FREE CPCS Knowledge Questions and Answers Flashcards
6 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 FREE CPCS Knowledge Questions and Answers flashcards as text
What is the role of the Federation of State Medical Boards (FSMB) in the credentialing process?
Answer: FSMB maintains databases of physician licensure information and disciplinary actions that can be used for PSV
The FSMB maintains centralized databases of physician license and disciplinary information across all state medical boards, which can be used as a resource for primary source verification.
Which of the following is a key difference between 'occurrence-based' and 'claims-made' malpractice insurance policies for credentialing purposes?
Answer: Claims-made policies cover claims filed during the policy period regardless of when the incident occurred; occurrence-based policies cover incidents that occurred during the policy period regardless of when the claim is filed
Occurrence-based policies cover incidents that occurred during the policy period (even if the claim is filed later), while claims-made policies cover only claims filed while the policy is active, creating a 'tail' coverage concern when the policy ends.
A hospital is implementing a new electronic health records (EHR) system and plans to link it to the credentialing database to automatically check that only credentialed practitioners are ordering and documenting care. This type of integration is an example of which quality improvement concept?
Answer: Hard stop / forcing function
Linking the EHR to the credentialing database to block non-credentialed practitioners from ordering or documenting is a 'hard stop' or 'forcing function', a system design that makes it physically impossible to do the wrong thing.
Which of the following organizations administers the ABMS Continuing Certification (formerly Maintenance of Certification) program?
Answer: ABMS and its member specialty boards
The American Board of Medical Specialties (ABMS) and its 24 member specialty boards administer the Continuing Certification (formerly MOC) programs for their respective specialties.
Under the Health Insurance Portability and Accountability Act (HIPAA), a health plan sharing credentialing information with a hospital about a mutual network practitioner is most likely covered under which HIPAA provision?
Answer: Treatment, Payment, or Healthcare Operations (TPO)
Sharing credentialing information (a healthcare operations activity) between covered entities about their mutual practitioners falls under HIPAA's 'Treatment, Payment, or Healthcare Operations' (TPO) exception, which permits information sharing without individual authorization.
A credentialing specialist at a large health plan is told that the organization has decided to stop querying the NPDB at recredentialing to save costs. What should the specialist do?
Answer: Document the concern, explain that NPDB queries at recredentialing are required by NCQA and CMS standards, and escalate through appropriate channels if the directive stands
NPDB queries at recredentialing are required by NCQA, URAC, and CMS standards. The specialist should professionally document the concern, explain the compliance implications, and escalate through appropriate channels.