CPCS Credentialing Processes & Accreditation Standards 4

Question 1

Which term describes the process of verifying a provider's credentials directly with the original issuing source?

Accepted Answer

Primary source verification

Answer

Primary source verification means confirming credentials directly with the institution, licensing board, or organization that originally issued the credential.

Question 2

Ongoing Professional Practice Evaluation (OPPE) differs from FPPE in that OPPE:

Accepted Answer

Is a continuous review of all practitioners with privileges

Answer

OPPE is an ongoing, systematic review of all privileged practitioners to ensure continued competency, unlike FPPE which is time-limited for new privileges.

Question 3

A provider receives an adverse credentialing decision. Under HCQIA, the provider is entitled to:

Accepted Answer

A fair hearing and appellate review

Answer

HCQIA requires that providers subject to adverse professional review actions be given a fair hearing and appellate review opportunity.

Question 4

What does the term 'delineation of privileges' refer to in credentialing?

Accepted Answer

Specifying the exact clinical procedures and services a provider is authorized to perform

Answer

Delineation of privileges defines the specific clinical activities and procedures a practitioner is authorized to perform within a healthcare organization.

Question 5

Which organization maintains the Healthcare Sanctions database that credentialing specialists use to identify excluded providers?

Accepted Answer

Office of Inspector General (OIG)

Answer

The OIG maintains the List of Excluded Individuals and Entities (LEIE), which identifies providers excluded from participation in federal healthcare programs.

(CPCS) Certified Professional Credentialing Specialist Practice Test

(CPCS) Certified Professional Credentialing Specialist Practice Test

CPCS Credentialing Processes & Accreditation Standards 4