CPCS FREE CPCS Basic Questions and Answers 3

Question 1

What is the purpose of requiring practitioners to disclose malpractice claims history on their credentialing application?

Accepted Answer

To allow the credentials committee to evaluate the practitioner's clinical risk profile and identify potential patterns of performance concern

Answer

To enable the organization to report the claims to the state insurance department

Answer

To calculate the practitioner's malpractice insurance premium for the organization

Answer

To satisfy tax reporting requirements

Question 2

In the context of credentialing, what does 'attestation' mean?

Accepted Answer

A practitioner's written certification that application information is accurate and complete, with authorization for verification

Answer

A third-party expert's evaluation of a practitioner's clinical competence

Answer

A legal document transferring malpractice liability from the practitioner to the hospital

Answer

An accreditation certificate issued to the credentialing department

Question 3

What is the meaning of 'expirable' in credentialing terminology?

Accepted Answer

A credential element that has a defined expiration date and must be renewed periodically

Answer

A practitioner who has retired and is no longer actively credentialed

Answer

A type of insurance claim that has passed its filing deadline

Answer

An application that was submitted but never completed

Question 4

A credentialing specialist discovers that a board certification listed on a practitioner's application does not exist in the ABMS Certification Matters database. What is the most appropriate initial response?

Accepted Answer

Contact the practitioner to obtain an explanation and additional documentation supporting the claimed certification

Answer

Assume it is a system error and approve the application

Answer

Immediately report the practitioner to the state medical board for fraud

Answer

Deny the application without contacting the practitioner

Question 5

Under NCQA standards, which of the following is acceptable for verifying a practitioner's current medical license?

Accepted Answer

Checking the state medical board's online license verification portal in real-time

Answer

A copy of the license provided by the practitioner along with their application

Answer

Calling the practitioner's office to confirm the license number

Answer

Asking a colleague at the state board to verbally confirm the license is active

Question 6

Which of the following terms describes the formal process by which a practitioner's appointment, privileges, or network participation is formally ended before the scheduled expiration?

Accepted Answer

Termination or revocation

Answer

Recredentialing

Answer

Reappointment

Answer

Delegation