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

The organization's own policy sets a 10-year retention minimum and must be followed regardless of shorter state requirements.

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 confidential peer reference letters outside the credentialing committee without authorization violates confidentiality protections.

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

Primary source verification with the malpractice carrier will resolve which amount is accurate before any record is modified.

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

Data conversion validation ensures historical records are accurately transferred to the electronic system before staff begins using it.

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

NCQA requires credentialing decisions to be made within 180 days of application, with committee review typically expected within 90 days of completed verification.

(CPCS) Certified Professional Credentialing Specialist Practice Test

(CPCS) Certified Professional Credentialing Specialist Practice Test

CPCS Data Management & Documentation Practices 3