Knowledge Flashcards
7 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 7 Knowledge flashcards as text
Which organization publishes the USMLE Step examinations used to verify physician competency?
Answer: National Board of Medical Examiners (NBME) and FSMB jointly
The USMLE is co-sponsored by the NBME and the Federation of State Medical Boards (FSMB).
What is the primary purpose of the National Practitioner Data Bank (NPDB) in the credentialing process?
Answer: To provide a repository of adverse actions and malpractice payments for query during credentialing
The NPDB is a federal repository that credentialers query to identify adverse licensure actions, malpractice payments, and clinical privilege restrictions.
Under NCQA standards, how often must a healthcare organization re-credential its participating practitioners?
Answer: Every 3 years
NCQA requires re-credentialing at least every 36 months (3 years) to maintain accreditation.
Which document formally delegates credentialing authority from a hospital's governing board to the medical staff?
Answer: Bylaws
Hospital bylaws define the structure through which the governing board delegates credentialing and privileging decisions to the medical staff.
A practitioner's application lists a gap in work history of 14 months. Per best credentialing practice, what should the credentialing specialist do?
Answer: Request a written explanation and supporting documentation from the practitioner
Unexplained employment gaps must be addressed by requesting a written explanation and any relevant documentation before the file advances.
Which accrediting body specifically governs credentialing standards for managed care organizations and health plans?
Answer: National Committee for Quality Assurance (NCQA)
NCQA's credentialing standards are the primary benchmark for health plans and managed care organizations.
What does 'primary source verification' mean in credentialing?
Answer: Confirming credentials directly with the original issuing organization
Primary source verification requires confirming credential information directly with the entity that granted the credential (e.g., the medical school itself).