CPCS Data Management & Documentation Practices 3

Question 1

A hospital's credentialing policy requires retention of closed provider files for 10 years. A department requests destruction of a file that is 8 years old. The specialist should:

Accepted Answer

Deny the request and retain the file until the 10-year threshold is met

Answer

Approve destruction since most states require only 7 years

Answer

Transfer the file to an off-site archive

Answer

Consult with the provider before deciding

Question 2

Which situation represents a breach of confidentiality in credentialing documentation practices?

Accepted Answer

Emailing a provider's peer reference letters to an unrelated department head

Answer

Sharing a provider's adverse action history with the NPDB as required by law

Answer

Disclosing malpractice history to the credentialing committee

Answer

Providing verification of licensure to another hospital upon provider request

Question 3

A credentialing specialist notes that the same malpractice case appears twice in a provider's file with different claim amounts. The FIRST step is to:

Accepted Answer

Contact the malpractice carrier to obtain a verified claims history

Answer

Report the discrepancy to risk management immediately

Answer

Delete the lower-amount entry as likely erroneous

Answer

Flag the file for legal review before any action

Question 4

An organization transitions from paper-based to electronic credentialing. Which risk should be addressed FIRST in the implementation plan?

Accepted Answer

Establishing data conversion validation protocols

Answer

Training staff on the new user interface

Answer

Purchasing additional server hardware

Answer

Communicating the change to providers

Question 5

The NCQA standards require that credentialing files be reviewed by a credentialing committee or physician within what timeframe after completion of verification?

Accepted Answer

90 days

Answer

30 days

Answer

60 days

Answer

180 days

Question 6

Which of the following is an example of a 'soft' credentialing data element that requires subjective documentation?

Accepted Answer

Peer reference assessment of clinical competence

Answer

State medical license number

Answer

NPI number

Answer

DEA certificate expiration date

Question 7

A provider submits an application with a 14-month gap in work history. Credentialing policy requires explanation of gaps exceeding 30 days. The specialist should:

Accepted Answer

Request a written explanation from the provider before proceeding

Answer

Approve the application if all licenses are current

Answer

Deny the application due to the unexplained gap

Answer

Refer the file to the medical director without further inquiry