the primary source or a designated equivalent. A copy provided by the applicant, even if notarized, is not a primary source. Acceptable sources include ABMS, AOA, and the specific issuing 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?
- Reject the application immediately due to the unexplained gap.
- Request a signed attestation from the provider explaining the gap. (Correct answer)
- Verify the gap with the provider's previous employer.
- Ignore the gap as it is less than one year.
Correct answer: Request a signed attestation from the provider explaining the gap.
NCQA standards require that gaps in work history of more than six months must be explained by the provider. The standard procedure is to obtain a written and signed explanation from the applicant.
Question 5: Which of the following is the primary purpose of conducting Primary Source Verification (PSV) in the healthcare credentialing process?
- To ensure the provider's contact information is up to date.
- To satisfy the provider's personal record-keeping requirements.
- To protect patient safety and ensure regulatory compliance. (Correct answer)
- To expedite the provider enrollment process with payers.
Correct answer: To protect patient safety and ensure regulatory compliance.
The fundamental reason for PSV is to ensure that healthcare professionals are qualified and competent, which directly impacts patient safety. It also ensures the organization complies with accreditation and regulatory standards.
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?
- The provider's curriculum vitae (CV).
- A search of public court records in the provider's state.
- The National Practitioner Data Bank (NPDB). (Correct answer)
- The provider's current professional liability insurance carrier.
Correct answer: The National Practitioner Data Bank (NPDB).
The National Practitioner Data Bank (NPDB) is the federally mandated repository for information on medical malpractice payments and certain adverse actions related to health care practitioners. It is the standard primary source for this verification.
CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers
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?