CPCS Cheat Sheet 2026

The 30 highest-yield CPCS facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. In a health plan's credentialing delegation arrangement, which party retains ultimate responsibility for compliance with NCQA credentialing standards? → The delegating health plan
2. Which of the following organizations administers the ABMS Continuing Certification (formerly Maintenance of Certification) program? → ABMS and its member specialty boards
3. Requires the greatest level of education and training among the three offered by HP/CVO. → Verification of Medical Education in Compliance with NCQA Guidelines
4. When adverse privilege action is taken against a practitioner, what due process right must hospitals guarantee under HCQIA to receive immunity protections? → The practitioner must be given notice of the action and an opportunity for a hearing
5. Which accreditation body requires a 'deemed status' survey that satisfies Medicare Conditions of Participation? → TJC and DNV GL Healthcare
6. Under NCQA standards, which practitioners must be credentialed by a health plan? → All licensed independent practitioners who provide services to plan members
7. What does OPPE stand for in the context of credentialing and performance review? → Ongoing Professional Practice Evaluation
8. Which of the following is typically included in a hospital reappointment review that is NOT required for initial appointment? → Review of OPPE data and peer review findings from the current appointment period
9. Which accreditation body sets widely recognized standards for health plan credentialing delegation programs? → NCQA (National Committee for Quality Assurance)
10. Who is typically responsible for officially declaring the internal emergency or disaster that activates a hospital's disaster privileging policy? → The hospital CEO or their designee
11. Which of the following elements is typically included in a 'query' to the National Practitioner Data Bank (NPDB)? → A request for information about adverse actions, malpractice payments, and exclusions
12. When an organization is cited for a deficiency during a TJC survey related to credentialing, what document must be submitted to demonstrate corrective action? → Evidence of Standards Compliance (ESC)
13. Which of the following best describes the 'two-midnight rule' as it relates to clinical privileging? → A CMS billing rule that does not directly relate to clinical privileging
14. Under NCQA standards, which of the following monitoring activities is required between the three-year credentialing cycles? → Checking the OIG LEIE and SAM.gov exclusion lists
15. Which document within a hospital organization should formally outline the process for granting disaster privileges? → The emergency management plan and/or medical staff bylaws or policies
16. An organization is reviewing its credentialing audit schedule. Under NCQA standards, how frequently must delegated credentialing activities be audited? → At least annually
17. Which of the following situations would trigger a Focused Professional Practice Evaluation (FPPE) for an already-credentialed practitioner? → A sentinel event involving the practitioner
18. When a practitioner application is received, what is the first step in processing? → Reviewing the application for completeness
19. Which data source is most commonly used in OPPE to assess a practitioner's clinical performance? → Patient outcomes data and quality indicators specific to the practitioner's privileges
20. What is the standard maximum interval for medical staff reappointment under TJC standards? → Two years
21. A practitioner submits a credentials application listing ABMS board certification in cardiology. How should the credentialing specialist verify this credential? → Verify directly through the ABMS website (certificationmatters.org)
22. URAC's credentialing accreditation standard requires initial credentialing to be completed within how many days of receiving a completed application? → 120 days
23. Under NCQA credentialing standards, peer references for initial credentialing must be obtained from individuals meeting which requirement? → They must have directly observed the applicant's clinical work within the past 3 years
24. Verification from the medical school or an approved PSV is necessary. → Verification of medical school credentials in accordance with TJC
25. During activation of a hospital's emergency management plan, who is authorized to grant disaster privileges to volunteer practitioners? → The CEO or designee
26. For which of the following credentials is the AMA Physician Master File an acceptable primary source verification source? → U.S. medical education (graduation from a U.S./Canadian medical school)
27. What is the primary purpose of peer review in the credentialing process? → To evaluate the quality and appropriateness of care provided by a practitioner
28. Which document typically outlines the specific clinical privileges available at a hospital and the criteria required to obtain them? → The delineation of privileges form
29. Is verification from the ECFMG appropriate for education and training completed through the AMA's Fifth Pathway program, as per NCQA Standards? → FALSE
30. In medical credentialing, what does the abbreviation 'LIP' stand for? → Licensed Independent Practitioner