CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers Flashcards
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Read the first 6 CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers flashcards as text
What is the purpose of the NPDB 'Continuous Query' (CQ) service for hospitals?
Answer: To provide automated, ongoing notification when a practitioner's NPDB record is updated between credentialing cycles
The NPDB Continuous Query service automatically notifies enrolled hospitals whenever a new report is filed on a practitioner, allowing real-time ongoing monitoring between credentialing cycles.
A credentialing specialist is verifying a physician's board certification through the ABMS website and finds that the certification has lapsed due to failure to complete Maintenance of Certification (MOC) requirements. How should this be handled?
Answer: The file should document the lapsed certification and the credentials committee should evaluate the significance for privileging purposes
Lapsed board certification is a finding that must be documented in the credentialing file and presented to the credentials committee for evaluation of its significance for specific privilege requests.
For which of the following credentials is the AMA Physician Master File an acceptable primary source verification source?
Answer: U.S. medical education (graduation from a U.S./Canadian medical school)
The AMA Physician Master File is an acceptable PSV source for verification of U.S. and Canadian medical education (medical school graduation), as it is recognized by NCQA and other accreditors.
A hospital's credentialing policy requires verification of a practitioner's 'five-year work history.' A practitioner's CV shows a one-year gap 4 years ago with no explanation. What is the most appropriate action?
Answer: Contact the practitioner to obtain an explanation for the gap and document it in the file
Work history gaps within the required verification period must be explained; the specialist should contact the practitioner to obtain and document the explanation for the gap in the credentialing file.
Which of the following correctly describes the relationship between PSV and CAQH ProView?
Answer: CAQH ProView contains practitioner self-reported data that may facilitate PSV but does not replace direct verification with primary sources
CAQH ProView contains self-reported practitioner information that can facilitate and streamline the PSV process, but the actual verification must still be conducted with the primary sources. CAQH data is not itself PSV.
A credentialing specialist is unable to reach a practitioner's listed employer from 3 years ago to verify work history. The employer has apparently closed. What is the best approach?
Answer: Seek alternative sources such as state licensing board records, professional references, or other documentation that may corroborate the employment
When a primary source is unavailable (business closed), the specialist should seek alternative corroborating sources such as professional references from that period, state licensing board records showing practice location, or other contemporaneous documentation.