CPCS Credentialing Information Management 3 — Questions and Answers
Question 1: A credentialing specialist is building a tracking system for reappointment cycles. According to The Joint Commission (TJC) standards, what is the maximum reappointment cycle length?
- One year
- Two years (Correct answer)
- Three years
- Four years
Correct answer: Two years
TJC standards require that medical staff reappointment occur at least every two years.
Question 2: Which of the following is an example of secondary source verification in the credentialing process?
- Calling the medical school registrar directly
- Reviewing a copy of the diploma submitted by the provider
- Using a credentials verification organization (CVO) to confirm licensure (Correct answer)
- Checking the provider's personal website for credentials
Correct answer: Using a credentials verification organization (CVO) to confirm licensure
A CVO performs verification on behalf of the organization but is considered secondary because it is not the original issuing source.
Question 3: When a credentialing record contains conflicting information between the application and primary source verification, what should the specialist do first?
- Choose the information from the application as most accurate
- Flag the discrepancy and request clarification from the provider (Correct answer)
- Approve the file and note the discrepancy in a memo
- Automatically deny the application
Correct answer: Flag the discrepancy and request clarification from the provider
Discrepancies between application data and primary source verification must be investigated and resolved before proceeding.
Question 4: A provider's state medical license is verified as active, but the license in the credentialing file shows an address different from the state board's record. What does this discrepancy most likely indicate?
- The provider has committed fraud and should be denied
- The provider may have moved without updating all records; clarification is needed (Correct answer)
- The state board's record is always wrong and should be ignored
- The application should be automatically approved since the license is active
Correct answer: The provider may have moved without updating all records; clarification is needed
Address discrepancies are common and typically require the provider to update information rather than indicating fraud.
Question 5: Which retention period is most commonly recommended for credentialing files after a provider leaves an organization?
- One year
- Three years
- Seven to ten years (Correct answer)
- Twenty-five years
Correct answer: Seven to ten years
Most accreditation bodies and legal standards recommend retaining credentialing files for seven to ten years after a provider's departure.
Question 6: A credentialing information management system allows providers to submit applications electronically. Which security feature is most important for protecting submitted credentials?
- Color-coded credential status flags
- End-to-end encryption and role-based access controls (Correct answer)
- Automatic email confirmation to the provider
- Integration with billing software
Correct answer: End-to-end encryption and role-based access controls
Encryption and role-based access controls protect sensitive provider data from unauthorized access during electronic submission.
Question 7: A hospital uses a credentials verification organization (CVO). Which responsibility typically remains with the hospital's credentialing specialist rather than being delegated to the CVO?
- Contacting medical schools to verify degrees
- Querying the NPDB on behalf of the entity
- Making the final credentialing and privileging recommendation (Correct answer)
- Verifying current state licensure status
Correct answer: Making the final credentialing and privileging recommendation
The final credentialing and privileging decision always remains with the credentialing entity and its medical staff, not the CVO.
CPCS Credentialing Information Management 3
A credentialing specialist is building a tracking system for reappointment cycles.
According to The Joint Commission (TJC) standards, what is the maximum reappointment cycle length?