CPCS Accreditation Standards and Compliance 3

Question 1

A provider's license was revoked in one state but they hold an active license in another state. What is the accreditation-required response when this is discovered during primary source verification?

Accepted Answer

Report the finding to the credentials committee for review and decision

Answer

A license revocation in any state is a red flag that must be reviewed by the credentials committee before a credentialing decision is made.

Question 2

Which federal database must be queried during the credentialing process to check for Medicare and Medicaid exclusions?

Accepted Answer

OIG List of Excluded Individuals and Entities (LEIE)

Answer

The OIG LEIE must be queried to identify providers excluded from participation in federal healthcare programs like Medicare and Medicaid.

Question 3

Which accreditation body uses the term 'deemed status' to allow its accredited hospitals to meet Medicare Conditions of Participation?

Accepted Answer

The Joint Commission

Answer

The Joint Commission holds CMS-granted deemed status, meaning TJC-accredited hospitals are considered to have met Medicare Conditions of Participation.

Question 4

An organization fails to complete recredentialing before a provider's two-year credentialing period expires. What is the accreditation-compliant action?

Accepted Answer

Suspend or restrict the provider's privileges until recredentialing is complete

Answer

Accreditation standards require that providers whose credentials have lapsed not be permitted to practice until recredentialing is successfully completed.

Question 5

What is the primary purpose of the Focused Professional Practice Evaluation (FPPE) required by TJC?

Accepted Answer

To assess a practitioner's competence when granting new or initial privileges

Answer

FPPE is a time-limited, focused review triggered by initial privilege granting or a specific concern about a practitioner's performance.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Accreditation Standards and Compliance 3