CPCS Credentialing Processes & Accreditation Standards 2

Question 1

Which accreditation body sets standards for hospital credentialing programs in the United States?

Accepted Answer

The Joint Commission (TJC)

Answer

The Joint Commission establishes and enforces credentialing standards for hospitals and other healthcare organizations seeking accreditation.

Question 2

What is the primary purpose of a Credentials Verification Organization (CVO)?

Accepted Answer

To independently verify practitioner credentials on behalf of health plans or facilities

Answer

A CVO performs primary source verification and other credentialing functions as a delegated agent for health plans or healthcare organizations.

Question 3

Under NCQA standards, how often must a delegated credentialing entity submit an audit file to the delegating organization?

Accepted Answer

Annually

Answer

NCQA requires delegating organizations to audit delegated entities at least annually to ensure compliance with credentialing standards.

Question 4

A provider's application reveals a malpractice settlement five years ago. What is the credentialing specialist's MOST appropriate next step?

Accepted Answer

Request the provider's explanation and obtain details of the settlement

Answer

The specialist should gather complete information about the settlement, including the provider's explanation, before the credentials committee makes a determination.

Question 5

Which document establishes the criteria a medical staff must meet for granting clinical privileges?

Accepted Answer

Bylaws and credentialing policies

Answer

Medical staff bylaws and credentialing policies define the criteria, process, and standards for granting, modifying, or denying clinical privileges.

(CPCS) Certified Professional Credentialing Specialist Practice Test

(CPCS) Certified Professional Credentialing Specialist Practice Test

CPCS Credentialing Processes & Accreditation Standards 2