FREE CPCS MCQ 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 MCQ Questions and Answers flashcards as text
What is the standard term of appointment for medical staff membership at most hospitals under TJC standards?
Answer: 2 years
Under TJC standards, medical staff appointments are for a maximum of 2 years, requiring reappointment at intervals not to exceed two years.
Which of the following best describes the function of 'CAQH ProView' in the credentialing process?
Answer: A universal credentialing application repository where practitioners maintain a single profile used by multiple health plans and hospitals
CAQH ProView is an industry-wide repository maintained by the Council for Affordable Quality Healthcare where practitioners maintain a single credentialing profile that multiple health plans and hospitals can access, reducing duplicative data submission.
A credentialing specialist receives an inquiry from a practitioner asking why their initial credentialing has taken 90 days. The specialist responds that processing is on schedule and will be complete before the URAC-required 120-day deadline. Which of the following is most accurate?
Answer: The specialist is correct, URAC allows up to 120 days for initial credentialing completion
URAC credentialing standards require that the initial credentialing process be completed within 120 days of receiving a completed application, so 90 days into the process is within the allowed timeframe.
Under NCQA credentialing standards, peer references for initial credentialing must be obtained from individuals meeting which requirement?
Answer: They must have directly observed the applicant's clinical work within the past 3 years
NCQA requires peer references to be from practitioners who have directly observed the applicant's clinical work within the past 3 years. They can be from any location or institution.
What does 'adverse action' mean in the context of medical staff credentialing?
Answer: A formal action that negatively affects a practitioner's appointment status, clinical privileges, or professional standing
An adverse action is a formal action that negatively affects a practitioner's medical staff appointment, clinical privileges, or professional standing, typically involving reductions, restrictions, suspensions, or revocations of privileges or appointment.
Which of the following is the BEST definition of 'credentialing' as it applies to healthcare organizations?
Answer: The process of collecting, verifying, and assessing qualifications of practitioners to determine if they meet an organization's standards for appointment or participation
Healthcare credentialing is the formal process of gathering, verifying, and evaluating practitioner qualifications against an organization's standards to determine eligibility for appointment, network participation, or clinical privileges.