CPCS Accreditation Standards and Compliance 5

Question 1

Under CMS Conditions of Participation, which practitioner category is explicitly required to be credentialed and privileged by the hospital medical staff?

Accepted Answer

All licensed independent practitioners (LIPs) who provide patient care

Answer

CMS requires that all licensed independent practitioners who are permitted to provide patient care services within the hospital undergo credentialing and privileging.

Question 2

A provider requests privileges for a newly FDA-approved procedure that the hospital has never offered. What is the accreditation-compliant first step?

Accepted Answer

Develop criteria for the new privilege before considering any individual application

Answer

Accreditation standards require that privilege criteria be established at the institutional level before evaluating any individual's qualifications for new procedures.

Question 3

Which scenario correctly describes a situation requiring mandatory NPDB reporting by a hospital?

Accepted Answer

A physician's clinical privileges are reduced for more than 30 days following a professional review action

Answer

Hospitals must report to the NPDB when a practitioner's clinical privileges are reduced, restricted, or revoked for more than 30 days following a professional review action.

Question 4

What is the accreditation significance of verifying a provider's work history for the past five to ten years during credentialing?

Accepted Answer

It helps identify any unexplained gaps that may indicate disciplinary issues or performance concerns

Answer

Reviewing work history helps uncover unexplained gaps that may signal disciplinary actions, substance abuse treatment, or other concerns requiring further inquiry.

Question 5

Under NCQA standards, what is the maximum time allowed between a practitioner's recredentialing decisions to maintain continuous network participation?

Accepted Answer

24 months

Answer

NCQA requires health plans to recredential network practitioners at least every 24 months (two years) to maintain their active participation status.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Accreditation Standards and Compliance 5