CPCS Credentialing Information Management 3

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?

Accepted Answer

Two years

Answer

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?

Accepted Answer

Using a credentials verification organization (CVO) to confirm licensure

Answer

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?

Accepted Answer

Flag the discrepancy and request clarification from the provider

Answer

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?

Accepted Answer

The provider may have moved without updating all records; clarification is needed

Answer

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?

Accepted Answer

Seven to ten years

Answer

Most accreditation bodies and legal standards recommend retaining credentialing files for seven to ten years after a provider's departure.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Credentialing Information Management 3