CPCS Basic 3

Question 1

Which federal law established the NPDB and requires hospitals to query it before granting privileges?

Accepted Answer

The Health Care Quality Improvement Act of 1986

Answer

The Health Care Quality Improvement Act of 1986 created the NPDB and mandated that hospitals query it when practitioners apply for or renew clinical privileges.

Question 2

What is the credentialing term for a formal agreement between two organizations where one performs credentialing on behalf of the other?

Accepted Answer

Delegated credentialing

Answer

Delegated credentialing is a contractual arrangement where an MCO delegates credentialing functions to a hospital, IPA, or group practice that performs them under agreed-upon standards.

Question 3

Which of the following best describes 'sanctions' in the context of provider credentialing?

Accepted Answer

Punitive actions taken by government or professional bodies against a provider

Answer

Sanctions are formal disciplinary actions imposed by government agencies, licensing boards, or professional organizations that restrict or penalize a provider's practice.

Question 4

The OIG List of Excluded Individuals and Entities (LEIE) is checked during credentialing to ensure:

Accepted Answer

The provider is not barred from participating in federal healthcare programs

Answer

Providers on the OIG LEIE are excluded from participating in Medicare, Medicaid, and other federal healthcare programs, making this check mandatory during credentialing.

Question 5

What type of malpractice insurance policy covers claims only if both the incident AND the claim occur while the policy is active?

Accepted Answer

Claims-made policy

Answer

A claims-made policy only covers claims made (filed) during the active policy period, as opposed to an occurrence policy that covers incidents that occurred during the policy period regardless of when claimed.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Basic 3