CPCS Data Management & Documentation Practices 4 — Questions and Answers
Question 1: When documenting a primary source verification call, which element is MOST important to record?
- The provider's home phone number
- The name, title, and contact information of the person who provided the verification (Correct answer)
- The date the call was scheduled
- The provider's preferred method of communication
Correct answer: The name, title, and contact information of the person who provided the verification
Recording who provided the verification creates an auditable trail that validates the source and credibility of the information obtained.
Question 2: Which scenario would require a mandatory query to the National Practitioner Data Bank (NPDB)?
- Annual performance review of an employed physician
- Initial appointment of a physician to the medical staff (Correct answer)
- Renewal of a provider's DEA registration
- Issuance of a new state medical license
Correct answer: Initial appointment of a physician to the medical staff
The NPDB must be queried at initial appointment and at least every two years during recredentialing for all medical staff members.
Question 3: A credentialing database shows a provider's board certification as 'active,' but the certifying board's website shows it lapsed 2 years ago. This represents a failure of:
- Initial verification
- Ongoing monitoring and continuous credentialing (Correct answer)
- Privileging documentation
- Peer review integration
Correct answer: Ongoing monitoring and continuous credentialing
Ongoing monitoring or continuous credentialing processes should detect post-credentialing changes like certification lapses between credentialing cycles.
Question 4: Which type of file organization system allows a credentialing specialist to most efficiently locate all documents related to a single credentialing cycle?
- Alphabetical by document type
- Chronological with tabbed sections per credentialing cycle (Correct answer)
- By document source (primary vs. secondary)
- By expiration date across all providers
Correct answer: Chronological with tabbed sections per credentialing cycle
Organizing by credentialing cycle with tabbed sections groups all related documents together, facilitating efficient review and audit.
Question 5: Under The Joint Commission standards, how long must a hospital retain credentialing and privileging records for a practitioner who has left the medical staff?
- 3 years
- 5 years
- 10 years (Correct answer)
- Permanently
Correct answer: 10 years
TJC requires credentialing and privileging records to be retained for a minimum of 10 years, regardless of the practitioner's status.
Question 6: A credentialing specialist is asked to provide a verification of privileges to another hospital. Before releasing the information, the specialist MUST confirm that:
- The requesting hospital is accredited by TJC
- A signed authorization from the provider is on file (Correct answer)
- The provider is not currently under investigation
- The requesting hospital is in the same state
Correct answer: A signed authorization from the provider is on file
A signed provider authorization is required before releasing credentialing or privileging information to external organizations.
Question 7: Which data governance concept ensures that a credentialing department has a designated person responsible for the accuracy of provider demographic data?
- Data custodian
- Data stewardship (Correct answer)
- Data provenance
- Data lineage
Correct answer: Data stewardship
Data stewardship assigns accountability for data quality to specific individuals or roles, ensuring someone owns the accuracy of each data domain.
CPCS Data Management & Documentation Practices 4
When documenting a primary source verification call, which element is MOST important to record?