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 state license has been verified but shows a restriction limiting their scope of practice. What is the MOST appropriate action?
Answer: Report the restriction to the credentialing committee for privilege delineation
License restrictions directly affect privilege delineation and must be reviewed by the credentialing committee to ensure privileges align with allowed practice.
In the context of primary source verification, what is the significance of a 'deemed status' organization?
Answer: It indicates the organization's accreditation meets or exceeds CMS standards, reducing duplicative verification
Deemed status means CMS has determined the accrediting body's standards are equivalent to or more stringent than CMS Conditions of Participation.
How long must credentialing files be retained according to standard best practices and most state regulations?
Answer: 7 years
Most state regulations and accreditation standards recommend retaining credentialing files for a minimum of seven years.
Which scenario represents an appropriate use of 'credentials by proxy' during primary source verification?
Answer: Using verification completed by another accredited hospital within the past 180 days
Some accreditation bodies allow acceptance of verification previously completed by another accredited facility within a defined timeframe as 'credentials by proxy.'
A provider claims to have passed a board examination but the certifying board has no record of the provider. What does this most likely indicate?
Answer: A potential falsification of credentials requiring committee review
When a primary source cannot confirm a claimed credential, it raises a material discrepancy that must be escalated to the credentialing committee as potential falsification.
Under CMS regulations, which type of practitioner is NOT required to undergo primary source verification before providing services?
Answer: Emergency locum tenens physicians under 60 days
CMS allows hospitals to grant emergency privileges to locum tenens practitioners for up to 60 days without completing full primary source verification, using an expedited process.
Which best practice should be followed when a provider's license number on their application does not match the number found through primary source verification?
Answer: Document the discrepancy, request clarification from the provider, and escalate if unresolved
Any discrepancy between application data and primary source findings must be documented, the provider given opportunity to explain, and unresolved issues escalated per policy.