CPCS - Certified Provider Credentialing Specialist Accreditation Standards and Compliance Questions and Answers Flashcards
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When an organization is cited for a deficiency during a TJC survey related to credentialing, what document must be submitted to demonstrate corrective action?
Answer: Evidence of Standards Compliance (ESC)
The Joint Commission requires organizations cited for standard deficiencies to submit an Evidence of Standards Compliance (ESC) document detailing corrective actions taken.
NCQA's credentialing standards require that the credentialing file contain a current, signed attestation from the provider. Which of the following must the attestation address?
Answer: Reasons for any gaps in work history, current competence, and lack of impairment
NCQA requires the provider attestation to address reasons for any gaps in work history of six months or more, current competence to perform requested privileges, and lack of current impairment.
Under URAC credentialing standards, what is the maximum time an organization has to complete recredentialing from the date the provider's previous credentialing period ends?
Answer: The recredentialing must be completed before the previous period expires
URAC standards require that recredentialing be completed and the new credentialing period begin before the previous credentialing period expires to avoid lapsing a provider's credentialing status.
Which of the following best describes the purpose of NCQA's Credentials Verification Organization (CVO) certification?
Answer: It certifies organizations that perform primary source verification on behalf of health plans
NCQA CVO certification recognizes organizations that perform primary source verification services on behalf of health plans, ensuring the CVO meets NCQA's standards for credentialing processes.
An accreditation surveyor finds that a hospital's credentialing files lack documentation that the department chief reviewed and approved privileges for new medical staff members. Under TJC standards, this would be cited as a deficiency under which standard area?
Answer: Medical Staff
Under TJC standards, deficiencies related to credentialing, privileging, and medical staff processes are cited under the Medical Staff (MS) standard chapter.
Which statement correctly describes the relationship between NCQA accreditation and state insurance department requirements for health plans?
Answer: NCQA accreditation may satisfy some state requirements but organizations must comply with whichever standard is more stringent
NCQA accreditation may satisfy some state credentialing requirements, but organizations must comply with the more stringent of NCQA or applicable state requirements when both apply.