CPCS - Certified Provider Credentialing Specialist Reappointment and Recredentialing Questions and Answers

Question 1

According to NCQA standards, what is the maximum time frame allowed for a provider's reappointment/recredentialing cycle?

Accepted Answer

Every 36 months

Answer

Every 24 months

Answer

Every 48 months

Answer

At the discretion of the organization

Question 2

A credentialing specialist is processing a reappointment application and discovers the provider has a new malpractice claim that was not disclosed on the attestation. Which of the following is the most appropriate immediate next step?

Accepted Answer

Request additional information from the provider about the claim.

Answer

Deny the reappointment application immediately.

Answer

Approve the application but make a note of the discrepancy.

Answer

Report the provider to the state licensing board.

Question 3

Which of the following data is a critical component of the reappointment decision-making process, specifically for evaluating a practitioner's current clinical competence as required by The Joint Commission?

Accepted Answer

Ongoing Professional Practice Evaluation (OPPE) data

Answer

Initial residency training records

Answer

Number of social media followers

Answer

The provider's age and years in practice

Question 4

A hospital recently transitioned from a two-year to a three-year reappointment cycle to align with new Joint Commission standards. What is the most important initial step the Medical Services Professional (MSP) should take?

Accepted Answer

Verify that state laws and medical staff bylaws permit a three-year cycle.

Answer

Immediately extend all current providers' appointments by one year.

Answer

Notify all providers that their reappointment is now due in three years.

Answer

Purchase new software to accommodate the longer cycle.

Question 5

During a reappointment file audit, it is noted that a provider's attestation, confirming the correctness of the application, was signed and dated 200 days prior to the credentialing committee's decision. According to NCQA standards, this is considered:

Accepted Answer

A deficiency, because the attestation must be signed within 180 days of the decision.

Answer

Acceptable, as long as it is signed before the expiration date.

Answer

Acceptable, because the provider is already part of the network.

Answer

A deficiency, because the attestation must be signed within 90 days of the decision.

Question 6

When preparing a provider's file for reappointment, which of the following must be re-verified through a primary source?

Accepted Answer

Current state license and DEA registration

Answer

Medical school graduation

Answer

Social Security Number

Answer

Date of birth