CPCS Basic 4 — Questions and Answers
Question 1: A credentialing specialist discovers a physician's state medical license expired two months ago. What is the most appropriate immediate action?
- Grant provisional privileges while the physician renews
- Place the credentialing file on hold and notify the medical staff office (Correct answer)
- Remove the physician from the panel immediately without notice
- Accept the license since it was recently expired
Correct answer: Place the credentialing file on hold and notify the medical staff office
An expired license is a critical credential deficiency; the file should be placed on hold and the appropriate stakeholders notified so the physician can resolve the issue before any privileges or panel status are continued.
Question 2: Which credentialing process allows a provider to begin seeing patients before the full credentialing review is complete?
- Conditional credentialing
- Provisional credentialing (Correct answer)
- Temporary credentialing
- Expedited credentialing
Correct answer: Provisional credentialing
Provisional credentialing grants limited, time-bound privileges to practitioners while their full credentialing file is being processed, often used to address urgent staffing needs.
Question 3: What is the standard timeframe within which a hospital must report a practitioner's voluntary resignation while under investigation to the NPDB?
- 15 days
- 30 days (Correct answer)
- 45 days
- 60 days
Correct answer: 30 days
Hospitals must report to the NPDB within 30 days when a practitioner surrenders or has restrictions placed on clinical privileges while under investigation or in return for not conducting an investigation.
Question 4: A credentialing coordinator receives a hostile response when contacting a previous employer for a reference. The best course of action is to:
- Accept the non-response and complete credentialing
- Document the attempt and try an alternate contact at the same organization (Correct answer)
- Automatically deny the application
- Accept a reference from the applicant's spouse instead
Correct answer: Document the attempt and try an alternate contact at the same organization
The credentialing specialist should document all verification attempts and pursue alternate contacts within the same organization to ensure thorough primary source verification.
Question 5: Which element is NOT typically required in a standard provider credentialing application?
- Work history for the past ten years
- Malpractice insurance information
- Personal financial statements (Correct answer)
- DEA registration number
Correct answer: Personal financial statements
Personal financial statements are not part of credentialing applications, which focus on education, training, licensure, malpractice history, and professional conduct.
Question 6: What is 'tail coverage' (also called an extended reporting endorsement) in the context of malpractice insurance?
- Coverage for incidents that occurred after the policy ended
- Coverage that extends the reporting period for claims arising from incidents during a prior claims-made policy period (Correct answer)
- A supplemental policy for high-risk procedures
- Coverage for malpractice suits filed in multiple states
Correct answer: Coverage that extends the reporting period for claims arising from incidents during a prior claims-made policy period
Tail coverage extends the reporting period of a claims-made policy, allowing claims to be filed after the policy period ends for incidents that occurred while the policy was active.
Question 7: Under NCQA delegation standards, how often must a delegating organization conduct an oversight audit of a delegated credentialing entity?
- Monthly
- Quarterly
- Annually (Correct answer)
- Every three years
Correct answer: Annually
NCQA requires delegating organizations to conduct at least annual oversight audits of their delegates to ensure credentialing activities meet required standards.
CPCS Basic 4
A credentialing specialist discovers a physician's state medical license expired two months ago.
What is the most appropriate immediate action?