Primary Source Verification 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 Primary Source Verification flashcards as text
A provider's application reveals training at a foreign hospital not accredited by a recognized U.S. body. What is the most appropriate verification method?
Answer: Contact the foreign hospital directly and use a credentialing verification organization (CVO) if needed
Direct contact with the institution or use of a qualified CVO experienced in international verification is appropriate for foreign training verification.
What does 'continuous enrollment' verification mean in managed care credentialing?
Answer: Verifying that malpractice coverage has been maintained without lapses
Continuous enrollment verification in malpractice insurance means confirming there are no gaps in professional liability coverage.
Which of the following is an example of a 'sentinel event' flag that would trigger mandatory review during primary source verification?
Answer: A malpractice payment reported to the NPDB within the past five years
An NPDB malpractice payment report is a sentinel event that requires mandatory disclosure and review by the credentialing committee.
A hospital grants temporary privileges to a provider pending completion of primary source verification. Which standard governs this practice?
Answer: CMS Conditions of Participation
CMS Conditions of Participation regulate how hospitals may grant temporary privileges during the credentialing process.
Which of the following is a legitimate reason primary source verification may be waived or delegated per accreditation standards?
Answer: The organization uses a NCQA-certified CVO that has already performed verification
NCQA allows delegation of primary source verification to a certified CVO, which meets the standard without the organization repeating the process.
When a discrepancy is found between the dates on a provider's application and those confirmed by a primary source, what is the required action?
Answer: Document the discrepancy and request the provider clarify or explain it
Discrepancies must be documented and the provider must be given the opportunity to explain before any determination is made.
Which element of primary source verification is specifically required by The Joint Commission (TJC) for all licensed independent practitioners?
Answer: Current licensure verification
TJC requires verification of current licensure as a core element of primary source verification for all licensed independent practitioners.