CPCS - Certified Provider Credentialing Specialist Initial Application Processing Questions and Answers Flashcards
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Read the first 6 CPCS - Certified Provider Credentialing Specialist Initial Application Processing Questions and Answers flashcards as text
A credentialing specialist discovers that a practitioner's DEA certificate will expire in 45 days. The practitioner has not yet started the renewal process. What action should the specialist take?
Answer: Notify the practitioner in writing and document the notification in the credentialing file
The specialist should notify the practitioner in writing about the upcoming expiration, request evidence of renewal application or renewed certificate, and document the notification and follow-up in the credentialing file.
Which of the following correctly describes the purpose of requiring a practitioner to sign an application attestation?
Answer: To provide legal acknowledgment that the information is accurate and complete and authorizes the organization to verify the information
The attestation is the practitioner's sworn statement that the application information is complete, accurate, and truthful, and that the organization is authorized to verify the information with primary sources.
A hospital receives a credentials application from a physician who completed a residency program outside the United States. Which verification body should be contacted to verify the foreign medical degree?
Answer: The ECFMG (Educational Commission for Foreign Medical Graduates)
The ECFMG (Educational Commission for Foreign Medical Graduates) verifies medical degrees from outside the United States and Canada for physicians who trained abroad.
What is the significance of 'clean application' processing in the credentialing workflow?
Answer: It describes applications where all information is verified and no adverse findings are identified, allowing for streamlined processing
A 'clean application' is one where all required elements are complete, all verifications return satisfactory results, and no adverse findings, discrepancies, or red flags are identified, enabling administrative approval without full committee review in some models.
A practitioner's malpractice insurance policy lists coverage of '$1 million per occurrence / $3 million aggregate.' For a hospital credentialing requirement of '$1 million/$3 million,' does this meet the requirement?
Answer: Yes, it exactly meets the stated coverage requirement
The coverage of $1 million per occurrence and $3 million aggregate exactly meets the stated hospital requirement of $1 million/$3 million, regardless of whether the policy is occurrence or claims-made.
Which of the following is a valid reason to grant provisional status to a practitioner while their credentials are being processed?
Answer: The practitioner has an urgent patient care need and a completed credentials file is pending final approval
Temporary or provisional privileges may be granted when there is an urgent patient care need and a completed credentials file is awaiting final committee approval, as allowed by TJC and most medical staff bylaws.