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 URAC credentialing standard specifically addresses the time frame within which an organization must complete re-credentialing?
Answer: URAC CR 6
URAC CR 6 addresses re-credentialing cycle time requirements, specifying that re-credentialing must be completed within 36 months.
What is the purpose of a 'tail coverage' endorsement on a claims-made malpractice policy?
Answer: To cover claims filed after the policy expires for incidents that occurred during the policy period
Tail coverage (extended reporting endorsement) covers claims submitted after a claims-made policy ends, as long as the incident occurred while the policy was active.
Which body has authority to exclude practitioners from participating in Medicare and Medicaid programs?
Answer: Office of Inspector General (OIG), HHS
The OIG has statutory authority to exclude individuals and entities from Medicare, Medicaid, and other federal healthcare programs.
A credentialing file is considered 'complete' when which condition is met?
Answer: All required primary source verifications have been received and the application is ready for committee review
A complete credentialing file means all primary source verifications have been returned and all required documentation is on hand, making the file ready for committee review.
Under NCQA standards, which practitioner type is exempt from credentialing requirements for health plans?
Answer: Practitioners providing only administrative services with no direct patient care
NCQA exempts practitioners who perform only administrative or non-clinical roles from credentialing requirements because they provide no direct patient care.
A practitioner's DEA registration is in a state different from the state where they are applying for clinical privileges. What should the credentialing specialist do?
Answer: Request the practitioner obtain a DEA registration in the state of practice before the file advances
DEA registrations are state-specific; a practitioner must hold a DEA registration for the state in which they will be prescribing controlled substances.
Which element distinguishes 'Focused Professional Practice Evaluation (FPPE)' from 'Ongoing Professional Practice Evaluation (OPPE)'?
Answer: FPPE is a time-limited evaluation triggered by concerns or new privileges; OPPE is a continuous performance monitoring process
FPPE is a defined review period triggered by new privileges or identified concerns, while OPPE is the ongoing systematic monitoring of all practitioners' performance over time.