CPCS Credentialing Information Management 2

Question 1

A credentialing specialist receives a provider's application with a gap in employment history from 2019 to 2021. What is the most appropriate next step?

Accepted Answer

Request a written explanation from the provider for the gap

Answer

CPCS standards require that all employment gaps be explained in writing by the provider before the application can be processed.

Question 2

Which document type is considered primary source verification for a provider's medical education?

Accepted Answer

Direct written confirmation from the medical school's registrar

Answer

Primary source verification requires confirmation directly from the originating institution, such as the medical school registrar.

Question 3

A hospital's credentialing database shows a physician's DEA registration expiring in 30 days. What action should the credentialing specialist take?

Accepted Answer

Send an automated renewal reminder to the provider immediately

Answer

Proactive expiration tracking and timely notifications are essential credentialing information management functions to prevent lapses.

Question 4

Under HIPAA, who is authorized to access a provider's credentialing file containing peer reference letters?

Accepted Answer

Only those with a legitimate need-to-know role in the credentialing process

Answer

Access to credentialing files must be restricted to individuals with a documented, role-based need to know.

Question 5

A credentialing specialist discovers that a provider's board certification lapsed two years ago and was never renewed. What is the correct action if board certification is a condition of privileges?

Accepted Answer

Immediately refer the matter to the medical staff office or appropriate committee

Answer

When a required credential lapses, the credentialing specialist must escalate immediately to the appropriate authority per medical staff bylaws.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Credentialing Information Management 2