CPCS Basic 5 — Questions and Answers
Question 1: Which of the following credentials would a Certified Registered Nurse Anesthetist (CRNA) need verified that a general RN would NOT?
- Basic nursing license
- CRNA certification from the NBCRNA (Correct answer)
- CPR certification
- Basic malpractice insurance
Correct answer: CRNA certification from the NBCRNA
CRNAs must hold specialty certification from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA), which is specific to their advanced practice role.
Question 2: What is the key difference between credentialing and privileging?
- Credentialing is done by hospitals only; privileging is done by health plans
- Credentialing verifies qualifications; privileging grants specific clinical rights based on those qualifications (Correct answer)
- Credentialing applies to physicians; privileging applies to allied health professionals
- There is no meaningful difference between the two terms
Correct answer: Credentialing verifies qualifications; privileging grants specific clinical rights based on those qualifications
Credentialing is the process of verifying a practitioner's education, training, and experience, while privileging uses those verified credentials to determine what specific clinical activities the practitioner may perform.
Question 3: A physician applies for credentials but discloses a malpractice suit that was settled five years ago. The credentialing committee should:
- Automatically deny the application
- Automatically approve if the suit was settled, not litigated
- Review the circumstances of the case before making a determination (Correct answer)
- Ignore it since it is more than three years old
Correct answer: Review the circumstances of the case before making a determination
A settled malpractice case is a red flag that must be reviewed in context — the committee must assess the nature of the case, the provider's explanation, and any pattern of behavior before deciding.
Question 4: Which statement about the Healthcare Integrity and Protection Data Bank (HIPDB) is most accurate as of 2013?
- It replaced the NPDB entirely
- It was merged into the NPDB, creating a single data bank (Correct answer)
- It is maintained separately and focuses exclusively on fraud
- It is only accessible to state licensing boards
Correct answer: It was merged into the NPDB, creating a single data bank
In 2013, the HIPDB was merged into the NPDB to create a single, comprehensive federal data bank accessible to eligible organizations for credentialing and fraud prevention purposes.
Question 5: When verifying board certification, the credentialing specialist should contact:
- The physician directly to request a copy of the certificate
- The specialty board that issued the certification (Correct answer)
- The American Medical Association
- The state licensing board
Correct answer: The specialty board that issued the certification
Primary source verification of board certification requires contacting the specific specialty board (e.g., ABIM, ABS) that issued the certification, not the physician or other intermediaries.
Question 6: A credentialing file is considered 'complete' when:
- The application form is signed by the provider
- All required primary source verifications are obtained and the application meets the organization's completeness criteria (Correct answer)
- The provider pays the credentialing fee
- The medical director reviews the file
Correct answer: All required primary source verifications are obtained and the application meets the organization's completeness criteria
A complete file requires all required verifications to be received and all application elements to meet the organization's defined completeness standards before it can be presented to the credentialing committee.
Question 7: Which of the following best describes 'focused professional practice evaluation' (FPPE)?
- An annual performance review for all medical staff members
- A time-limited, defined period of monitoring granted to new practitioners or those with identified performance concerns (Correct answer)
- A peer review process triggered solely by patient complaints
- A credentialing audit performed by an external accreditor
Correct answer: A time-limited, defined period of monitoring granted to new practitioners or those with identified performance concerns
FPPE is a structured, time-limited evaluation of a practitioner's clinical performance, used for new appointees or when performance concerns are identified, before granting or modifying privileges.
CPCS Basic 5
Which of the following credentials would a Certified Registered Nurse Anesthetist (CRNA) need verified that a general RN would NOT?